US jury finds that antidepressant did not cause boy to kill his grandparents

Charleston, South Carolina Jason Cato

A jury has rejected a claim that the antidepressant sertraline caused a boy to kill his grandparents with a shotgun.

Christopher Pittman was aged 12 in November 2001 when he shot his grandparents in their heads as they slept. He then set fire to the house and fled in a family car. Now 15, he spent three years in a juvenile jail after his criminal trial was delayed when different lawyers and a new judge became involved. Christopher was tried as an adult in Charleston, South Carolina, and was sentenced last week to 30 yearsí imprisonment. He could have been given a life sentence.

Prosecutors said Christopher shot his grandparents after they punished him for getting into a fight on a school bus. Their key psychiatric expert, Dr James Ballenger, testified that Christopher killed out of anger. Dr Pamela Crawford, a forensic psychiatrist, said Christopher had a conduct disorder and that he should be held responsible for his actions.

Medical experts called by the defence told jurors that Christopher developed akathisia, emotional blunting, and mania or psychosis as a result of taking sertraline (marketed as Zoloft in the United States and Lustral in the United Kingdom). Medical experts on both sides agreed that sertraline can cause these side effects.

Christopher had been taking sertraline for three weeks. He took paroxetine (marketed as Paxil in the United States and as Seroxat in the United Kingdom) for about a week before that. A family doctor testified that he switched Christopher to sertraline because he had been given free samples.

Dr Lanette Atkins, a child psychiatrist, diagnosed Christopherís illness as a drug induced mood disorder. She said she believed in the efficacy and safety of sertraline and prescribed it widely. However, she said the drug caused Christopher to hallucinate commands telling him to kill.

All selective serotonin reuptake inhibitors, such as sertraline, paroxetine, and fluoxetine, can cause certain patients to become suicidal or violent, testified Dr David Healy of the University of North Wales. He and Dr Richard Kapit, a former medical officer with the US Food and Drug Administration, supported Dr Atkinsís diagnosis and belief that Christopher did not know right from wrong.

The jurors disagreed. "Just because you take prescription medication doesnít mean that you canít be held accountable for your actions," said juror Stephen Platt. But he said the 12 jurors did believe that the drug affected Christopherís behaviour.

Judge Daniel Pieper ordered the manufacturer of sertraline, Pfizer, to provide hundreds of internal documents on the drug to defence lawyers (BMJ 2004;329:1365, 11 Dec). Only one document, however, was allowed in evidence: an unpublished summary of the combined results of two company sponsored clinical trials testing sertraline in depressed children.

Dr Steve Romano of Pfizer testified that those reactions were not necessarily caused by sertraline. He said that no scientific data linking sertraline to violence existed.

After the verdict Pfizer said: "Zoloft didnít cause his problems, nor did the medication drive him to commit murder."

The defence plans to appeal.