In 2003, the pharmaceutical industry passed out $16.4 billion worth of free drug samples to doctors. These so-called free samples are literally killing people. Two young lads who were lucky enough to get free samples of Zoloft are now sitting in prison.
After visits to their family doctors, Christopher Pittman and Zachary Schmidkunz were both sent home with a bag of Zoloft samples with no warnings about the drug's side effects. They both went on to commit murder, were sent to prison, and are now waiting for hearings on their appeals.
These lethal selective serotonin reuptake inhibitor antidepressants (SSRIs) are being passed out to kids like candy. Dr Thomas Moore, MD, with the Drug Safety Research group, conducted a study on the use of antidepressant drugs with children that showed that in the 4-period of 1998 to 2001, the use of SSRIs with children doubled and in 90% of the cases the drugs were prescribed off-label to kids for uses not approved by the FDA.
For instance, among boys 6 to 12 years old, 52% of the prescriptions were written for treating attention deficit or conduct disorders, and typically, Dr Moore says, in combination with an antipsychotic or a stimulant.
There is "no scientific evidence that says that combination therapy is effective in these disorders and I know of no evidence that it is safe either," he says.
Yet the study found that 17% of the children were taking drugs that were ineffective in clinical trials, and 42% were taking two of more antidepressant drugs.
"So," Dr Moore says, "what we are seeing is when drugs are ineffective, rather than abandoning them or trying alternatives, doctors increase the dose or combine the drugs in ways, the safety of which we are not aware."
This is exactly what happened to 12-year-old Christopher Pittman, according to his family members.
He was prescribed Paxil shortly before he went to live with his grandparents. When he needed a refill, his grandparents took him to their family doctor and because the doctor had no samples of Paxil, he sent Christopher home with samples of Zoloft with instructions written on the outside of the bag.
Forty-eight hours after the Zoloft dosage was increased to 200 milligrams, Christopher shot both of his grandparents in the bed where they slept, set the house on fire, and took off in his grandfather's pickup truck with a loaded gun. The following morning two hunters said they found the 12-year old boy wandering around in the woods acting hysterical, "hollering and screaming," and waiving a fully cocked and loaded gun around.
Neither Paxil or Zoloft is approved for pediatric use and thus, the prescriptions Christopher received were off-label. A most alarming fact that surfaced during the criminal trial, was that even though the family doctor apparently passes out free samples of drugs on regular basis, he testified that he was not aware of the association between SSRIs and violent behavior, towards self or others.
In addition, it was revealed that Christopher was not weaned off the Paxil before he was placed on Zoloft even though it is known that Paxil has a history of serious withdrawal side effects.
The lead attorney in Christopher's case is Andy Vickery, of the Houston, Texas law firm Vickery & Waldner, LLP, who has spent the better part of a decade representing families who have been harmed by SSRIs.
In 2001, Mr Vickery, was the lead attorney in a landmark case against Paxil maker GlaxoSmithKiline brought by the family members of Donald Schell, a retired oil-rig worker who had been on Paxil for just 2 days when he shot and killed his wife, daughter and granddaughter, before shooting himself. The jury in the case found that Paxil "can cause some individuals to commit suicide and/or homicide" and awarded $8 million to the surviving family members.
On the West Coast, Los Angeles based, Baum Hedlund law firm partner, Karen Barth Menzies, has also been litigating claims for more than a decade, involving injuries associated with SSRIs. Although a plaintiffs attorney, due to her extensive work in SSRI cases, Ms Menzies was recruited to join the "dream team" to help defend Christopher.
Christopher was 12-years-old when he killed his grandparents. He was held in the custody of the juvenile court system for over a year and a half before he was waived up to Circuit Court, and after that, he was held in continued pretrial custody for another year and a half before trial.
He was tried as an adult after being interrogated while under the influence of Zoloft, with no parent or legal representative present, and the statements he made were used against him in court. According to the prosecutor, the 6th grader waived his Miranda Rights.
Christopher is reportedly the second youngest person in US history to be prosecuted in an adult court. The youngest being an 11-year old boy who was prosecuted in 1999 for murder in a Michigan court.
Unbeknownst to young Christopher, he was playing against a stacked deck from day one. Not far into the case, it was discovered that prosecutors working to convict Christopher had been provided materials by both GSK and Pfizer, the makers of Paxil and Zoloft.
GSK provided the prosecutor a copy of a "prosecutor's manual" created by the company to help fight cases alleging Paxil had anything to do with a crime and Pfizer has a similar manual, according to Ms Menzies.
It was also later learned that on January 18, 2002 before the "involuntary intoxication" defense had even been raised, a Pfizer attorney, Jim Hooper, sent information on Zoloft to Dr Pamela Crawford, the prosecution's star expert witness.
Why would a Pfizer lawyer send Dr Crawford this information? Because she was working on a "criminal responsibility" opinion for Christopher's case and Pfizer wanted to make darn sure that she did not blame his criminal conduct on Zoloft.
But as it turns out, this was no isolated incident and Pfizer was not simply responding to a doctor's questions. The company has been providing assistance to prosecutors for years, and Mr Hooper has been at the fore-front for that activity.
On at least 15 prior occasions, attorneys discovered, Pfizer has provided a "Prosecutor's Manual" or "Litigation Manual" to prosecutors so that they could overwhelm any defense lawyer who dared to raise the "involuntary intoxication" defense.
The company has sworn for years that Zoloft does not cause people to become violent, yet on May 15, 2004, Pfizer issued a Canadian Health Care Professional warning in which the company cautioned about Zoloft triggering "harm to others."
The truth is, Pfizer has known for many years that Zoloft causes violence. On May 28, 1998, Brynn Hartman was on Zoloft when she shot her husband, actor Phil Hartman, as he slept and then committed suicide herself the next morning. Friends reported that Brynn had been complaining that she felt odd after taking Zoloft.
Mr Vickery handled a wrongful death lawsuit for the Hartman family, against Pfizer and Ms Hartman's psychiatrist, and Pfizer settled the case out of court for an undisclosed amount.
According to Mr Vickery, providing manuals to prosecutors is just one of the ways that SSRI makers have tried to keep the lid on the tendency of their drugs to trigger violence towards others by helping prosecutors convict people who: (1) are taking their drugs; (2) commit acts of violence; and (3) have the temerity to raise the drug's involvement as a defense.
The drug giants also gather and maintain data, he says, on prominent expert witnesses in the SSRI field who are often called to testify and they furnish the information to prosecutors with instructions on how to attack their credibility.
"It is a deplorable practice," Mr Vickery says, "and one that we are committed to exposing."
Through her work on civil cases, Ms Menzies had documents to counter some of the information provided to the prosecution by Pfizer and GSK. She was also able to bring previously concealed documents regarding Zoloft into the case. Unfortunately, Ms Menzies says, she was prevented from using most of the incriminating documentation.
According to Christopher's maternal grandmother, Delnora Duprey, the family's nightmare started when Christopher was diagnosed with depression and "placed on medication that was never tested on children and never meant for their use."
"He had no say in this," she points out. "We, as adults," she continued, "trust our doctors and the FDA to know what they are doing."
"Even when we get complaints," Ms Duprey notes, "we say the doctor said it will help you."
In their appellate brief, Christopher's attorneys Andy Vickery, Paul Waldner, and Fred Shepherd, make the same point in this case, "that prescription drugs are a unique consideration in the context of criminal culpability."
Christopher had no other option, they said, but to rely upon his father and the health care professionals for his mental health well-being. "He was completely helpless in his ability to determine whether these drugs were beneficial or harmful to him," they wrote in the brief.
"In fact," they attorneys note, "unlike an adult, he could not even refuse their use."
In 20/20 hindsight, very early on there were signs that Christopher was experiencing adverse reactions to Zoloft but no one knew there were any side effects to watch for.
When Christopher complained about how the drug made him feel, the doctor increased the dose and the tragic event that followed, experts say, never would have happened had he not been placed on SSRIs.
Ms Menzies explains that SSRIs are "extremely powerful drugs, designed to alter a person's brain chemistry."
They can cause a person to completely change behavior and their way of thinking, she says, leading some people to become psychotic. The SSRIs can cause "severe agitation and suicide to some," she says, "and cause others to commit acts of violence against others."
Christopher's aunt, Melinda Pittman Rector, told the jury that 5 days before he killed his grandparents, Christopher talked to her on the phone and said he did not like the medication he was taking because it gave him nightmares, and described feeling like "his skin was crawling," "burning underneath," and he couldn't "put it out," she said.
During the trial, this syndrome was described as a classic lay description of drug-induced "akathisia," in testimony by two well-know experts in the SSRI field, Dr David Healy and Dr Richard Kapit.
During the trial, Police Officer Lucinda McKellar testified that she Mirandized Christopher, who was not even old enough to drive, marry, or sign a binding legal contract in South Carolina, and asked him if he wanted to waive his rights and sign a confession, supposedly dictated by him, but written entirely by Ms McKellar, using an adult vocabulary.
This is a major issue raised in Christopher's appeal. In their appellate brief, his attorneys summed it up like this: "In this case, the agents extracted two signed statements from a 12-year old boy of below-average intelligence, with no prior experience with law enforcement, who was under the influence of a psychoactive drug that was prescribed "off label" to him by a general practitioner."
Apparently, in the US, whether a child will be tried as a juvenile or an adult depends on where the child lives. According to Christopher's attorneys, only a handful of states permit children to be tried as adults but South Carolina is one of them.
In South Carolina, a presumption of incapacity to form criminal intent to commit a crime is given to a child between the ages of seven and fourteen. However, it is a rebuttable presumption, if it can be shown that the child was mentally capable of committing a crime, even though he was between the age of seven and fourteen.
At trial, the first line of defense was the presumption against the capacity for 12-year
old Christopher to form criminal intent, and the second was "involuntary intoxication" from Zoloft.
According to his attorneys, there was no evidence produced at trial to rebut the presumption given to a child under 14. "Nowhere is there one whit of evidence to rebut the presumption," Mr Vickery says.
The prosecution introduced no evidence, he says, to show that Christopher was any different, mentally or otherwise, from any other 12-year-old child. However, Mr Vickery notes, there was evidence produced by the defense that supported the presumption.
Dr Lanette Atkins, a board-certified child psychiatrist with the South Carolina Department of Mental Health, testified at length about the underdeveloped 12-year-old brain, the physiological and psychological differences between the developing brain and that of an adult, and specifically how those differences related to behavior and judgment.
In fact, Dr Atkins testified that Christopher was academically behind other 12 year-olds.
A prosecution rebuttal witness, Dr. Julian Sharman, described the Christopher he interviewed on November 29, 2001 as a "normal 12 year old."
Another state witness, Detective Darrell Duncan, testified that Christopher was "a little scrawny little boy," "just a young boy," "a young juvenile," and said that he had acted as Christopher's "baby-sitter" while he was in law enforcement custody.
On the involuntary intoxication defense, during the trial, Keith Altman, a database analyst, testified about similar reports of adverse reactions to Zoloft and told the jury that FDA statistics showed that between 1997 and June 2004, there were 18 reports of children between the age of 12 and 17 who had adverse reactions to Zoloft that involved "hostility," and that 3 cases involved murder.
Dr Atkins told the jury that Zoloft caused Christopher to kill his grandparents. She said Zoloft induced a psychotic reaction that sent him into a homicidal mania. As for any statements made by Christopher during the interrogation soon after the crime, Dr Atkins explained that, "mania can last for months, particularly in children."
A former FDA psychiatrist, Dr Richard Kapit, told the jury during his testimony, that one could map the deterioration of Christopher's condition, day by day, starting with the ingestion of Paxil.
Even today, his attorneys say, Christopher does not begin to understand the events of November 28, 2001.
"When I was taking Zoloft," Christopher wrote in a letter, "I took the lives of two people that I loved more than anything, my grandparents."
Indeed, the fact that he adored his grandparents was backed up throughout the trial. From the first witness to the last, every person who knew this family described his relationship with his grandparents, particularly his grandfather, as extremely close, loving, and devoted.
His sister Danielle testified that Christopher "absolutely worshiped the ground my grandfather walked on."
Christopher and his grandfather, who he called "Pop Pop," were like "two peas in a pod" and they were "glued" together, according to his aunt Melinda. He was even given the nickname "shadow" because of the close association he had with his grandfather, she told the jury.
At Christopher's sentencing hearing, even though her parents were the victims in the case, his aunt Melinda begged the judge for leniency, explaining that if her parents were alive, they would be asking for mercy for their grandson.
The judge showed no leniency and sentenced Christopher to the full 30 years in prison.
However, serious evidence of jury misconduct surfaced soon after the trial ended. One juror admitted to having discussed the case with a bartender during a break in deliberations and according to the bartender, the juror expressed a belief that Christopher was guilty and the same juror also admitted to having spoken about the case with his wife.
Jurors are repeatedly warned to not discuss the case with anyone but the other jurors during deliberations. They are also instructed to not form an opinion about the guilt of a defendant until they listen to all the evidence and receive juror instructions from the judge.
By discussing the case with a bartender and his wife, and specifically expressing a belief that Christopher was guilty, the juror sabotaged his right to a fair trial.
Two other jurors said that they did not believe Christopher was guilty but they had been coerced by other jurors into voting for a conviction.
Juror, Roberta Diamond, said that she was "appalled" at the "guilty" verdict. She said she found no evidence whatsoever to overcome the presumption that 12-year- olds do not have the mental capacity to form "criminal intent," and that she found the evidence linking Zoloft to Christopher's actions "compelling."
Soon after the verdict, Ms Diamond contacted Christopher's attorneys and voiced her concerns and as a result, she filed an affidavit that was a key attachment to the defense's second motion for new trial.
Despite all this, the judge in the case refused to grant a new trial and for some odd reason, ordered the identity of the juror who violated his oath in speaking to the bartender and his wife not be disclosed.
Looking back to when he placed on the SSRIs, Christopher says he did not recognize the changes in in his thinking and behavior. That it wasn't until months later after he was completely off the medication, that he could see how bizarre his actions were.
The people who actually knew this child best described him at trial as being shy, loving and gentle before he was placed on SSRIs. And according to Christopher himself, when the dosage of Zoloft was increased everything got worse. "I snapped," he says.
"It made me hate everyone," he recalls. The smallest things would make him blow up, he said.
He started getting into fights, when before he would always avoid fights. "I just hated the whole world for no apparent reason," Christopher says.
If family members had been alerted to watch for the side effect of Zoloft, the signs of violence and mania were there. For instance, Christopher, who by all accounts had never threatened or harmed another human being, choked a 2nd grade student on the school bus shortly before he killed his grandparents.
Christopher's memory of what happened the night his grandparents died is: "When I was lying in my bed that night, I couldn't sleep because my voice in my head kept echoing through my mind telling me to kill them until I got up, got the gun, and I went upstairs and I pulled the trigger."
According to Christopher, the whole thing was like watching a show on TV. "You know what is going to happen," he says, "but you can't do anything to stop it."
"All you can do is just watch it in fright," he recalls.
In August 2005, in a rather unusual occurrence, the Supreme Court of South Carolina issued an order, on its own motion, by-passing the court of appeals and permitting a direct appeal for Christopher's case. The rule cited by the court provides for a direct appeal if a case involves significant legal issues and or a matter of public concern.
If Zoloft does not lead to violence, anger, or hostility, somebody needs to change the FDA guidelines given out with each prescriptions of Zoloft because according to the FDA, you should contact your child's healthcare provider right away if your child exhibits any of the following signs for the first time, or if they seem worse, or worry you, your child, or your child's teacher:
• Thoughts about suicide or dying
• Attempts to commit suicide
• New or worse depression
• New or worse anxiety
• Feeling very agitated or restless
• Panic attacks
• Difficulty sleeping (insomnia)
• New or worse irritability
• Acting aggressive, being angry, or violent
• Acting on dangerous impulses
• An extreme increase in activity and talking
• Other unusual changes in behavior or mood
The FDA also says to never stop taking an antidepressant without fist talking to a healthcare provider because stopping suddenly can cause other symptoms.
Zachary Schmidkunz is living proof that suddenly stopping Zoloft can cause "other symptoms."
On November 17, 2003, the police in Minot North Dakota, received a report from Rhonda and Gail Schmidkunz, of a female body they discovered in their basement that had been shot in the upper area of the body.
Mr and Mrs Schmidkunz did not know the girl, who was later identified as Alexis Walter, a friend of their son, Zachary, who was not at home.
As the police began the investigation of the crime scene, they learned that Zachary had turned himself in to police and was claiming to have shot a girl in Minot.
Zach gave statements in which he admitted that he had shot Alexis and his subsequent statements revealed the prior events as they unfolded. He said he had struggled with depression and was recently prescribed Zoloft by Dr Joe Smothers.
However, a couple days prior to the crime, he had stopped taking the drug.
Exactly like Christopher above, Zach was sent home from a visit to his family doctor's with samples packs of Zoloft, without any warning about the adverse reactions that could occur.
In hindsight, had they known, his father says, the signs were there. "By Saturday, there were symptoms of discontinuation syndrome," he recalls. "They continued to intensify through Monday when the murder happened," he said.
Without knowing what to watch for, Mr Schmidkunz says, Zach and everyone else missed the signs that might have alerted them to the dangers and prevented the tragic event.
A jury trial began on December 2, 2004, but according to Mr Schmidkunz, "when the day finally arrived for the start of Zach's trial, no one could have prepared us for what to expect."
"The immediate, vicious attack on our son, Zach's character," he said, "by the State's Attorney during his opening arguments was a nightmare filled with horrors."
"They wanted to send away my son for a long, long, time," he said.
"Someone who had no history of crime, rage or angry outbursts," Mr Schmidkunz noted, "a kind gentle young man who never so much had even a traffic ticket."
Pfizer also supplied materials to the government in this case. "The prosecution," Zach's father said, "followed the Zoloft prosecutors manual to a T by attacking Zach's makeup and personality arguing that Zach was a monster planning to murder someone."
"That tactic was effective, very effective," Mr Schmidkunz noted.
"So effective," he said, "that early that evening Zach's Grandmother, who had been at the trial that day, had an heart episode that sent her to the hospital from church via the ambulance."
From then on, against her wishes because she wanted to support her grandson, Zach's family decided that his Grandma should not attend any more of the trial.
Zachary testified in his own defense and spent more than 6 hours on the witness stand. He told the jury how he shot Alexis and said he acted out of complete rage, not at Alexis or anything in particular, just uncontrollable anger.
Zach told the jury that Alexis told him that "people who are depressed always end up committing suicide. Medicine can't help," and this remark apparently set him off.
He told the jury how he went into his room, turned on some music and went into a rage. He then went and unlocked the gun cabinet and Alexis asked him what he was doing.
He went back into his room, Zach recalled, laid the gun on his bed, went and grabbed a box of shells, turned the music up louder, loaded a shell into the chamber, and came back out of his room and Alexis again asked him what he was doing.
By this time he was pointing the gun down at Alexis and he says, she again asked, "what are you doing?" She crouched down on her knees and started crying, and it was then that Zach shot her.
He then went back in his room and put three more shells into the gun, grabbed a bag and started throwing stuff like socks and underwear in it. He says he didn't think about Alexis when he left the house. He went and got some money out of an ATM machine, drove to a gas station and filled up his car with gas, and drove off with no destination in mind.
He drove on the interstate to Jamestown and there, in a gas station parking lot, Zach says, things started coming back to him and he thought he remembered shooting someone so he went and turned himself into police.
During the trial, 4 expert witness testified that Zach was clinically depressed. Dr Maureen Hackett, MD, testified for the defense, and said that it was her opinion that Zach was in a state of mind of an automaton that was induced by extreme physiologic excitement fueled by a reaction to Zoloft withdrawal that created a worsening of his symptoms and a sudden onset of novel rage resulting in a prolonged episode of extreme emotional disturbance.
"None of this made any difference to the jury or the prosecutor," Mr Schmidkunz says.
With the help of the Pfizer manual, Zach's father says, the "prosecutor convinced the jury my son was a monster and that Dr Hackett was a hired gun bought for a price and would tell the court whatever we wanted her to say."
"The State's Attorney and law enforcement," he said, "don't understand or just don't care what an SSRI does to a person's brain when you have an adverse event."
They wanted nothing to do with the possibility, he says, that Zoloft had altered Zach's brain chemistry causing the uncontrollable rage.
"For two weeks," Mr Schmidkunz recalls, "we sat through a barrage of attempts by the prosecution to lead the jury to believe that Zach was a good kid who went bad and his psychological profile was such that he was destined to be a murder."
"It was nearly more than we could bare," he says, "sitting through this fabrication and distortion of facts."
Even after the trial, Zach says, it took him a long time to get to the point where he accepts that the adverse reactions from Zoloft caused him to commit murder.
"I came to realize that I would not normally kill a human being," he explained, "most importantly not somebody I considered a friend."
"After much self-reflection over days without sleep in jail," he recounts, "I realized that there was no other explanation for what I did, other than the medication having an effect."
"I was suicidal," Zach said, "not homicidal."
And like so many other people who have committed violent acts brought on by adverse reactions to SSRIs have said, Zach said, "it was like watching himself in a movie going to get the shotgun."
He had this over-powering urge to shoot something and tried to stop himself but was powerless to do so, he told his parents.
Zach describes the guilt he feels as devastating. "I took a human life," he said, "its the most horrific feeling in the world."
Another thing that really bothers him, Zach says, is that he hates violence against women. "I was taught to hold doors open for them, to be nice and never, never hit a woman," Zach said.
"It tears me apart knowing that the person I killed was female," he added.
He feels the most remorse over what this has done to Alexis' family. "Its a tough reality accepting the responsibility of what you've done," Zach said, "to see the other family's pain."
He describes this feeling as "gut wrenching."
During his closing argument, the prosecutor said Zach made a choice to take a life when he became angry, instead of just walking away. He also chipped away at every area of Zach's character.
All his life, Zach had attended church regularly with his family and had even been a counselor at a Christian Bible camp the previous summer.
Yet, during closing arguments, the prosecutor told the jury: "Perhaps if Mr. Schmidkunz had been a better Christian, this murder would not have happened."
On top of everything else, his father said, the family was crushed by this comment.
But the worst anguish was yet to come. The jury deliberated less than 4 hours before returning a guilty verdict
Mr Schmidkunz describes that moment by saying, "a stake driven through my heart would have hurt less than hearing the words: "We the jury find Zachary Schmidkunz guilty".
But the nightmare did not end there for Gail and Rhonda Schmidkunz, in fact, it must seem like their Zoloft nightmare will never end.
In December 2005, Alexis' mother, Lisa Anderson filed a wrongful death lawsuit against Pfizer and Zach's parents, alleging that his parents should have known about his depression and suicidal thoughts and kept him away from a gun and that Pfizer knew of, but failed to warn that Zoloft's side effects could lead to uncontrollable rage in young patients.
Bryant Haskins, a spokesman for Pfizer, said in a statement that Zoloft has been on the market for 14 years and has been used safely by millions. "There is no scientifically based evidence to suggest that Zoloft causes patients who are being treated to commit violent acts harming other people," Haskins said.
That statement does not jive with the warning below issued in a Dear Doctor letter to physicians in Canada on May 26, 2004, which states in part:
Health Canada Endorsed Important Safety Information on ZOLOFT
Adult and Pediatrics: Additional data
"There are clinical trial and post-marketing reports with SSRIs and other newer antidepressants, in both pediatrics and adults, of severe agitation-type adverse events coupled with self-harm or harm to others. The agitation-type events include: akathisia, agitation, disinhibition, emotional lability, hostility, aggression, depersonalization. In some cases, the events occurred within several weeks of starting treatment.
"Rigorous clinical monitoring for suicidal ideation or other indicators of potential for suicidal behavior is advised in patients of all ages. This includes monitoring for agitation-type emotional and behavioural changes."