The Zoloft defense: Could anti-depressants be the next big criminal defense panacea?

A South Carolina jury has rejected the so-called Zoloft defense of a teenage boy accused of murdering his grandparents. Christopher Pittman, who was 12 years old at the time of the killings but tried as an adult, had been put on the antidepressant drug after threatening suicide three weeks before he shot Joe and Joy Pittman. His dose had been doubled just two days before the shootings. His defense team argued that the drug altered Christopher's concept of right and wrong and that he was acting out during a manic episode when he shot his guardians.

The Story Begins...

Christopher Pittman had been sent to live with his grandparents, Joe and Joy Pittman, after having trouble with his allegedly physically abusive father. His mother had already left. While attending choir practice with his grandparents on November 28, 2001, Christopher was fidgeting, repeatedly kicking the stool of the music director, and was taken outside by his grandfather to be disciplined. When he returned, the choir leader said that Christopher wore "a look I'd never seen before."

Later that night, Christopher shot his grandparents while they slept, burned down their house, drove off in the family car, and when he got stuck in a ditch, told passing motorists the person who had killed his grandparents then kidnapped him and left him on the side of the road. During subsequent interviews with investigators and psychiatrists, Christopher reportedly said that his grandparents deserved to die—his grandfather for paddling him and his grandmother for doing nothing to stop it.

With the increasing number of claims that antidepressants are causing precisely the behavior they attempt to curb, we face some important, fundamental questions in both the legal and medical professions—namely, who is responsible for criminal acts when committed while under the influence of antidepressant drugs? The individual? The drug company? The doctor?

As in any trial where the defendant claims to have been under the influence of a mind-altering drug, the inevitable battle of the experts ensued. One psychiatrist opined that Christopher killed his grandparents out of rage for being disciplined, and that if Christopher had acted during a manic episode, it was the shortest one that he had ever seen. Another stressed that although Christopher may have appeared fine to the layperson, only a trained expert would have noticed a bad reaction to Zoloft. Also, one psychiatrist testified that fidgety, restless behavior, including swinging legs, can be a side effect of antidepressants like Zoloft.

The prosecution relied on Christopher's actions surrounding the killings, notably his attempts to cover up the crimes, and painted the teenager as a cold-blooded killer based on his later statements. The defense decided to fight on the presumption under South Carolina law that a person under the age of 14 cannot form the criminal intent to commit murder—and make Christopher's knowledge of right and wrong the central question.

The jury sided with the State and found Christopher guilty of the murders, ignoring the possible verdicts of guilty but mentally ill and not guilty by reason of insanity, as requested by defense counsel. With the latter two verdicts, Christopher would have spent an undetermined amount of time in a psychiatric facility. However, with the guilty verdict, the presiding judge was compelled by law to sentence Christopher to at least the minimum mandatory prison term of 30 years, which he did.

Was Christopher's claim completely lacking in medical evidence? Between the crimes in 2001 and when Christopher's trial began, the Federal Drug Administration (FDA) had recognized that Zoloft and other antidepressants may increase suicidal thoughts and attempts. Indeed, in October of 2004, the regulating agency put a "black box" warning on antidepressants, one step shy of a ban, warning doctors to advise the guardians of juvenile patients of the serious potential risks of suicidal behavior.

Many, including the prosecution in Christopher's case, argue that suicide and murder are not the same. However, one psychiatrist's statement that Christopher "literally burned his house down around him" shows the fine line that is drawn between the two acts. Moreover, the FDA recently sent a letter to drug companies, including Pfizer, Inc., the maker of Zoloft, with a template to include on antidepressants stating that they may increase agitation, panic attacks, irritability, hostility, and impulsivity in children.

Christopher's case isn't alone in its assertion that antidepressants can cause aggressive behavior. Hundreds of trials have involved Prozac, the most recent of which was in Michigan, where, on the same day that Christopher was convicted, a judge threw out a guilty verdict of murder, saying that "jurors should have considered evidence Prozac could have driven him to kill." Zoloft's court appearances are increasing as well; last April, a California jury acquitted a man of the attempted murder of his friend, accepting that Zoloft had altered the man's rational thinking.

This issue isn't confined to the United States, either. A young Australian mother who pled guilty to trying to kill her two children had her sentence suspended when the judge ruled that the antidepressants she was taking "impaired her capacity for rational thought to such a degree that her responsibility for her actions was substantially diminished and her capacity for rational thought and action was gravely impaired." The mother had a history of depression and had been placed on antidepressants after the first of four suicide attempts. She had been taking the drugs Aropax and Efexor, also sold by the names Zoloft and Prozac.

With the increasing number of claims that antidepressants are causing precisely the behavior they attempt to curb, we face some important, fundamental questions in both the legal and medical professions—namely, who is responsible for criminal acts when committed while under the influence of antidepressant drugs? The individual? The drug company? The doctor?

These questions can be largely avoided by preventative measures such as the utilization of the DNA Drug Reaction Test, a simple procedure that can determine whether there will be harmful drug reactions based on the presence or absence of certain genetic materials. This test, which was announced by the FDA in December, along with careful, individualized treatment can help balance the interests of everyone involved—and that includes all of us whether we take antidepressants or not.