Did Drugs Distort Mother’s Nature?

Andrea Yates’ crime shocked the nation. Did mind-altering drugs prescribed to treat her depression actually drive this young mother of five to drown the children she loved?

Only weeks ago, Houston wife and mother Andrea Pia Yates methodically drowned each of her five children. One by one Yates forced her children, ages 6 months to 7 years, into the family’s bathtub and held their struggling bodies under the water until each fell limp.
       Whatever possessed the 36-year-old mother to commit these unconscionable acts remains murky. Depression and postpartum syndrome topped early speculation, but there has been little discussion about the possible effects of the powerful mind-altering drugs she was taking. Although Texas District Judge Belinda Hill issued a gag order concerning the case, family members have released disturbing facts about Yates’ psychiatric treatment that specialists say may account for her state of mind at the time of the murders.
       During a two-year period, Yates was prescribed four extremely potent mind-altering drugs intended to help her through two episodes of severe depression that began after the birth of her fourth child. The first of these psychopharmacological cocktails included Haldol, an antipsychotic most often used to treat schizophrenia; Effexor, an antidepressant very similar to selective serotonin reuptake inhibitors (SSRIs); and Wellbutrin, a unique antidepressant that has amphetaminelike effects. According to Yates’ husband, Russell, his wife appeared to respond well to this treatment regimen and, after a short time, became her “old self.”
       At the onset of the second episode of depression following the birth of her fifth child, and the subsequent death of her father, Yates again was prescribed a psychopharmacological cocktail. This one contained Effexor and, at the end, Remeron. While information about the Remeron dosage was not made public, Yates’ husband has said that his wife was given Effexor at a dosage nearly twice the recommended maximum limit. Just days before the murders, the Effexor was for some reason reduced to just slightly more than the recommended maximum dosage of 225 mg per day and the Remeron was added.
       Psychiatrist Peter Breggin, a psychiatrist, court-qualified medical expert and author of numerous books, including Talking Back to Prozac and the recently released The Anti-Depressant Fact Book, tells Insight: “The mixture of Remeron and Effexor would tend to be extremely agitating and certainly could lead to behavioral disturbances. The mixture of Haldol, Wellbutrin and Effexor is unpredictable in its effects. Haldol actually can cause depression, and putting the three drugs together is somewhat experimental.”
       Breggin continues: “Haldol is a very blunting drug. It’s difficult to come to any definitive conclusions with so little data about her state of mind at the time. However, Haldol is a drug that produces what can only be referred to as a chemical lobotomy that tends to make a person more docile and robotic.”
       Many Americans who have read or heard reports about this case have little doubt that Yates was “out of her mind” when she killed her children. What appears to be developing, however, is an argument within the medical community about whether the mother’s homicidal state of mind was triggered by the depth of her depression or by the mind-altering drugs prescribed to her.
       Were these the actions of a severely depressed woman who “lost it,” or did the mind-altering drugs push this emotionally distraught woman over the edge? Should the latter be established in the criminal court, it could raise an even greater issue: Who was responsible? Was it a chemically poisoned mother who carried out the crazed act, the physician who prescribed the mind-altering cocktails or the pharmaceutical companies that manufactured and marketed the treatment?
       Immediately after reports of the tragic events, psychiatrists flooded the airwaves with commentary about Yates’ depression. Most pooh-poohed or avoided any connection between her violent behavior and the prescription of mind-altering drugs. These commentators included psychiatrist Lauren Marangell, chief of the Baylor College of Medicine’s mood-disorder research program in Houston. Marangell tells Insight that “there is no truth to the suggestion that the antidepressant could have had side effects that played a role in the killings.” She confirms that, like most medical schools, Baylor receives financial research grants from major pharmaceutical companies. How much? “I think I’ll refrain from comment on that,” Marangell says.
       Only recently have pharmaceutical companies been held responsible for violent behavior associated with their product lines of mind-altering drugs. A case in point is a June trial in which a jury in Cheyenne, Wyo., found that the antidepressant Paxil, one of the newer SSRIs distributed by GlaxoSmithKline PLC, “can cause some individuals to commit suicide and/or homicide.” The jury said Paxil caused Donald Schell, a retired oil-rig worker, to shoot and kill his wife, daughter and granddaughter before turning the gun on himself. Schell had been on the mind-altering drug only two days.
       The jury awarded surviving family members $8 million in damages, finding that 80 percent of the fault lay with the drugmaker. Andy Vickery of the Houston law firm of Vickery & Waldner, lead attorney in the Wyoming case, has taken dozens of similar cases seeking to hold responsible those dispensing and manufacturing these drugs. “The important thing,” Vickery explains, “is to lay the responsibility and accountability at the doorstep of those who ought to have it and those who could and should do something about it. Whether it’s criminal or civil responsibility, there isn’t a lot of difference.”
       As Vickery puts it, “Look, if I give you a loaded gun and for whatever reason it’s likely that you’re going to shoot someone, then I’m an accessory before the fact of murder. Shouldn’t the drug company that’s encouraging doctors to prescribe a drug and is aware that these drugs cause adverse reactions be held responsible? No one can believe that a mother would do such a thing. It’s too horrible. But the fact is these people get completely out of touch with reality because of these drugs. Unfortunately, in most of the cases that I get involved with, we never know if the people committing the violence knew what they were doing when they did it because they also killed themselves.”
       Although alcoholic-beverage distillers have yet to be held responsible for the overwhelming number of fatalities resulting from alcohol abuse, in many states bartenders are held civilly and criminally liable when customers get drunk and cause automobile fatalities. With the growing number of physicians and psychiatrists prescribing mind-altering drugs and the alarming data filtering out about adverse reactions to them, tort lawyers are asking if medically trained dispensers of psychotropic drugs shouldn’t also be held liable.
       For example, Yates’ psychiatrist, Muhammad Saaed, reportedly prescribed at least one mind-altering drug (Effexor) at almost twice the maximum recommended dose as part of a cocktail of mind-altering drugs that also included Haldol and Wellbutrin during her first bout with severe depression. A cautionary note in the Physicians Desk Reference says Effexor negatively interacts with Haldol. Apparently, Effexor hinders Haldol’s drug clearance by a factor of more than 40 percent and can cause Haldol concentration levels to increase by nearly 90 percent, creating toxicity.
       Did Saaed know the contraindications associated with the cocktail he prescribed? If the psychiatrist was unaware of the toxic mix, would ignorance of the potential poisoning make him any less liable than if he had known and prescribed the mind-altering drugs anyway? These are just a few of the questions Saaed may be asked should he have to defend his treatment under oath.
       According to Ann Blake Tracy, executive director of the International Coalition for Drug Awareness (www.drugawareness.org) and author of the recently updated book Prozac: Panacea or Pandora?, there is little doubt about Saaed’s culpability. Tracy, a doctor of health sciences specializing in adverse reactions to serotonergic medications, tells Insight that “when doctors start prescribing ‘off label’ outside the FDA [Food and Drug Administration] guidelines, they run the risk of being sued for malpractice. In the case of Yates, her psychiatrist already had her on superhigh doses, and on the Monday before the tragedy he dropped the Effexor back to almost the maximum dosage, then added Remeron. It’s well-documented that when doses are increased or decreased, patients experience negative reactions. A great many of the court cases, but certainly not all of them, are a result of the drastic change in the medication.”
       According to Tracy, “There’s a lot of science to demonstrate that depression is the result of an inability to metabolize serotonin, but somehow the drug companies have got the world believing that an increase in serotonin, rather than an increase in serotonin metabolism, is what the depressed person needs. This is the exact opposite of what research on depression shows and, if you look at the research over the last 50 years it is clear that there has been a horrible mistake. There is such a wanton disregard for life. Why can’t these doctors at least read the package inserts so they know how to prescribe the drugs properly? They’re not supposed to prescribe over the maximum doses, and they know that they are at toxic levels at that point. That’s why they have maximum-dose information; that’s why the Food and Drug Administration puts a maximum dose on the packaging. They do it to show that over the allowable dose level, a person becomes toxic and it’s extremely dangerous.”
       When asked what questions she might have for Yates’ psychiatrist, Tracy tells Insight: “I’d want to know how he could have ignored so many warnings and contraindications in [reportedly] giving this poor woman this dangerous drug cocktail. I’d also like to know which sleeping pill he uses to knock himself out at night when those five children’s faces run over and over again through his mind?”
       Harsh words? It appears this is just the beginning. Many who follow such matters say that because of the high profile of the likely trial of Yates for capital murder, it may turn into a landmark case pitting the pharmaceutical giants against the medical practitioners and vice versa, perhaps even dragging in the American Psychiatric Association.
       George Parnham, Yates’ attorney, has reported that he will enter a not-guilty plea on behalf of his client for reasons of insanity. After meeting with Yates and speaking with psychiatrists that had examined her, Parnham told reporters, “I’ve accumulated evidence in the last 24 hours that strongly suggests that the mental status of my client will be the issue.” Just what Parnham has discerned is anyone’s guess, including whether he’ll defend his client by challenging the pharmaceutical companies and his client’s psychiatrist. In the meantime, sources close to the case report that Yates still is being medicated. Saaed has turned his files on Yates over to the court and has, to date, made no public statement.

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