Defense for a Boy's Rampage: The Medicine Made Him Kill

Christopher Pittman said he remembered everything about that night in late 2001 when he killed his grandparents: the blood, the shotgun blasts, the voices urging him on, even the smoke detectors that screamed as he drove away from their rural South Carolina home after setting it on fire.

Now, Christopher, who was 12 years old at the time of the killings, faces charges of first-degree murder. The decision by a local prosecutor to try him as an adult could send him to prison for life. While prosecutors portray him as a troubled killer, his defenders say the killings occurred for a reason beyond the boy's control - a reaction to the antidepressant Zoloft, a drug he had started taking for depression not long before the slayings.

Such defenses, which have been used before, have rarely succeeded. And most medical experts do not believe there is a link between antidepressants and acts of extreme violence.

But the Pittman case has attracted special attention because it is among the first to arise amid a national debate over the safety of antidepressant use in children and teenagers. Depression is a complex condition, and antidepressants like Zoloft have helped countless children and adults.

In recent months, however, the federal Food and Drug Administration has been examining data from clinical trials indicating that some depressed children and adolescents taking antidepressants think more about suicide and attempt it more often than patients given placebos. The findings varied between drugs. The F.D.A. is scheduled to hold an advisory committee meeting on the issue next month.

Against that backdrop, the case of Christopher Pittman - an otherwise obscure small-town murder case that may go to trial this fall - has become a battleground, where the scientific threads of the F.D.A. debate have become entangled with courtroom arguments and a family's tragedy.

Pfizer, the maker of Zoloft, has helped the county solicitor who is prosecuting Christopher Pittman. Plaintiffs' lawyers from Houston and Los Angeles, who between them have brought numerous civil lawsuits against Pfizer and other antidepressant makers, have signed onto the defense team. Groups opposed to pediatric antidepressant use have also championed the boy's case, which is being played out in Chester, S.C., a town of 6,000 near the North Carolina border.

Locally, some people involved in the Pittman case said they have been stunned by the rush of outsiders. Even a forensic psychiatrist, who testified at a hearing that she believed that Christopher committed the murders while in a psychotic state induced by Zoloft, said she worried that the publicity may frighten parents whose children could benefit from Zoloft and similar drugs.

"I wished it could be staying in Chester, S.C., with this one kid," said the psychiatrist, Dr. Lanette Atkins of nearby Columbia, S.C., who has been retained by Christopher's public defender.

While the pediatric antidepressant debate has focused on potential suicide risks, aggressive behavior can be a side effect of antidepressants. There have also been case reports of adults and children on antidepressants acting violently. But only a handful of psychiatrists have ever argued that such medications can unleash rages so uncontrollable as to overwhelm a person's ability to distinguish between right and wrong and commit murder.

With the Pittman case pending, Pfizer, based in New York, declined to make company executives or lawyers available to be interviewed for this article. The company has previously said that no regulatory agency has ever found a connection between Zoloft and suicidal or homicidal behavior.

Zoloft belongs to a class of medications known as selective serotonin reuptake inhibitors, or S.S.R.I.'s, which also includes other popular drugs like Paxil and Prozac. In the last year, federal drug regulators have issued cautionary statements about most S.S.R.I.'s and similar medications prescribed for the treatment of pediatric depression. The one exception has been Prozac, the only S.S.R.I. formally approved for pediatric use after it was shown to be effective in tests with children and adolescents.

Regulators issued their advisories after a re-examination of drug makers' test data, much of which had not been publicly released. The disclosure of the test results has spurred demands by doctors' groups and others that drug companies be required to list all drug tests publicly, and a few producers have announced plans to do so.

If for some doctors such controversies seemed to have sprung up suddenly, the issues behind them were already stirring about three years ago - right around the time that Christopher Pittman fired four shotgun blasts into his grandparents as they slept.

When Christopher Pittman arrived in Chester in October 2001 to live with his paternal grandparents, Joe and Joy Pittman, the move seemed like his last, best chance to find stability.

He felt abandoned by his mother, according to medical reports. And his relationship with his father, who raised him in Florida, was troubled. "I haven't had that good a life; my real mom left when I was 2," Christopher Pittman told a forensic psychiatrist with the South Carolina Department of Juvenile Justice.

Psychiatric reports suggest that Christopher's tailspin began when his parents revived their relationship in 2001, only to end it yet again. After his mother left this time, he threatened to kill himself and was hospitalized. His diagnosis, records show, was mild chronic depression accompanied by defiant and negative behavior. He was put on Paxil.

But after about a week, his father, Joe D. Pittman, decided to remove him from the hospital and send him to live with his grandparents. There, a doctor put Christopher on Zoloft, the most widely prescribed S.S.R.I. antidepressant for pediatric patients and adults alike.

Initially, Christopher Pittman appeared to thrive. After a few weeks in Chester, though, he got into a dispute on a school bus and his grandparents threatened to send him back to his father. By the next morning, they were dead.

Dr. Pamela M. Crawford, a forensic psychiatrist who was asked by the case's prosecutor to examine the boy, concluded in her report that Christopher knew what he was doing when he took his grandparents' lives.

He provided "nonpsychotic reasons" for killing his grandparents, setting fire to the house, taking money from his grandparents and then stealing their car, Dr. Crawford's report states. "Following his detention by police, Christopher made self-protective statements to avoid arrest prior to admitting his actions."

Citing the continuing case, both Dr. Crawford and Dr. Atkins, the other forensic psychiatrist, declined to answer questions about their reports or court testimony.

At the time of the murders, questions about the safety of antidepressants were focused on adults, not youngsters. Just a few months earlier, a plaintiff's lawyer, Arnold Vickery, who is known as Andy, had convinced a federal jury hearing a lawsuit in Cheyenne, Wyo., that Paxil had caused a man to go on a murderous rampage.

In June 2001, that jury ordered GlaxoSmithKline, the maker of Paxil, to pay $6.5 million to the relatives of Donald Schell, who, two days after starting on the drug, murdered his wife, his daughter and his granddaughter before killing himself. The company appealed, before settling the case, for undisclosed terms.

It is hard to draw comparisons between civil lawsuits and criminal cases like the one involving Christopher Pittman. Still, the Wyoming verdict was significant because it was the first time, after more than a decade of litigation, that a jury had concluded that an S.S.R.I.-type antidepressant could make users so agitated and unbalanced that they could kill others or themselves.

To date, no other jury in a lawsuit has made a similar finding, and drug makers like Pfizer take the position that antidepressants do not cause suicide or homicide.

Little is known about Christopher Pittman's response to Paxil, because he took the drug for only a few days. And reports about his reactions to Zoloft vary sharply.

He later told a psychiatrist that his mood changed on the medication, to the extent that he "didn't have any feelings."

The notes of the local doctor who prescribed the medication for Christopher paint a different picture, according to court records.

That physician, who saw Christopher just a few days before the killings, described him this way: "Lots of energy. No plans to harm self. Not flying off the handle."

Psychiatrists have long known that adult patients might experience increased suicidal thinking or agitation during the first weeks of treatment with S.S.R.I.-type antidepressants. But in May 2003 GlaxoSmithKline made a disclosure related to pediatric use of the drug, which would set off a cascade of events that are still in motion.

That month, the drug maker told the federal Food and Drug Administration and its British counterpart agency that its re-examination of published and unpublished test data showed that adolescents who took Paxil during clinical trials had more suicidal thoughts or attempted suicide more often than those who received a placebo. About six months earlier, a curious F.D.A. analyst had contacted the company seeking more safety information.

Within weeks, British drug regulators told doctors not to prescribe Paxil to new patients younger than 18. In June 2003, the F.D.A followed suit, and a month later the agency asked all antidepressant makers for more safety data about their pediatric tests. In the weeks leading up to an emotionally charged F.D.A. hearing this past February on antidepressant safety, doctors learned that the drug industry had not published all the data gathered during pediatric trials.

Dr. David G. Fassler, a child and adolescent psychiatrist in Burlington, Vt., who attended the meeting, recalled being struck by the number of pediatric studies he had never known about although he followed medical journals.

"This was a lot more data than I knew existed," said Dr. Fassler, who is an official of the American Academy of Child and Adolescent Psychiatry, a professional group.

That hearing also served as a public forum for grieving parents to testify about children who had committed suicide soon after they had started on antidepressants. Joe D. Pittman, Christopher's father, was there, reading a letter written by his son in prison, in which he blamed Zoloft for the killings.

"Through the whole thing, it was like watching your favorite TV show," wrote Christopher, who is now 15. "You know what is going to happen but you can't do anything to stop it." A Gathering of Lawyers

By then, his case had become the center of a pitched legal struggle. Mr. Vickery, the plaintiffs' lawyer who had won the Wyoming trial, was contacted about the Pittman case by the International Coalition for Drug Awareness, a group based in Utah opposed to antidepressant use.

Over the past decade, the group's director, Ann Blake Tracy, has become involved in several murder cases in which a defendant has been on antidepressants or other drugs. Ms. Tracy maintains that antidepressants "overstimulate the brain stem and cause you to go into a sleep-walk state where you can act out the nightmares you have." Mr. Vickery, who has been suing antidepressant makers since the mid-1990's, soon joined the defense team, offering his services for free. So did another plaintiffs' lawyer who has filed similar lawsuits, Karen Barth Menzies of Los Angeles.

Lawyers for Pfizer have also gotten involved. The case's prosecutor, Chester County Solicitor John R. Justice, was recently hospitalized with a serious illness and has not been available to comment. But he stated at a court hearing that Pfizer had provided information to him last year to help him prepare for the trial, according to a published report in The Herald, a newspaper in Rock Hill, S.C.

Christopher Taylor, an assistant country solicitor, said he thought that Pfizer had contacted Mr. Justice. The material provided by Pfizer, the article reported, included F.D.A. reports about Zoloft and previous court testimony by a psychiatrist, Dr. Peter R. Breggin, who is scheduled to testify on Christopher Pittman's behalf. Dr. Breggin, who has campaigned against the use of psychotropic drugs in children, has testified in numerous lawsuits and criminal trials that a link exists between S.S.R.I.-type antidepressants and both suicide and violence - positions rejected by drug makers like Pfizer and by many other experts.

"I have been given advice on how to cross Breggin," Mr. Justice was quoted as saying, adding that he had "been schooled on how these drugs are supposed to work."

The involvement of a drug company like Pfizer in a criminal proceeding is not unusual. Jennifer Yoder, a spokeswoman for Eli Lilly & Company, the maker of Prozac, said that over the years, a "Prozac defense" had been raised about 75 times in criminal cases and that the company had worked with prosecutors at times. She said she was unaware of any case in which the Prozac defense succeeded.

Not long ago, Mr. Vickery and Ms. Menzies asked the case's presiding judge to order the release of scores of Pfizer documents about pediatric trials of Zoloft, claiming they were critical to their client's case. Those records were reviewed in the past by Ms. Menzies, the plaintiffs' lawyer, as part of a 2002 civil lawsuit filed in a Los Angeles federal court against Pfizer by the widow of a man who committed suicide while taking Zoloft. The case was dismissed before trial.

According to court filings, the documents include early drafts of a published positive pediatric report about Zoloft that was later criticized by researchers for its methodology. F.D.A. officials also did not find that the study provided convincing evidence of Zoloft's efficacy in children and adolescents. Both Mr. Vickery and Ms. Menzies said they were barred from speaking specifically about the Pfizer documents because they were covered by confidentially agreements they signed during civil proceedings. But with the Pittman defense, "I am hopeful that this case is the one that all of Pfizer's dirty laundry comes out," Mr. Vickery said.

Pfizer's lawyers have argued in court papers in the Pittman case that the documents being sought have nothing to do with the boy's situation. In addition, they have effectively accused Mr. Vickery and Ms. Menzies of using the case to make a cynical end run in order to obtain documents they want for other Zoloft-related lawsuits they are pursuing.

A Pfizer spokeswoman, Mariann Caprino, said in an e-mail message that Mr. Vickery had made a business out of suing antidepressant makers. "In his three cases against Pfizer that were decided by the court in which he claimed Zoloft caused suicide, each case was decided in Pfizer's favor and dismissed by the court," she stated.

Christopher Pittman's trial, scheduled to begin this fall, may be delayed because of the illness of Mr. Justice, the prosecutor. The teenager's lawyers are trying to move his case to juvenile court, where if convicted, he would be released by age 21 from a juvenile facility.

Meanwhile, lawyers like Mr. Vickery have continued to file lawsuits. Although Mr. Vickery failed earlier this year in his first attempt use an S.S.R.I. defense to win an acquittal in a murder case, at a trial in Detroit, the calculus of such cases may be changing.

In April, a time of intense media publicity about the issue, a man was acquitted of attempted murder after a state jury in Santa Cruz, Calif., found that he was not liable for his actions because of a reaction to Zoloft.

The case's prosecutor, Barbara Rizzieri, an assistant district attorney for Santa Cruz County, said the growing debate about antidepressants had played a role in the outcome. "If this had happened a year ago," she said "it truly would have been different."

Please RESEARCH before making judgemental statements. Particularly when doing so on a CHILD who, after all - even if you're right -is LESS able than adults to determine between good and bad. Not MORE guilty because he's a child. Adults have years more experience and opportunities to learn, to be more responsible, than children, so we should be more compassionate shouldn't we?

Try a google search on perhaps

pfizer corruption zoloft pittman

and see what can be learned about the drug's effects.

I can see your point, and might well have agreed with you without having researched, years ago, but research will help to bring more understanding to the drug's effect,often fatal on ADULTS let alone children who are unable to understand or find out why they feel the way they do (and therefore with information being able to avoid acting on the drug-induced psychosis and akathisia).

Would you feel the same if the child had a crooked doctor who had 'prescribed' him large daily doses of LSD, or cocaine?

In fact, the drug he was prescribed is little different. You'll find that out if you research.

Its really necessary to keep an OPEN mind to see the reality of just WHO is guilty and to use that mind, which you and all of us were given from the moment we existed, to
think, research, make conclusions based on what we research, etc rather than coming to conclusions on what we have simply 'accepted' (quite understandably) through years of advertising and other persuasive but biased influences etc.

Hoping you will do this :-) Interested in your more 'informed' views when you have done so.

Ok, using your points - there are THOUSANDS of deaths on SSRIs, mostly by suicide, including suicides of HEALTHY VOLUNTEERS on clinical studies.

Many of the clinical studies that have come to light have EXCLUDED anyone that is suicidal, but still the suicide rate on those studies are MANY TIME HIGHER than on older antidepressants.

The suicides that occur are not used by the unfortunate victims of pharmaceutical corruption as 'excuses' for lawyers, the victims DIED. There is no going back for them.

There are also VERY MANY CASES evidenced in clinical studies of HOMICIDALITY. Those people do NOT die. They are just as affected by the drugs as those who throw themselves off cliffs, crash their cars into walls, stab themselves, hang themselves, etc. There is no more reason to believe that someone who becomes homicidal rather than takes his/her own life is using the drug as an excuse than there is to believe that someone who takes their life because of the drug was 'doing it to get legal attention'.

Both 'types' of drug-induced mania/akathisia are as surreal as each other, acting out a world (drug induced) that is hard, sometimes impossible, to distinguish from reality.

That is NOT actually psychopathy. Its recognised by most people who have NO information as being the sort of effect that happens on LSD. LSD was also once a medicine. There isn't very much difference.

Until people realised that, regardless of how it was promoted by the manufacturers, and regardless of how many people got 'high' or 'relaxed', LSD was a dangerous drug that killed FAR TOO MANY PEOPLE than those who 'enjoyed' taking it. Hence it was made illegal.

There is ABSOLUTELY NO EVIDENCE that SSRIs have actually SAVED lives. There is no way of proving that someone taking an SSRI would have DEFINITELY died without them. Anymore than there was that LSD saved lives. Thats simply pharmaceutical hype.

What there IS EVIDENCE OF is that many thousands of people who were NOT suicidal (not counting those who were to begin with) have committed suicide on those drugs.

What I find really appalling REGARDLESS of whether opinions are informed or uninformed as the the drug's effects are the number of people in any event who would judge a child more harshly than they would an adult, without compassion or understanding of that child's background, or the insight to consider as to how a child copes with a disfunctional background.

Or how a system supposedly based on JUSTICE can put a 12 year old boy in an ADULT prison where, as a child he is at risk of all kinds of abuse from adults far older and harder than he is.

I'm really appalled.

Justice is supposed to be about law tempered with mercy and compassion and the ability to think for yourself and recognise the vulnerability of children and the responsiblity adults have to guide them wisely, EVEN if dismissing evidence of the serious additional harm that mind-altering drugs, whether heroin, LSD, cocaine etc, can do to a child.

I'm sorry to see evidence of it here, but not unexpected - when members of law firms whose clients include the pharmaceutical companies have 'second jobs' in the FDA and the Justice Department and other governement departments, its no wonder that people get duped into believing that these drugs are fine.

This is probably my last visit to this forum, I hope you've got enough independent thought, and enough insight into how other people feel to start to think about things that are going on.

In the meantime, you'll find its the PHARMACEUTICAL INDUSTRY that USE the law, and lawyers, more than it is victims of their drugs, and perhaps you could start looking at a list of lawyers who ensure they have seats in high places IN ADDITION to their jobs, so that they are in positions of influence and power whenever a decent lawyer aims to protect those who have suffered from their drugs.

Look carefully. This article isn't a one-side view, its a LIST of who works in how many different places and who their clients are. Then think why?

http://www.cptech.org/ip/health/politics/revolvingdoor.html

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