Suicide ruled in plane crash — (Fredericksburg Free Lance Star)

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Suicide ruled in plane crash

The pilot who died in a crash near Shannon Airport one year ago had been diagnosed with severe depression seven weeks earlier, according to the final report from the National Transportation Safety Board.

Edwin G. Hassel, 22, was living in Spotsylvania County and engaged at the time of his death.   The investigation concluded that Hassel intentionally crashed the Cessna 172M he had rented the evening of July 22, 2013.

An autopsy performed by the Chief Medical Examiner’s Office in Richmond listed the cause of death as blunt force trauma and the manner of death as suicide, the NTSB report states.

Before the crash, Hassel had been diagnosed with “severe recurrent major depression.”  He was prescribed an antidepressant and urged to seek counseling, according to the report.

Toxicology tests conducted by the Federal Aviation Administration’s Bioaeronautical Sciences Research Laboratory in Oklahoma City detected an antidepressant in his system.  It also detected ethanol, which is the active agent in alcoholic beverages, according to information from the Mayo Clinic medical laboratory.

The ethanol level detected was below Virginia’s legal limit for impairment.

“The investigation was unable to determine if pre-flight ethanol ingestion played a role in pilot’s decision-making,” the report states.

Hassel went online at 5:54 p.m. that July evening to reserve the Cessna for a flight, the report stated. He showed up at the airport on Tidewater Trail afterward and got the keys after speaking to a flight instructor who said he “seemed to be in good spirits and was not otherwise behaving abnormally.”

However,  Hassel’s fiancée contacted authorities about the same time to say she believed he planned to commit suicide “based on her previous interactions with him and a note she discovered in her home,” the report states.

She arrived at the airport as he was walking to the plane. Deputies soon arrived along with the flight instructor and they witnessed the crash.

Hassel performed a low pass down the runway, then started erratic maneuvers near the airport, then climbed to an estimated altitude of 3,000 feet before placing the plane in a “near-vertical attitude,” the report states.

The plane’s engine sounded like it was at full power prior to impact with the ground about 200 feet northwest of the runway.

The plane burst into flames on impact but fire and rescue personnel were quickly on scene.

Hassel had accumulated about 165 hours of flight experience as of May 2013.

The plane was operated by JLS Aviation Flight School and was not found to have any mechanical problems.

“Although the wreckage was significantly fragmented and fire-damaged, no evidence of any preimpact mechanical malfunctions or failures of the airframe or engine that would have precluded normal operation were observed,” the report states.

Pamela Gould: 540/735-1972     pgould@freelancestar.com

Lawsuit Alleges Celexa, Lexapro Makers Mislead On Safety for Children — (AboutLawsuits.com)

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AboutLawsuits.com

By: Irvin Jackson

Published: June 25th, 2014

The makers of Celexa and Lexapro intentionally misled the medical community about the safety of their popular antidepressants for children, according to allegations raised in a recent lawsuit that indicates the drug maker illegally promoted the medications for uses that were not approved by the FDA.

A complaint (PDF) was filed against Forest Pharmaceuticals earlier this year in the U.S. District Court for the District of Massachusetts, seeking class action status on behalf of all individuals who purchased or paid for prescriptions of Celexa or Lexapro.

In response to an attempt by Forest to have the case dismissed, plaintiffs filed a brief (PDF) on June 13, indicating that the case should be allowed to move forward.

According to allegations raised in the case, Forest engaged in deceptive and unlawful marketing that was purposefully designed to deceive the public about the safety of Celexa and Lexapro for children, and which violated the law so that the drug maker could sell the medications it knew had safety problems for children. Forest allegedly bribed doctors, rigged clinical trials and unlawfully marketed Celexa and Lexapro to get prescriptions for children.
“By using fundamentally misleading drug labels, the ‘endorsements’ of paid opinion leaders, gerrymandered clinical trials, and a legion of specially trained sales personnel, Forest misled consumers and the medical community about Celexa’s and Lexapro’s efficacy in treating pediatric depression,” the lawsuit states. “The clinical trials that examined whether the antidepressants Celexa and Lexapro are effective at treating adolescent major depressive disorder (“MDD”) indicate that Celexa and Lexapro are no more effective clinically than a sugar pill.”

In September 2010, Forest pled guilty to charges of illegally marketing the drugs, and a felony count of obstructing justice. The company agreed to pay more than $313 million as part of a whistleblower lawsuit.
The charges stemmed from off-label promotions Forest Pharmaceuticals now admits that it conducted following a study involving Celexa. The company trumpeted the positive results of the study while failing to mention negative results during a similar study conducted in Europe. The company also gave kickbacks to doctors and others to prescribe both Celexa and Lexapro and had its sales representatives and outside speakers talk to pediatric specialists about prescribing both drugs to adolescents and children. -

While Forest admitted to illegal marketing of Celexa and Lexapro, the company has asked that the lawsuit be dismissed, saying plaintiffs waited too long to file a claim. The company argues that under statute of limitation laws, the plaintiffs knew or should have known of their actions involving Celexa and Lexapro as early as 2005, when charges were first brought against the company. However, plaintiffs maintain that does should not bar the filing of the class action lawsuit at this time.

Their opposition brief notes that statute of limitations is suspended when a lawsuit seeks class action status in case it is denied. That is what happened when a complaint was first filed in 2009, the brief states.

Forest reached a number of Celexa and Lexapro lawsuit settlements in 2010 over claims that the drugs caused suicidal tendencies in children.

More than 50 suicide lawsuits over Lexapro and Celexa alleged that children taking the two drugs were prone to violence and suicide. The plaintiffs in those cases claimed that Forest knew from studies that there was a higher risk of suicide associated with the drugs when used by children, but failed to warn patients or doctors. The lawsuits charge the company with failure to warn, negligence and fraud.

In 2005, the FDA required that a black box warning be placed on a wide variety of antidepressants, warning that they could cause increased thoughts of suicide in children and adolescents. Both Celexa and Lexapro were required to carry those warning. The suicides that sparked the lawsuits predated the FDA-required label change.

 

Mother sought treatment, claimed to hear voices before tossing kids out window — (ABC 13 Action News)

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ABC 13 Action News

By Joyce Lupiani.

CREATED Jun 19, 2014

Las Vegas, NV (KTNV) — A Las Vegas mother who threw her two young children out of a second-story bedroom window before jumping herself told police that she heard a male voice saying “throw yourself” before the incident.

35-year-old Luz Robledo Ibarra has been booked in absentia on two counts of attempted murder and two counts of child abuse with substantial bodily harm.

The incident happened just before 6 a.m. June 12 on Spiritual Way, near Lake Mead Boulevard and Walnut Street. According to a report released today by the Las Vegas Metropolitan Police Department, police officers found the children’s grandmother holding one of the young children, who was bleeding from the head, upon arrival. They discovered another child and Ibarra nearby.

During their investigation, it was revealed that Ibarra had sought medical treatment on two occasions before that day. On March 6, 2014, Ibarra complained to a local doctor about insomnia, anxiety, pain in her upper back and neck, and told the doctor that she was overwhelmed with responsibilities.

The doctor prescribed Zoloft to be taken at bedtime.

On April 7, the doctor saw Ibarra again. At that time, Ibarra was offered psychiatric treatment at Harmony Clinic but she declined saying she would control it on her own. The doctor made a note that although Ibarra was previously prescribed Zoloft, she had stopped taking it because she did not like it. The doctor also documented that the Ibarra denied suicidal thoughts, but she looked very restless and uncomfortable.

The children’s grandmother told police that she was a resident of Mexico, but she had arrived in March 2014 to help care for the children and planned to permanently relocate. She also told police that Ibarra asked “what did I do, what did I do?” as she lay on the ground after jumping out of the window. Another family member told police that when he asked Ibarra why she had thrown the children out of the window, she told him that “she didn’t want to live anymore.”

The mother and children were transported to University Medical Center.

Both of the children were badly injured, including head injuries. The mother also suffered a fractured pelvis.

During an interview with investigators at the hospital, Ibarra told police that she had never heard voices in the past and denied that she had ever had thoughts of hurting herself or her children. She also told police that she tossed her six-month-old son out the window first, followed by her daughter.

 

Police: Arson suspect upset he had to move out — (The Columbian)

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The Columbian

By Paris Achen, Columbian courts reporter

Published: June 16, 2014, 11:17 AM

 A Vancouver man may have set fire to a house he shared with his former boyfriend because he was upset that he had to move out after the couple’s break-up, court records show.

Timothy C. Meagher, 57, had recently learned from an attorney that his partner of 17 years, James L. Hansen, 52, would retain ownership of the house because Hansen had owned the house prior to Meagher moving in, Clark County sheriff’s Detective Beth Luvera wrote in a court affidavit.

Meagher made a first court appearance Monday morning in Clark County Superior Court on suspicion of first-degree arson domestic violence.

He shuffled into the courtroom wearing shackles and a green suicide smock, indicating he is on a suicide watch at the Clark County Jail.  Judge Gregory Gonzales held him in lieu of $100,000 bail. Deputy Prosecutor Julie Carmena requested bail in that amount because Meagher tried to hide from law enforcement after the fire.  He also may have taken some Zoloft pills, she said.

“We have some concerns about his safety, as well,” she said.   Gonzales appointed Vancouver attorney George Marlton to defend Meagher.  He is scheduled to be arraigned on the charge June 25.

Court documents claim that Meagher focused on some of Hansen’s most treasured possessions when he started four separate fires Friday afternoon in the house at 6208 N.E. Wilding Road in the Sunnyside neighborhood. He poured gasoline on Hansen’s favorite recliner and on an heirloom lace tablecloth that had belonged to Hansen’s mother, Luvera noted. Another fire was started downstairs in the family room, where Hansen’s favorite recliner was located.

No injuries were reported. Damage was estimated at about $100,000, according to the sheriff’s office.

Hansen said he saw Meagher drive by his workplace during his lunch hour Friday and thought Meagher might be stalking him, court records say.

A neighbor, Tim Robinson, saw Meagher enter the house about 12:45 p.m. About an hour later, he saw smoke wafting from the eaves and called 911.

Meagher was apprehended at a cabin in Cougar owned by his employer. A sheriff’s bulletin said Meagher did not have permission to be in the cabin, and a neighbor alerted authorities after noticing a suspicious vehicle parked in front of it. Luvera said that Meagher hid in the woods for about 15 minutes before surrendering to law enforcement.

Meagher refused to give a statement to detectives, court records say.

GSK pays $105 million in settlement for alleged improper marketing of drugs — (MoneyLife)

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MoneyLife

TruthInAdvertising.org

06/06/2014

GSK reached a $105 million settlement agreement (its fifth so far) with 44 states and the District of Columbia for its promotion of anti-depressants Paxil and Wellbutrin and its asthma drug, Advair

GlaxoSmithKline LLC (GSK) has once again settled with regulators for alleged improper marketing of drugs for off-label uses. The company reached a $105 million settlement agreement this week with 44 states and the District of Columbia for its promotion of anti-depressants Paxil and Wellbutrin and its asthma drug, Advair. The settlement is the fifth it has had with regulators in recent years.

The complaint by the Attorneys General charged that GSK promoted Advair for the treatment of mild asthma when the FDA only approved it for treatment of more serious asthma conditions. Though doctors can prescribe medication for any reason, drug makers themselves cannot advertise medications for uses not approved by the FDA. The company, the complaint alleged, also concealed and misrepresented clinical studies that demonstrated Paxil’s ineffectiveness in treating children and teens with major depressive disorders and those that demonstrated a connection between Paxil and increased risk of suicidal thoughts and acts in adolescents. The company promoted Wellbutrin as a treatment for weight loss and sexual dysfunction through its “happy, horny, skinny pill” marketing campaign even though those were unapproved uses, regulators charged.

“Medical decisions are among the most personal and important decisions an individual makes, ‘’ said New York State Attorney General Eric Schneiderman, “and drug companies should be held accountable for misleading claims made in advertising.”

Settlement details

Under the settlement, the company – which admitted no wrongdoing — is prohibited, among other things, from making claims that a GSK product is better, more effective or has less serious side effects than other drugs unless the claims have been backed up by “substantial evidence or substantial clinical experience. ‘’ The company is also prohibited from presenting favorable information or conclusions from a study that is inadequate in design and scope and has to acknowledge if it is a funding source when submitting the study for publication. In addition, it has to stop providing samples of GSK products to health care professionals who are expected to prescribe them for off-label uses.

The company also has to continue a program that reduces financial incentives for sales reps to engage in deceptive marketing and start ending direct payments to health care professional for speaking engagements and attendance at medical conferences.

Past history of trouble

This isn’t GSK’s first encounter with federal regulators on its marketing of Paxil and Wellbutrin for off-label use. In 2012 the company settled criminal charges it illegally marketed the drugs and withheld safety data from U.S. regulators. In that case, which regulators called the largest health care fraud in U.S. history, the company paid out $3 billion and entered (irony noted) into a corporate integrity agreement.

Other companies

In November, Johnson & Johnson agreed to a $2.2 billion settlement in an off-label use case involving its anti-psychotic drug Risperdal. And last July, Wyeth Pharmaceuticals, which Pfizer acquired, paid out $490 million to settle an off-label case involving its organ transplant drug, Rapamune.

Read more here about issues surrounding off-label promotions of drugs.

Courtesy: TruthInAdvertising.org
 

Expectant mothers taking antidepressants are ‘more likely to have a child with autism’, say scientists — (Daily Mail)

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Daily Mail

By Emma Innes

The U.S. study supports previous research which has shown that taking SSRI antidepressants during pregnancy increases a woman’s risk of having a child with the developmental disability.

Despite the link, researchers say the chances of a woman who takes SSRIs during pregnancy having a child with autism remain very low.

For the latest study, researchers at Drexel University, in Philadelphia, analysed large population based registers of nearly 750,000 births in Denmark from 1997 through 2006.

They found that about 1.5 per cent of children born to women who had taken an SSRI during pregnancy were diagnosed with autism spectrum disorder (ASD), compared to about 0.7 per cent of children born to an otherwise similar group of women not taking the medication.

‘We found a two-fold increased risk for ASD associated with in utero exposure to SSRIs compared to the unexposed reference group,’ said lead author Dr Nicole Gidaya.

Dr Gidaya, added that ‘if the increased ASD risk we saw here is real, it is important to realise that the number of ASD cases that could be prevented by reducing SSRI exposure in pregnancy still represents only a small fraction of overall cases of ASD.’

The researchers also urged people to be cautious about the results as they say it is difficult to distinguish between the effects of the underlying condition and of the medication.

 ‘As we complete research in our attempts to understand autism’s causes we continue to realise that there are likely many genetic and non-genetic contributors,’ said Dr Craig Newschaffer, director of the A.J. Drexel Autism Institute and professor in Drexel’s School of Public Health, and the study’s senior author.

‘We must begin trying to map these multiple risk factors on to common pathways, so that these pathways can be a focus in our effort to prevent the impairment associated with ASD.

‘Pathways involving the brain’s serotonin system are still one viable candidate.’

The news comes just after another U.S. study suggested that mothers-to-be who take antidepressants may be three times more likely to have a baby boy with autism.

Researchers from the John Hopkins Bloomberg School of Public Health found boys were much more likely to develop autism when their mothers took antidepressants than girls were.

They also found that the link between autism and SSRIs was particularly pronounced in children whose mothers took the drugs during the third trimester of their pregnancy.

Singer, 21, sectioned after attempting suicide six times in three weeks killed herself after hospital staff let her out unescorted — (Daily Mail)

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Daily Mail

By Mia De Graaf

Samantha Maritza admitted to St George’s Hospital, Stafford, in May 2010

  • Had tried to hang herself, was sectioned after further 6 attempts on her life
  • Within a month she was let out alone for 2 hours, stepped in front of train
  • Parents have received five-figure sum from hospital which denied liability

A singer who killed herself while on leave from hospital had been sectioned after attempting suicide six times in three weeks.

Samantha Maritza was killed when she stepped in front of a train travelling at 125mph in June 2010.

It was just hours after the 21-year-old was released from St George’s Hospital in Stafford on unescorted leave.

Miss Maritza, the lead singer of up-and-coming electro band China Red, had been admitted to the ward the previous month when she tried to hang herself.

After a further six attempts on her own life in three weeks – and diary entries mentioning trains – she was sectioned.

But within a month, she was being prepared for unaccompanied day release away from medical staff and family.

Despite warning their daughter wasn’t ready, her parents claim their protestations went unnoticed.

Later that day it emerged that she had died in a fatal collision with a train at Lichfield Trent Valley and was able to be identified by her treble clef tattoo.

Today, her parents, Stephen, 57, and Joan, 55, have been paid a five-figure sum after launching a negligence claim against the hospital.

South Staffordshire and Shropshire Healthcare NHS Foundation Trust settled with them out of court after refusing to accept liability.

Miss Maritza, a trainee hairdresser, had suffered from depression for two years before her death.

After making an attempt on her own life she agreed to be admitted and after a further six suicide attempts in three weeks she was sectioned.

But despite being on anti-depressants, she dedicated her time to mentoring young musicians who lacked confidence.

An inquest in 2011 found Sam killed herself while mentally unwell and her devastated family, including her brother Billy, 20, and sister Jamie, 23, launched a negligence claim against the hospital.

The hospital did not admit liability and settled out of court.

Amanda Godfrey, spokeswoman for South Staffordshire and Shropshire Healthcare NHS Foundation Trust, said: ‘We are truly saddened by the death of Samantha and our condolences go to her family.

‘In line with our usual policy, a full investigation was carried out into the circumstances surrounding her death and a number of changes have been implemented, including an emphasis to staff that patient notes must be completed in full and observation sheets correctly filed.

‘We have also recently introduced a new clinical information system which will allow all staff to have access to electronic health records, offering more comprehensive and up to the minute detail on each patient.’

Now her family are hoping to use the money to raise awareness about mental health problems, including contributing to the memorial fund they set up in her name – The Sam Maritza Trust.

They are calling for changes to the procedures and care in relation to unescorted leave as they believe more families could be saved from the grief they have experience.

Stephen said: ‘We were hoping that this would be a warning for the hospital but we don’t think it has.

‘Sam was in the worst situation possible to be left on her own.

‘Although we were hoping that things were getting better and she was coming back to us, we weren’t even sure if she was taking her medication.

‘It just didn’t add up and we can’t believe that letting her out alone was a risk they were prepared to take. The anger that came with our grief was horrific.

‘We just wish they had given one more day to improve before she was let out on her own. It’s too late for Sam, we just hope we might be able to help someone else, to show that mental health problems are an illness not a weakness that needs to be hidden.’

 

Whitewash from the Outset, the Fort Hood Shootings April 2, 2014 — (Donald J. Farber, Attorney at Law)

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Authored by Donald J. Farber, Attorney at Law

©2014 May 20, 2014

For 15 years Donald J. Farber has represented clients in actions involving antidepressant-induced side effects and testified as an expert witness on the subject.  He has additionally testified before the House of Representatives and before FDA public hearings on antidepressants and pharmaceutical industry practices. In 2002 he met with senior FDA officials with allegations and evidence that antidepressant suicidal risk was being suppressed by certain drug companies.  The FDA investigated the allegations and, as a result of the agency’s findings, conducted hearings which resulted in the antidepressant suicide warnings that the FDA ordered in 2004. Farber served as a surface warfare officer in the U.S. Navy for 25 years, with 13 years sea duty

***

How can the Army be accused of whitewash when the results and findings of Fort Hood are still pending? That is a fair question, but the premise is wrong. The Army’s findings on Fort Hood were determined long ago.

At the live news conference following the April 2nd Fort Hood shootings, on scene commander Lieutenant General Michael Milley was asked this follow up question by the reporter who had just solicited from him that the shooter was on medications: “Like SSRIs 1 or other antidepressants, things of that nature?” Milley answered “Yes he was.” [FN] 2

The next day in Washington Secretary of the Army John McHugh and Army Chief of Staff Raymond Odierno briefed the Senate Armed Services Committee on the shootings. McHugh reported Specialist Ivan Lopez had been “undergoing a variety of treatment and diagnoses for mental health conditions ranging from depression to anxiety to some sleep disturbance…(and)…was prescribed a number of drugs…including Ambien” a short term sleep aid.3

No media outlet reported Milley’s antidepressant revelation. The few outlets that ventured to identify medication dutifully followed McHugh’s cue, mentioning only “Ambien.”

Those thinking the Secretary’s choice of a sleep aid to associate with the shooter instead of a Prozac, Zoloft, or Paxil was an innocuous inadvertence stemming from fast moving events between Texas and Washington—think again!

The Secretary’s choice of the sleep aid but not the antidepressant was as predictable as it was diversionary.  One pondering McHugh’s aversion to antidepressants need merely be reminded the Army has sacred policy cows to protect as it undergoes yet another investigation of violence amidst record suicides.

McHugh identifying only Ambien was particularly incongruous given General Milley’s statement hours earlier indicating the shooter had been undergoing treatment for depression and anxiety. Both are psychiatric disorders for which the SSRI Paxil, for example, is FDA indicated.  Ambien has no FDA authorized indication for either.

Identifying a sleeping pill instead of a drug required by the FDA to carry a “black box” warning for suicidality could not but send a signal to subordinates beginning the Fort Hood investigation that the Army’s narrative on its suicide crisis would continue uninterrupted.   Amidst its suicide crisis the Army has disregarded antidepressant suicide warnings from the Food & Drug Administration (“FDA”) since they were first issued in 2004 and, like Secretary McHugh, won’t touch the subject whenever suicide or violence erupts in the ranks.

The Army’s suicide rate rose dramatically starting in 2005, exceeding the civilian rate beginning in 20084. “Suicide rates double(d) among U.S. soldiers between 2004 and 2009.”5

The service experienced 325 completed suicides in 2012 and 301 in 2013.6

Army History

Americans know from history what government, including the U.S. Army, is capable of undertaking if allowed to its own devices without oversight. This has included the Army’s occasional sordid history of human experimentation and ethical lapses in medically related matters. One need look no further than the U.S. Supreme Court in U.S. v Stanly (483 U.S. 669 (1987)) in documenting what the Army has perpetrated on unknowing individuals in the name of science. The Army secretly administered LSD into Master Sergeant James Stanly when he was assigned to Aberdeen Proving Grounds to test its effects on human subjects, causing Stanley hallucinations, incoherence, memory loss, and impairment of military performance.  His marriage dissolved because of the personality changes wrought by the LSD.7  The online encyclopedia lists a multitude of government and Army projects in history with unethical underpinnings, insightful reading for those placing unconditional faith that government will not at times intentionally abuse the rights of citizens through unbridled exercise of executive powers.8

Understanding the bureaucratic mindset and the history of U.S. involvement in Iraq and Afghanistan aids in unraveling the Army’s sensitivity to the subject of psychotropic medications. A top down hierarchy, Army medicine adapted well to the exigencies of combat casualties in Iraq and Afghanistan, admirably saving countless lives and aiding the battle wounded to restore their lives. The matter of mental health and psychotropic medications in the Army and the other services, on the other hand, is a horse of a different color.

The Army became enamored with antidepressants much like the rest of the nation.  SSRI use ascended rapidly in the nation as Prozac led the way in 1988, with Zoloft and Paxil soon following.9  It didn’t take long for the Army to jump on the bandwagon. Aggressive use of antidepressants and anti-anxiety medications (anxiolytics) started in the 1990s as antidepressant manufacturers, citing strong endorsements from medical organizations like the American Psychiatric Association (“APA”) successfully lobbied the Department of Defense (“DOD”) to stock pharmacies and implement use of psychiatric medications, particularly antidepressants and anxiolytics, as a staple of military medicine. What sold in civilian life took hold in the military, including casual dispensing for minor stresses and mood swings by troop physicians without training in psychiatry. The FDA’s first antidepressant suicide warning was issued in 2004 in part because of the overly casual approach with which physicians dispensed the drugs with minimal screening to determine actual psychiatric need.10

Drugging with psychiatric medications became a routine aspect of military medicine in which it was intended to facilitate overall force readiness—in short, drugging soldiers to get them out of the barracks and out on patrol! While the infantry generals running the Army hardly had time to oversee psychotropic medications in their medical corps, their involvement in preparing combat units for deployment and maintaining force structure was a call for all subordinates to fall in line. Army doctors and medics were integral to mobilizing the troops for war zone readiness.

Army Doctors and Haircuts

Army doctors in the field are extensions of the chain of command, implementing top down policies with nearly the zeal of infantry officers. It was not always that way. While medical corps commanders and hospital commanding officers were almost by definition career types, junior doctors out in the field were not. A few decades ago the Army physician in the field was a short time reservist, needed a haircut, and was more sympathetic to enlisted gripes than unit discipline or orders from on high. The TV series MASH was not entirely fictional in that respect.

The all-volunteer force changed that. The 1972 establishment of the military’s own medical school, i.e. Uniformed Services University of the Health Sciences (“USU”) and the end of the draft the next year set a new direction in the medical corps of all the uniformed services.

The 2014 Army physician served in the military before s/he took the Hippocratic Oath, went to medical school at USU, and stays in the service longer than the colleague of a generation ago.

The Sacred Cows

One such sacred cow is the widespread and compelled use of psychiatric medications as a cornerstone of Army medicine. Twenty (20%) percent of Army soldiers were on antidepressants in 2010, according to House testimony by a general officer. The Army sees that as no big deal, the Medical Corps witness shrugging off the percentage because that is: “what you see in the general population.”11 The analogy may be pure rationalization. CBS News reports “13 percent of the overall population… (are)…on antidepressants.”12 Health news from San Francisco Gate reported 11% of Americans over twelve take antidepressants.…13

Even assuming the civilian figures correct, the ordinary citizen may not view “the general population” as the desirable standard for our troops. In what Army leaders rightly herald as “the best Army in the world,”14 the healthy and motivated American youth meeting the enlistment standard and desiring to serve wouldn’t need brain altering drugs to do what earlier generation of soldiers did as a matter of course.

While one would not expect any Army physician to acknowledge subordinating any patient’s care to service policy, the reality is that the medication policy, unstated though it is, serves force needs more than patients’ stated needs and depends on Army physicians for implementation.

That the modern generation of soldiers must be forced fed psychiatric drugs at the same rate as the collective disabled, elderly, mentally incapacitated, incarcerated, felons, and drug and alcohol abusers is troubling to that ordinary citizen. Americans believing their sons and daughters are qualified in their own right to defend their country without the stimulating—or blunting—effect of antidepressants have to be concerned where the leadership has taken the American Army and its soldiers under the mantle of readiness.

Why the High Dosing?

In a sentence–the Army remains stuck in the 1990’s, the halcyon era of antidepressants.15

Stuck in the 1990’s speaks of bureaucracy in general and Army inertia in the face of major antidepressant developments shedding light on the medication’s drawbacks. The halcyon era occasioned uncontested glee sparked by rising SSRI sales and pharmaceutical marketing that the new antidepressants not only “worked,” but that Prozac, the “miracle drug” would end depression forever.16 SSRI makers marketed their products in the 1990’s under the guise depression was just a chemical imbalance in the brain and that their pills would restore the balance.17 The claim was never proven; yet the media spread it uncritically. It took a decade for critical researchers to verify it as a combination of market hyperbole and unwitting journalism.18 One SSRI manufacturer published information in 1995 that its drug outperformed placebo in preventing suicidality.19 The actual results were just the opposite.20 But the Army kept on dispensing its troops the medications without pause, actually increasing usage.

Were SSRI efficacy viewed as positively today as in the 1990s, there would arguably be justification for the Army to work through the suicide revelations without undue disruption. Such would not be incompatible with medical ethics given other safeguards providers work through. Indeed the American Psychiatric Association (“APA”) remains a strong proponent of antidepressants under appropriate treatment conditions. The Army’s bureaucratic nature, however, has not come to grips with updated knowledge on antidepressants as it has been revealed in recent years both in the media and scientific literature.

Even mainstream psychiatry, originally indignant that the FDA issued black box antidepressant suicide warnings that upset the APA’s talking points that suicide warnings scare away patients who need the medications the most, has come around to acknowledge the wisdom of suicide “Warnings.”21   That includes briefing patients directly in the case of adults, and family members or caretakers in the case of minors and the infirm. It also includes briefing 3rd party observers to monitor patients for suicidal symptoms during the early stages of antidepressant usage and upon dosage changes. Third party observance protects the patients experiencing the suicidal and other dangerous side effects but whose mental state cannot rationally process events. Both the patients and 3rd party observers are instructed to notify the health care provider immediately if any of the cited symptoms are observed. In the case of competent adults, the patient for privacy reasons may veto the physician’s recommendation that a 3rd party be advised to monitor, but rarely do patients object.

The APA remains opposed to the “black box” warning, arguing it deters treatment.22

Surprise: Antidepressants Don’t Work

Harvard psychologist Irving Kirsch, PhD, has almost single handedly destroyed the 20 year myth that antidepressants work. Before qualifying this more accurate than inaccurate statement, it is noted that unlike all other commentators in recent history Kirsch accessed via Freedom of Information (“FOI”) previously unpublished trial data submitted to the FDA by antidepressant manufacturers seeking licenses, and along with colleagues published findings of that review in 2008.23 The qualifier to this paragraph’s first sentence is that Kirsch’s study confirms pharmaceutical claims that antidepressants are effective in treating severe depression, but not the lesser the forms of “mild” and “moderate” depression.

In 2012 Sixty Minutes ran a segment on Kirsch and his research. Leslie Stahl explained Kirsch’s findings: “if you’re moderately depressed or mildly depressed, a sugar pill would do just as good.”24

Not unexpectedly Kirsch came under fire from antidepressant advocates, a given over the years when anyone raises a red flag questioning the medications. They took swipes at Kirsch for spearing their sacred cow, charging that he and his colleagues never proved that antidepressants don’t work. Kirsch’s pushed back at his critics, stating that what they alleged was “absolutely true…what we have shown is that the data upon which drug approval was based does not show clinical significance…Possibility is a long way from fact…The onus should not be on critics to demonstrate that s treatment in ineffective, but rather for proponents to demonstrate that it is.”25

Kirsch should be mandatory reading for Army physicians casually passing out antidepressants.  It seems highly likely that the vast majority of Army soldiers to whom antidepressants are prescribed, if suffering depression at all, were not suffering severe depression which is, technically more akin to “major depressive disorder” (“MDD”).  While outsiders such as this writer have no access to such medical information, it is likely the Army doesn’t either, including the individual physicians who actually treated the patients at the time unless the medical documentation was more detailed than is usually the case.

The overwhelming majority of civilian physicians, 79%, prescribing antidepressants are primary care physicians (“PCP”).26 This 79 percent figure is probably higher in the Army given the relative unavailability of psychiatrists out in the field.

Given large patient loads, PCP’s administering sick call routinely diagnose quickly, bypassing the more formalistic clinical depression diagnostic process. War zone sick calls can require improvisation as in the movies, but even in a clinical setting PCPs diagnose and prescribe pills quickly. This does not violate the PCP standard of care, a factor in civilian care. The PCPs ensure the medical charts properly reflect the antidepressant prescribed, an easier process today given portable devices and electronic records. The indication for which treatment is prescribed would be added, e.g. “depressed,” “depression,” “anxious,” “anxiety,” often omitting the more refined formality of “severe,” “moderate,” or “mild” depression or “generalized anxiety disorder.”

This writer’s information from Army mental health professionals supports the proposition that over prescribing antidepressants and anxiolytics and the lack of monitoring of troops for suicidality after dosage lies with physicians and medics in the field having no specialized psychiatric training. One senior Army psychiatrist insisted off the record he would never prescribe an antidepressant to a patient he couldn’t personally monitor, and cringed when relating the difficulties out in the field of monitoring troops for suicidality after they were prescribed antidepressants. The psychiatrist declined offering specifics when asked whether PCPs out in the field were violating the FDA’s monitoring recommendations. The animated nature of the response, however, suggested he was aware of physicians in troop units dispensing psychiatric without follow-on observation and that he disapproved of the practice.

The Army has not published, and appears to have intentionally avoided establishing procedures for ensuring troops in field units are monitored for suicidality in a manner compliant with the FDA’s antidepressant suicide warnings.  In theory the FDA’s recommended assignment of a family monitor or caretaker perfectly fits the culture of the military’s chain of command. The officers and senior NCOs customarily ensure the health and welfare of the troops that in turn ideally result in a cohesive unit and that morale remains high.

Command assurance that adequate suicide monitoring occur during antidepressant dosing is problematic. The military culture at the senior level is deferential to command discretion. Issuing standardized monitoring instructions to subordinate commanders is shunned for fear of alienating leadership morale. The other side of that coin is that without such directives, it is inevitable that a large percentage of local commanders will simply ignore the FDA’s guidance, not out of spite, but of unawareness of antidepressant dangers.

In the Army’s 2010 suicide report lamenting the crisis the service was struggling through, considerable commentary and emphasis was placed on leadership and looking out for the troops. While not stating it directly, the report strongly suggests the Army’s highest generals believe the suicide crisis is simply failed leadership—and adding, of course, the long wars.27.  That the Army itself may be at fault for policy failure, one can assume, was never under discussion.

In the broad sense, however, the Army’s emphasis on leadership is outstanding advice in any case. Positive leadership could probably marginally improve the Army’s obvious suicide problem.

Good leadership in the Army has as its equivalent the dynamic that occurs during antidepressant clinical trials. In these usually several week trials sponsored by pharmaceutical company to test their drugs, the mere presence and attention of the psychiatrist investigator directed to the participating patient, calling this in the vernacular the “love and attention” factor, pays positive dividends to the mental health of the participants. As a general matter, patients in clinical trials do not commit suicide.28 Completed suicides, by the numbers, occur when the victim(s) are not directly and frequently monitored either by health care providers, family, or caretakers. The greatest number of suicides, by far, have occurred in the normal course of routine antidepressant distribution where no one expected the patient to suffer the ultimate fate, including when the indication for which antidepressant therapy was prescribed was not depression. That the placebo effect is so positive in depression clinical trials to render antidepressant efficacy clinically insignificant may be that the “love and attention” is nothing more than the uplifting nature to the patient of a positive physician-patient relationship.29

While the Army’s emphasis on leadership can only be positive, its elephant in the room attitude ignoring antidepressants has a substantially negative effect to invalidate whatever potential gain may otherwise have occurred with caring “leadership.”. General leadership emphasis does not compensate for misguided leadership. The Army’s failure to ensure platoon leaders and first sergeants are brought into 3rd party status in accordance with the FDA’s guidance on monitoring troops for suicidality during antidepressant therapy remains the Army’s weakest link in overcoming its suicide problem.

It would be a mistake to presume the exigencies of the war zone is the only circumstance in which liberal antidepressant dispensing occurs and danger lurks. Prescribing for battle fatigue symptoms, obviously, occurs under those conditions. Numbers wise, however, the Army’s casual dispensing practice is worldwide and applies in non-combat areas with the same risk. In U.S. and overseas based units, including the Active Reserve and National Guard, treatment is provided by physicians without psychiatric training with no professional limitations on their status to administer antidepressants and anxiolytics freely.

The internecine struggles ongoing within the Army may well speak to a major factor contributing to if not responsible for the suicide crisis. The Army is not unique in terms of divergences between psychiatrists and PCPs. The same phenomena occurs in civilian medicine. What makes the Army’s situation problematic is the difference in the sheer numbers of field physicians in the Army and the lethal combination with a 20% dosage rate of antidepressants.  For better or worse, the Army’s suicides are added up accurately and counted against the service at the end of the day.

Unlike civilian society, however, the U.S. Army has the authority, rhetorically speaking, to muster all doctors on the parade grounds, read the riot act to them, and order compliance. The Army “MEDCOM” theoretically has that mission. As a practical matter, however, large bureaucracies resist change with the Army, viewed by many, as the most bureaucratic of all the military services. It may simply be too much for the Secretary of the Army, the infantry generals, and the medical generals to unravel and correct the Army’s out of control system of coercive medication and to order troop monitoring for signs of suicide after dosing is ordered.

In the meantime the Army would be well advised to require troop physicians to read Dr. Kirsch’s updated findings that antidepressants, in most cases, don’t work. That would be a good start at turning the corner away from the Army’s antidepressant vending machines.

The Cubbyhole in the Pentagon!

Until suicides escalated sharply in 2005, mental health in the Army was on few radar screens. Even fewer paid heed to psychiatric medications. Such was within the exclusive domain of medical bureaucrats and a smattering of military psychiatrists. Virtually no oversight or interest on the matter was shown by the infantry generals who run the Army from another wing of the Pentagon.

The antidepressant world changed in 2003, the same year as the Iraq invasion. In 2003-2007 when the FDA was engaged tumultuousness regulatory events concerning antidepressant induced suicide, the Army and Pentagon’s priorities focused on the wars in Iraq and Afghanistan. Psychotropic medications were on auto pilot.

Increased Psychotropic Drugs to Meet Combat Numbers

The Army has not released medication figures for antidepressants and anxiolytics, but it appears psychiatric drugging rose significantly as force requirements confronted dwindling troop availability in Iraq and Afghanistan. We can’t backtrack from the 20% antidepressant dosage rate in 2010, but it appears dosage rates rose with the Iraq war. The marked rise in prescribed opiates and amphetamines starting in 2005 would appear to bear that out.30  The 20% rate, in any case, is where the debate is grounded.

In 2005 the year the Army’s suicide rate rose dramatically as National Guard troops were recalled to active duty to provide 8 of the Army’s 15 combat brigades in Iraq.31   The Army’s 2010 suicide report called attention to the problem whereby field deployment prescriptions handed out to troops could not be accounted for and were considered susceptible to drug abuse by troops exchanging pills for kicks and getting high.32 The report showed near paranoid tracking by unannounced testing of what the Army considered drugs of abuse though they were prescription drugs, e.g. amphetamines, oxycodone, opiates.33 This was entirely appropriate and necessary for discipline, our use of “paranoid” merely contrasting the Army’s ostensible indifference over the far more dangerous antidepressant.

In 2003 civilian patients and their physicians began to respond negatively to disclosures of suicidal and other antidepressant side effects reported in the press. As a result, in the civilian world “the use of antidepressants fell sharply in 2003 and 2004.”34 “(T)he markets for these drugs grew sluggish in 2005, following the…(FDA’s)…adoption in 2004 of warning labels indicating that the drug may cause suicidal thoughts in children and adolescents.”35 Army troops read newspapers too. Many became reluctant to take antidepressants and anxiolytics; others resisted but eventually succumbed under pressure, and others resisted to the point of being processed for discharge.

The Army reacted by doubling down. The generals took the position that those resisting the medications, especially soldiers with disciplinary history, were malingering to evade war-time deployment.

Decline in antidepressant use has since rebounded since the downward trend associated with the commencement of suicide warnings. According to the latest Center for Disease Control data published in 2013, antidepressants as a class are the third most prescribed class in the U.S., following cardiovascular and cholesterol lowering drugs.36

“PTSD”

The Army’s other sacred cow is PTSD (“post-traumatic stress disorder”). If the Army didn’t have PTSD to explain its suicides and violence, it would have to invent it. “PTSD” commands the spotlight. General Milley was so anxious in his April 2nd news conference to get the Army’s nomination of PTSD as a cause of the rampage that he effectively predicted the diagnosis in advance. This was after the shooter was already dead and diagnosed earlier, apparently, with depression and anxiety.37

If sounding slightly facetious to make a serious point on a serious issue detracts from understanding my attempt to characterize the Army’s diversionary tactic, I’ll try to restate it with pinpoint accuracy. The Army’s basis for explaining over 2,000 suicides since 2005 lies with soldiers’ mental health issues aggravated by 13 years of war.38 The theory sounds enticing, one element undisputedly true. Enamored with the theme, one that invokes emotionalism and patriotism and counts on citizens’ gratitude for the service’s 13 years of continuous sacrifice, the Army in putting forth this disjointed theory has hedged it bets.

A Disjointed Theory: “13 years of continuous war”

The problem with the theory is that individual soldiers commit suicides—not staffs or command centers.  Few doubt that the Army Chief of Staff’s civilian secretary at the Pentagon hearing shouts of panic and anger from her 3 or 4 different bosses over these 13 years issuing war time orders was probably a nervous wreck 5 years into the war.. But that’s not how the methodology goes. Individual service members, one by one, and each’s status at any given time over the past 13 years is what is material to individual soldier suicides.

A media outlet accepting the Army’s theory hook, line, and sinker was USA Today. The paper attributed to “scientists” a long held view that it was the overall strain on the Army during the war years that contributed to the suicides, not merely individual soldiers who had been in and out of combat.39 The “scientists” the paper quoted were NIMH civilians and contractors retained by the Army for the STARRS project, addressed below. One understands Army uniformed psychiatrists, as well, played a role in STARRS but it is not thought they were inclined to counter the Army’s theory which—practically speaking, reflects the vested interests of Army psychiatry more so than even the Army line.

That civilians, psychiatrists or otherwise, comprehend wartime combat and its effect on those who serve through it reminds classic movie fans of a scene from the movie of Herman Wouk’s epic novel The Caine Mutiny. The prosecution’s psychiatrist, new to the Navy, testified as an expert that Captain Queeg, played by Humphrey Bogart, was perfectly sane and should not have been relieved by the executive officer of command on the bridge of the Caine in the midst of the deadly typhoon. The executive officer’s lawyer, a grounded flyer played by Jose Ferrer, attacked with ferocious determination the psychiatrist’s credibility to render that opinion without having ever been to sea and having never witnessed the pressures of combat required of a ship’s captain.40 The executive officer, played by Van Johnson, was acquitted following Bogart’s renowned unraveling on the witness stand twirling the little steel balls in his hand.  Wouk’s tale, purely fictional of course, was as compelling as it was entertaining in the context of serious dialogue regarding the serious matter of civilian psychiatrists venturing opinions on the effects of war and combat stress without having ever heard the tocsins call to battle.

More importantly the numbers don’t match up. The narrative that wartime deployments in combination with mental health problems is causing of the record number of suicides has been debunked by cold hard facts. Numbers showed Army National Guard and Army Reserve suicides nearly doubled from 2009 to 2010, and that about half of those soldiers who killed themselves never deployed to a combat zone.41 The futile nature of the Army’s narrative is aptly illustrated by then Army Vice Chief of Staff General Peter Chiarelli who commented at the time: ‘”if you think you know the one thing that causes people to commit suicide, please let us know, because we don’t know what it is.’”42

Wishful thinking shouldn’t make it so either. Chiarelli, a top Army combat officer over decades who has tasted the ravages of war led Army voices in maintaining it is continuous years of war that unlocks the mystery of the suicide epidemic. Chiarelli doesn’t have the same problem as the psychiatrist in Caine Mutiny, but that he could not offer more than gut instinct as the basis for his opinion has to be seen as lacking persuasiveness. General Chiarelli stated to the press it would be wrong to blame the suicides on the war–but then–proceeded to blame the suicides on the war.43

After retirement Chiarelli, the Army’s second in command 2008-2012 and who personally directed and signed the Army’s 2010 suicide report showed frustration at the lack of progress in solving the problem. He called criticism of the Army, and presumably himself as well, “scapegoating” for the fact civilian suicides, in his view, presented the same problem to the country as Army suicides, but that civilian suicides did not receive the same public focus.44 Interviewed by the networks after the April 2nd Fort Hood shooting, Chiarelli was sticking with his narrative that general mental health problems in the Army and the wars are responsible.

Recent USA Today coverage further noted the above data were not helpful to the Army’s argument, that “while suicide rates…(for those who served in Afghanistan and Iraq)…more than doubled from 2004 to 2009 to more than 30-per-100,000, the trend among those who never deployed nearly tripled to between 25- and 30-percent per 100,000…Rates for civilian(s)…remained steady at 19 per 100,000.”45

The April 2nd Fort Hood News Conference

Why PTSD was the focus of General Milley’s news conference when reporters’ questions were posed to him and not “depression” or “anxiety” illustrates two obvious truths. One is the herd mentality of the media and its copycat syndrome of what Rush Limbaugh calls the “drive by media.” PTSD is a living example of group think in the media, feeding the psychic prevalent in Congress as well. PTSD is a staccato phrase, implying one who utters it, reporter or congressman, must know what s/he’s talking about given its authoritative ring—not bad for a disorder that didn’t exist until 1980.46

Stress in Iraq/Afghanistan Greater than Iwo Jima and Battle of the Bulge?

Nobody has challenged the Army why its theory on Iraq and Afghanistan veterans committing suicide in record numbers due to prolonged operational tempos does not—and did not apply to World War II, Korean War, and Vietnam veterans. It is necessary to belabor the point–as the Army has apparently so forgotten the struggles of earlier generations.

There were 292,131 American battle deaths in World War II.47 Korean War U.S. battle deaths were 33,629.48 In the 9 year Vietnam War, 47,318 American service members were killed.49

Deaths of U.S. service members in Iraq totaled 4,489, and in Afghanistan through May, 2014 totaled 2,320.50

In World War II in the North African campaign in February, 1943, German Field Marshall Erwin Rommel at the two mile wide Kasserine Pass handed the U.S. its first defeat of the war “inflicted devastating casualties on the U.S. forces …more than 1,000 American soldiers were killed …and hundreds were taken prisoner…”51 The Allies suffered “about 70,000 casualties” in North Africa before Rommel was defeated and the Axis surrendered on May 12, 1943.52 The invasion of Sicily, and the boot of Italy followed. There were 60,000 allied casualties in the Italian campaign 53 including 29,200 in the bloody 4 month battle of Anzio, 16,200 of which were Americans (5,500 killed in action, 17,500 wounded, and 4,500 prisoners or missing).54 “In April and May 1944, the Allied air forces lost nearly 12,000 men and over 2,000 aircraft in operations paving the way for D-Day.”55 Rome was liberated two days before troops landed on Normandy. Allied casualties on D-Day “have been generally estimated at 10,000…(with recent verification that there were)…2.499 Americans killed on June 6, 1944 in Operation Overlord.”56 The Normandy invasion saw over 209,000 Allied casualties.57 The remains of 9,386 American war dead are entombed at Normandy.58 On December 16, 1944 the Germans attacked in the wintry cold of the Ardennes forest to drive a spear between American and British armies. After 40 days and Hitler’s gamble having failed, American casualties in the Battle of the Bulge totaled 89,500, killed in action 19,500, captured or missing 23,000.59 After VE Day in April 1945, action shifted to the Pacific” but the Pacific theater was yet to see its deadliest days.”60

In the intense Pacific campaigns following the attack on Pearl Harbor and the loss of the Philippines, ground forces of the U.S. Army and U.S. Marines fought island hopping campaigns the likes of Guadalcanal, New Guinea, Tarawa, the Gilbert and Marshalls, Guam, Kwajalein, Saipan, Truk, Tinian, Peleliu, Philippines and Leyte Gulf, Iwo Jima, and Okinawa and others over a 3-4 year period.

In the Bataan death march in 1942 following the fall of Manila, “the exact figures are unknown, but it is believed thousands of troops died because of the brutality of their captors, who starved and beat the marchers, and bayoneted those too weak to walk.”61 On August 7, 1942, the First Marine Division landed on the beaches of Guadalcanal in the Solomon Islands, setting the stage for one of the most pivotal and contested pieces of real estate in the history of the world. The 25th Infantry Division later joined forces with the Marines. Jungle disease was deadly in the malaria infested swamps, as the combatants fought hand to hand with bayonets.

Hostilities ended February 9, 1943 as the Japanese abandoned the island. “Allied losses

numbered around 7,100 men, 29 ships, and 615 aircraft.”62

The New Guinea campaign from 1943-1944 saw 12,000 American casualties, less than the 17,107 attributed to Australian forces.63 In the bloody 4 day invasion of Tarawa, “American losses were a costly 978 killed and 2,188 wounded.”64 In the 3 month Gilbert and Marshall’s campaign in which U.S. Marines were supported by naval forces, American dead or missing totaled 3,300 with 4,830 wounded.65 In the Mariana and Peleliu campaign in mid-1944, U.S. forces executed landings on Saipan, Guam, and Tinian. U.S. killed in action totaled 9,500.66 “More than 15,000 Americans were killed or wounded” retaking Leyte in October, 1944, fulfilling General MacArthur’s pledge “I Shall Return.”67 In the battle to retake Luzon and liberate Manila in January, 1945,, “MacArthur’s Sixth Army suffered 38,000 individuals killed or wounded.”68 In the 5 week battle of the tiny atoll of Iwo Jima ending on March 26, 1945”as many as 7,000 Americans were dead and 24,000 wounded…almost 6,000 of those killed were U.S. Marines.”69 Following Iwo Jima, U.S. forces attacked Okinawa, 350 miles from the Japanese homeland. “U.S. Marines and Army troops fought a bloody battle of attrition against an enemy concealed in intricate underground defense systems…When the island was finally secured, more than 12,000 U.S. soldiers and Navy personnel were dead or missing and more than 36,000 were wounded.”70 Those continuously deployed in World War II without seeing their families did not have Email or Skype to communicate with their loved ones.

It would seem under the Army’s theory and its civilian mental health experts opining the same, suicides would seemingly have at least modestly risen near the end of these wars. There were over 12,000,000 Americans serving in the military in 1945, the last year of World War II.71 That never happened as can be noted in the graph on the next page. As can be seen in the graph, not only did national suicides not spike at all, but both eras experienced the lowest rate of suicides every experienced. Military suicides were so minimal, no records or writings on the subject were recorded until 1981.

The Vietnam War presents perplexing, and certainly tragic issues in regard to suicide.

There is no question that Vietnam veterans are in one of the highest demographics for suicide.72

Tying this to the subject matter at hand, however, is not only impractical but statistically

impossible given the numerous confounding factors involved. Active duty suicides in Vietnam

were not archived. If there was any spike in Army suicides during that war heavily covered by

the reporters in the field, they seemingly would have been reported. There were no such reports.

The Army’s narrative, however, does not enhance its theory in regard to the lengthy 9 year

Vietnam conflict. One returns to the 2010 report to show the inconsistency. The Army’s claim

is that it let its guard down on “good order and discipline” in Iraq and Afghanistan as a result

of the continuous years of war.73 This seeming mea culpa, possibly interesting if it were true,

is anything but. The all-volunteer Army, even if as chagrined at involuntary extensions in the

war zones as the Army argues,74 would seem to pale in comparison to the low morale and lack

of discipline that occurred during the 9 years in Vietnam. Those forgetting or unaware of

history need to be reminded that the Vietnam draftee was every bit as opposed to that war as

those more recently serving were or are opposed to the current wars. What the Army postulates

makes no sense. While the current crop of soldiers may be partisan one way or the other as to

President Bush or President Obama, all are volunteers and professionals. No one from the war

zone has reported open hostility to either of the two presidents involved. There was open

hostility in Vietnam among the troops toward the country’s leadership, particularly in the last

few years of that war. Open drug use and refusing to follow orders was not rare in Vietnam.

Looking back at history, Americans, finally, have expressed gratitude for all those who served

in Vietnam, something long overdue. On the other hand the notion of the current Army

leadership, too young to have served in Vietnam, that “good order and discipline” of the current

force explains the suicides misses the mark, and misses history.

Blaming the Troops

The Army’s theory that its suicide crisis is attributable to 13 years of continuous casts

dispersion, unwittingly no doubt, on the current generation of soldiers. Many would consider

it degrading to suggest that this generation of soldiers are not as mentally resilient as their

predecessors in Bataan or the Battle of the Bulge.

Let us be clear. It is Army thinking, not the thinking of its critics,’ that raises the spectre of generational inadequacy in coping with long wars. The Army, of course, would reject that characterization, but it is the essence of what the Army is maintaining. There is unanimous agreement that the modern service member should be encouraged to seek mental health treatment when troubled and that doing so should not be detrimental to the career. But neither enlightened policy nor the soldiers’ responses to that policy relates to the Army’s theory that 13 years of war has produced this suicide crisis. The Army’s theory states simply this generation of soldiers is more subject to wartime stresses than previous generations. With no data able to prove it, the logic behind this theory is equally lacking.

The policy failure of unrestrained antidepressants and the resultant suicide crisis has

been aggravated by Army leadership turning on its troops to explain the problem rather than

looking inward. The Army changed its tune from its troops being “the best and the brightest”75

a mere decade ago to a force that in the Army’s 2010 suicide report is one of drug and alcohol

abusers, high risk soldiers, spouse beaters, and felons?76 Such people problems that the Army

cites are not questioned. They exist. They always existed; it is only since the suicide crisis

rapidly evolved that Army leadership has pointed its fingers at the troops.

No one diminishes the prolonged stresses of the current Army and its soldiers that Iraq

and Afghanistan have presented. Developing the theme that World War II, Korean War, and

Vietnam soldiers, on the other hand, had fewer personal stresses and “mental health” problems

resulting in the mass increase in Army suicides of today is unpersuasive to those observers who

place military history in perspective and understand the dynamic of the times.

Of course there are great differences between 50 years ago and now. The troops back

then were not fed antidepressants. Those today–are!

Congress

No challenge from Congress or the media has resulted from the Army’s narrative that

its suicides and violence are attributable to 13 years of continuous war and the mental health

problems of its soldiers and families associated with it.

The mood in the Congress is to avoid at any cost any discussion that the All Volunteer

Force (“AVF”) is a failure and that some aspects of a draft are required to keep up with U.S.

defense obligations around the globe. Neither has Congress shown any inkling to challenge

the Army on its suicide narrative. Thus, a grateful nation mourns its fallen warriors and

respects the military for defending the country at this time of crisis. Period—done!

Pro defense Republicans defer to the generals and admirals as a matter of philosophy

except when they feel the uniformed military is doing the administration’s bidding in weakening

the military. Army suicides do not fit that criteria.

Democrats in Congress are not challenging the Army on its suicide theory either. Such

could imply criticism of President Obama’s defense policies; Democrats are not about to do

that. That the uptick in suicides began in the Bush administration is inconsequential to the

The April 2nd Fort Hood shootings presented the Democrats an opportunity to do what

they do well; “never let a serious crisis go to waste.”77 Senator Richard Durbin (D, IL) practices

the principle faithfully. On April 9, 2014 Durbin chaired the Senate’s defense subcommittee

hearing budgetary requests from the surgeon generals of the military services. A longtime

opponent of military spending and Bush’s strong defense policies, he was one of 23 Democrat

senators who voted against the original Iraq action and later opposed the successful Iraq surge.

He never served in uniform, though graduating from college in 1966 his draft number for the

next 9 years of the Vietnam War apparently never called. On April 9th Senator Durbin could

not have been more the exuberant. He praised the military, conveying to the Army surgeon

general his condolences to the Fort Hood victims and vowing his sub-committee’s support for

all the mental health funding that the Army, and other services need to deal with mental health

problems as were demonstrated at Fort Hood. Durbin’s discomfort with U.S. military

superiority apparently extended to war winning generals as well. He took a swipe at General

Gorge Patton, rehashing the movie “Patton” and the slapping incident where actor George C.

Scott slapped the soldier who had excused himself from battle for suffering the shakes and

sought refuge in the medics’ tent alongside the bloodied wounded. Durbin stated it was

marvelous that the U.S. military has come so far since Patton to understand the mental health

problems soldiers face in battle. He vowed he and his subcommittee would give the Army

whatever support it needed to deal with mental health problems that plague the services and played out so tragically at Fort Hood.

Game, set, and match for the Army. The service didn’t even have to ask for money or

defend its narrative. It was simply a done deal. More soberly, there is little likelihood Congress

and politicians like Senator Durbin will ever challenge the Army generals in their “PTSD” and

mental health narratives to explain suicides and violence. One hopes a House or Senate

maverick will start thinking out of the box; that seems possible, but it hasn’t happened yet. In

the meantime the degree of political capital being expended by both political parties to curry

favor with the military trumps any collateral issue, however serious, that arises in DOD.

Media

The media blackout on antidepressant induced violence is similar to the dynamic in Congress. Wire services like AP and Reuters invariably repeat the government releases, venturing nowhere near the territory of what used to be critical journalism. There is no marked difference among TV, cable, and the print media. Media, particularly TV, has the added factor of strong pharmaceutical influences through advertising revenues, the effect of which discourages news executives from going against the grain of their sponsors’ products. Occasional TV specials as well as individual print articles have been run which raises the issue of antidepressant risk. The ideological divide among the media has no effect on the allowance that all outlets give military leaders.

The afternoon and evening TV news covers only the major, breaking stories of the day from Washington and around the world. Whether its NBC or Fox News, there has been no challenge to the Army’s narrative on Fort Hood simply as a matter of limited time and that media’s business model.

Army leaders understand the dynamic. They know that PTSD and the shield of mental health from 13 years of continuous wartime footing gives them unlimited leeway in their attempts to explain away a problem that they cannot otherwise unravel. The Army is not about to tinker with a defense that is still working.

FDA and Other Suicide Warnings Disregarded

The Army obviously understands knows the FDA’s overall role in the federal apparatus, and invokes that agency’s findings on drug alerts when they do not conflict with the service’s agendas.78. No such Army guidance or alert exists on antidepressants and the FDA’s warnings to closely monitor patients for suicidality once antidepressant dosing starts.79

The Army has been, and continues to defy antidepressant suicide warnings issued by antidepressant manufacturers, the FDA, and independent researchers. The most recent federally funded research published on April 28, 2014 confirmed what the FDA originally published in 2004, and again in 2006. Harvard researcher Matthew Miller and colleagues utilizing data from 162,625 patients between 1998 through 2110, found suicidal behavior was “twice as likely when children and young adults are randomized to antidepressants compared with when they are randomized to placebo.”80 Young adults less than 25 are the Army’s largest demographic.81

Taking DOD wide figures of 39.6 % of the military population comprising individuals under 25 and applying that to 1,201,146 in the active Army, National Guard, and Army Reserve components, 475,654 patients under 25 for whom the Army prescribes any antidepressant will be prescribed a drug that causes suicidality.82

The FDA’s first suicide warning for antidepressants was issued March 22, 2004.83   Warnings are not issued casually.  The legal standard does not simply allow the warning, but “the labeling must be revised to include a warning about a clinically significant hazard as soon as there is reasonable evidence of a causal association…”84 The FDA’s public statement at an antidepressant hearing emphasized that standard and the process: “we tend to put adverse events in the Warning section when we are pretty sure, when we think we have pretty good evidence that the drug actually does it as opposed to its just being associated with it.”85  The March 22nd mandate to warn occurred during a review of double blinded randomized control trials (“DBRCT”) involving children and adolescents under 18.86 DBRCTs are the gold standard for assessing clinical trial results.87 The FDA’s decision to add adults under that protective umbrella was based on a 28 member expert’s panel that heard testimony on all demographics and made that recommendation without age restriction, The FDA’s highest form of warning, the “black box” warning (“BBW”), was issued for antidepressants on October 15, 2004 following more analyses of the data that resulted in the March 22, 2004 ordered warning. 88

The FDA official articulating the agency’s position on warnings further articulated the

process on BBWs: “A boxed warning…is a judgment…as a general matter…we don’t put a

description of adverse events in a boxed warning, which is sort of the most stringent warning

you can apply in a labeling unless we really believe that the drug is causally related to the

adverse event.89 Unlike the Army’s flirtation with intellectually interesting studies by individual

contractors on suicide like STARRS (infra et al), the FDA’s data and findings are based

exclusively on DBRCT data, the gold standard of scientific research.90 The October 15th BBW

directive specifically stated: “A causal role for antidepressants in inducing suicidality has been

established in pediatric patients.”91

As earlier, adults of all ages remained in the suicide “Warning.” Glaxo SmithKline, the

manufacturer of the SSRI Paxil and widely prescribed in the Army, issued a “Dear Health Care

Professional” letter on May 8, 2006 alerting physicians that statistical significance existed

between depressed adult patients taking Paxil and suicidal behavior.92 Statistical significance is

operationally defined as causality.93

A further FDA review of data from adult DBRCTs conducted in 2006-2007 and

reviewing data from trials conducted in the 1980s through 2006 found, as with children earlier,

that antidepressants cause suicidality in adults less than 25 years of age.94 Accordingly, the FDA

ordered young adults under 25 be added to the BBW.95

These young soldiers, e.g. under 25, count for 57% of the Army’s suicides, the below

graph constructed from the Army 2010 suicide report, page 19.

The under 25 age group by far exceeds in percentage other age groups in the Army

experiencing suicide thoughts, having made suicide plans, and having attempted suicide. The

graph below is extracted from page 15 of the Army’s 2010 Suicide Report.96

In 2010 the Department of Army and the National Institute of Mental Health (“NIMH”) jointly

undertook STARRS at the taxpayer cost of $65 million.97  The Army’s original press release

reported cost would be $50 million.98 The first fruits of STARRS were released March 3, 2014

through a series of articles. STARRS manifested Washington thinking in confronting a difficult

problem. Kick the can down the road by funding a study. The one scientific fact known about

antidepressant induced suicidality from the FDA, i.e. that antidepressants cause suicidality in

the Army’s most populous demographic, was somehow excluded from the STARRS design.99

Excluding antidepressants was not surprising to those who noted the lead author of the study designs was a paid consultant for Eli Lilly, GlaxoSmithKline, and Pfizer, makers of Prozac, Paxil, and Zoloft respectively.

The research community thrives on government grants. One civilian psychologist’s impression of STARRS was typical, labeling it “one of the most significant scientific undertakings in the history of suicide research.”100 It was anything but that. STARRS was designed from the outset to ignore totally the possible role of antidepressants in the suicide epidemic, rendering the project a near scam if its purpose was to find out all possible reasons why soldiers are committing suicide.

While most any STARR’s expenditure would be meager if our warriors were saved from

the pitfalls of suicide, it is not surprising that the Army and NIMH are just as perplexed now as

when they started. The conclusion in the March 3rd STARRS release reported: “(T)he root

causes for the rise in Army suicides still remain unknown.”101

One can be confident the Army and NIMH bureaucrats who put together the STARRS will defend their methodology and the huge expenditure of funds as a worthy project. With the ink barely dry on the March 3rd report showing no results the STARRS contractors are already back at the trough soliciting more taxpayer dollars.102 While it is understood there is more to come from STARRS, there aren’t any scientific probes to determine whether antidepressants are causing or contributing to the suicide epidemic.

The Army’s 2010 Suicide Report

In response to the suicide crisis the Army, in 2010, released a report comprising 352 pages. The Army understood the adverse significance of the Army’s traditionally low suicide rate rising to exceed the civilian rate in 2008 and stated that fact in the report.103  Apparently hoping to put the best face on a bad situation, the Army played loose with the categories. It acknowledged its rate had increased to 20.2 suicides per 100,000 while noting “the civilian demographically adjusted rate typically is about 19.2 per 100,000.”104 In fact the national rate for the 5 preceding years for all ages averaged 11.5 per 100,000.105 Invoking “demographically adjusted” wording the Army could have been referring to age, race, or gender, or any combination in arriving at 19.2, each of these factors swings the calculus significantly.

Nationally males commit suicide at nearly 4 times the rate of females; white males commit suicide at 2 ½ times of rate of black males; individuals in the age group 45-54 commit suicide at a higher rate than any other age group. Giving the Army the benefit of the doubt in its representations, its reported figures closely aligned with national “white male” rate of suicide.106   In its report the Army failed to break out the demographics of its suicides and suicide attempts by age, race, or gender by the 100,000 denominator, leaving readers without the underlying data to make independent calculations.

A Smidgen on Antidepressants

In its report the Army devoted one page to what it called “medication implications” of

the suicide problem.107 The Army’s unfamiliarity with the subject matter was manifest

throughout the report. In the report the Army touched briefly on the subject of clinical trials.

The Army expressed perplexity with the collective results of the trials, all trials conducted by

the drug companies and reviewed by the FDA in its comprehensive series of hearings over four

years from 2003-2007. The Army report stated “There is contradicting evidence on the

association between the use of some antidepressants medications such as…(SSRIs)…and

suicidal behavior.”108 In the next sentence, the Army acknowledges a 2009 report by the

Agency for Healthcare Quality Research and the U.S. Preventive Services Task Force that there

was “fair quality evidence” that SSRIs, especially Paxil, increased suicidal behavior in adults

age 18-29.109 Next the Army presented what it apparently thought was breaking news:

“However, other research evidence shows the benefit of antidepressant use for the treatment of

depression and anxiety, which are known suicide risk factors.”110 Acknowledging the 18 to 29

year old demographic fits the “predominant” Army demographic, the report tasked the Army

Medical Command (“MEDCOM”) to solve the contradiction and “determine those specific

medications that will reduce anxiety and depression without increasing suicidal risk.” 111

The Army’s directive to its subordinate medical command to find medications that cure

depression and avoid suicidality could only raise eyebrows. Finding such an antidepressant

would be a noteworthy discovery—considering none exists. Whether the Army is disregarding

the U.S. drug regulatory agency (FDA) on antidepressant induced suicidality for reasons of spite

over turf or simply institutional incompetence, either should be grounds for more vigilant

oversight by Congress.

Understanding the Army’s elephant in the room disregard of antidepressants and its

avoidance of speaking openly may have its origin in Army culture. The U.S. Army and its

culture have a treasured place in American hearts through history. In the case of its suicide

crisis, however, tradition and culture may be working against a solution. Speaking with vocal

force to the troops that the old macho character of refusing to seek mental health help is no

longer acceptable, for the Army itself there are hints in its 2110 suicide report that it exempts

itself from that advice. This report said the Army when faced with a problem can investigate

itself and fix what is broken with honest dialogue to mitigate suicides.112 One can cite the

Army’s STARRS’ effort working with NIMH as positively reaching out to other agencies. On

the other hand, there is nothing more disingenuous than ignoring the FDA’s data and advice on

antidepressants. That is neither “honest dialogue” with its leaders nor courageous leadership.

MEDCOM’s 2013 Guidance—Aberdeen Proving Ground All Over Again?

One miscalculates if the view is that Army thinking that tricked Master Sergeant Stanly

into agreeing to be a participant in a chemical warfare clothing program and secretly injecting

him with LSD ended with that incident. The Army’s window dressing on informed consent

exhibited with Stanly in 1958 presented itself again on May 21, 2013 with an Army Medical

Command (“MEDCOM”) policy statement. The memorandum provides insight on the Army’s

tactical thinking on antidepressants and is congruent with the service’s whitewashing of

antidepressant induced suicidality.

The Army’s tactical thinking exhibited in the memorandum incorporates

antidepressants into the broader subject of drug abuse. The effect is to lessen what should be a

strong emphasis on antidepressant safety.

The MEDCOM memo’s stated purpose was to prevent overdose and manage soldiers’

“polypharmacy,”113   The Army’s injection of antidepressants into this mix was not without

some historical bases.  SSRIs were originally sold on the basis they not only treated depression,

but that they were extraordinarily safe from accidental overdose leading to death.114 Some

SSRIs, particularly those with short half-lives, possess anxiety indications as well that increases

the risk of physical dependence and habit forming usage.

MEDCOM’s guidance was wrapped in verbiage suggesting Soldiers enjoyed a patients’ bill of rights akin to any civilian. MEDCOM’s guidance on “Clinical Pharmacy Referral” and “Informed Consent” calls for the patient to be “educated” on the drug treatment being contemplated. The education entails a discussion between the prescribing physician and soldier on the details of the medication, that after hearing the benefits and risks of the proposed treatment and the soldier agrees to proceed, the soldier will then monitor himself or herself for the drug’s adverse effects.115 There are separate provisions that the military pharmacist and physician exchange communications in case records show the soldier is up to no good by abusing refills to get high. The provisions have the enticing appearance of a meeting of the minds between the doctor and the patient

There’s a catch however. Like Sergeant Stanly at Aberdeen Proving Ground, soldiers signing off on the Army’s informed consent form for antidepressants will not have been told the truth that antidepressants cause suicidal behavior in soldiers under 25.

Defying the FDA’s scientifically developed findings and recommendation, MEDCOM in a blatantly false statement reported in the memorandum that “it is not known to what extent prescription medications cause suicides of suicidal behavior.”116 It is known. Antidepressants do cause suicidal behavior in young soldiers as the FDA proclaimed.

MEDCOM’s inability to tell the truth on antidepressants will solicit the same degree of

credibility as that contained on informed consent forms signed by gullible soldiers not told the

truth about “Clinical Worsening and Suicide Risk” on the antidepressant labels.

That’s how Sergeant Stanley got hooked from LSD. The Army must start telling the truth about antidepressants—if not, the Army through reckless disregard will continue to put its soldiers in the throes of death.

What the Army Demonstrates it Cannot or Refuses to Grasp

There is a good reason why Congress assigned drugs to the FDA and ground wars to the

Army. That the Army remains oblivious to antidepressant induced suicidality in its 2110

Suicide Report and STARRS may well be explained by its inability to wean off antidepressants

as the cornerstone of Army medicine. One might make the case the Army is merely out of its

element. On the other hand, some key architects of STARRS from the NIMH side of the ledger

were aggressive advocates for antidepressants well before the FDA acted, and criticized the

FDA for its “warning” actions. One of the most zealous defenders of antidepressants over the

years, a psychiatrist from Columbia University hired by drug companies as expert witness to

testify that antidepressants don’t cause suicide was publicly thanked personally by the STARRS

coordinator for his role in the design of the project.117

It took the FDA several years to understand that many of the horrific adverse events

occurring with antidepressant patients were the result of the drugs and not the underlying

disorder for which the drugs were prescribed. The U.S. regulator finally came to terms with the

data beginning in 2004, and in 2009 articulated what the Army has been unable to grasp.

The FDA’s Insightful Summary

Those inclined to think the question of antidepressant induced suicide or violence is out of the scientific mainstream should read the FDA’s suicide warnings mandated on antidepressant labels. The U.S. drug regulator got it right beginning in 2004 with its label changes, but later reflected on the dynamic that caused confusion for so many so years. In 2009 these FDA scientists living through the transformational era, recapped to the British Medical Journal their research findings from their study of adult trials. The FDA’s conclusion “support the idea that antidepressant drugs can have two separate

effects: an undesirable effect in some patients that promotes suicidal ideation or suicidal behaviour and a therapeutic effect in others that alleviates depression and reduces any suicidal sequelae from depression.118

What the Army Should Do Now:

Commence Psychological Autopsies!

The Army’s calculated decision to ignore antidepressants as a factor in its suicide crisis

is indefensible. That calculation extends to STARRS, where in expending $65 million to study

troop suicide the Army ensured no focus would be paid to the drug that causes suicidal behavior

in soldiers under 25, the group with the most suicides.

The general nature of STARRS was a diversion of ease. It was a project put together

that had the effect of making those responsible feel good that they were at least trying to cope

with the crisis. But what was it worth for the Army to determine the actual reason for each

soldier’s suicide in 2011? 2012? 2013? Apparently not very much—at least not according to the Army’s 2010 suicide report.

The most thorough and accurate process known to determine the cause of a suicide is

the psychological autopsy (“PA”). 119 The process combines the traditional county medical

examiner’s investigation into a questionable death with, in the case of suicide, an examination

into why the individual did it. In the PA, no stone is left unturned.

The Army’s reaction? It disavows PAs. It is not because the service necessarily disputes

the claim they are the most accurate process to determine the cause of suicides. Disavowal is

based on the Army’s contention, one, that it does not have the authority to convene PAs; two,

PAs have no value in the many suicides where the manner of death has already been determined;

three, that much of the PA’s traditional value has been rendered moot by modern technology;

four, that even if appropriate, PAs require resources that the Army finds scarce; and five, the

suicide crisis is not so bad that the Army requires PAs to solve it.

The Army professes neither the authority to conduct psychological autopsies nor any interest in conducting them. In its 2110 report the Army, explained that psychological autopsies are conducted “only when approved by AFME…(Armed Forces Medical Examiner)…and have a very narrow and specific function.”120 The Armed Forces identity conveys control by a joint commander under Department of Defense (“DOD”) auspices. The suicide report was the Army’s and the place to make the argument that it needed more flexibility to convene PAs. Rather than urge DOD to open up the process in light of the present suicide emergency or seek a change in the law, the Army passively sat idly by, clicked it heels and saluted, and defended DOD’s hamstringing. Such is the nature of pleasing the boss.

Two, the Army stated the PA has value only “if all other investigative leads have proven

futile in determining…(the)…manner of death.”121 If the “manner of death” is a bullet to the

head as was the case at Fort Hood with Specialist Lopez, the Army states there is no need for a

PA. The Army should have reviewed it notes and gone back to 1988. DA Pamphlet 600-24

issued that year that stated the reason for convening PAs. The relevant grounds for ordering a

PA is that the reason for the decedent’s suicide is unknown, not whether or not the mode of

death is clear.122 Fort Hood and Specialist Lopez illustrate the principle with clarity. The

manner of death was indisputable; Lopez, in addition to killing others, put a bullet to his head.

The real question; indeed the only question in follow up is “why” did Lopez do it. The Army’s

rationale in its 2110 report defies the basis of PAs.

Three, the Army stated the PAs purpose of determining the decedent’s intent has largely

been satisfied by the investigator’s access to the decedent’s inner thoughts by examining the

likes of cell phone, social media, and texting history, etc.123 While these mediums exist

whereas decades ago they didn’t, they do not necessarily depict the reason the decedent did

what s/he stated s/he would do, with the effect it is diversionary. The reasoning that “texting”

and “Emails,” for example, will always reflect fact in establishing intention is simply fallacious.

As it was General Chiarelli who signed out this explanation in the 2010 suicide report, he was

the same general who told the Washington Post the Army had no idea why its soldiers were

committing suicide (see footnote 38).

Four, the Army stated besides, PAs “have limitations…Most significantly, a…(PA)…must be performed by a behavioral health professional with specialty training in psychological forensics, which limits the number of individuals who can conduct them.”124 In short, the Army states PAs take too long and there aren’t sufficient numbers of mental health professionals to conduct them.”125 Had the Army desired to get to the core cause of its suicides, it could have funded 325 forensic psychiatrists and paid them $200,000 a year for the cost of the STARRS $65 million price tag which did not explain the reason for a single suicide.

Five, the Army saved its most remarkable rationale for rejecting PAs for last, throwing up its hands and conceding that yes, “nevertheless, the…(PA)…provides an investigative tool when other investigative means to determine intent have been exhausted.”126 As one can see, the Army’s displeasure with PAs intensifies as its reasoning for rejecting them diminishes.  One has to question how many years of 300 plus suicide deaths will it take before it concludes all leads are exhausted and PAs, to the Army, at that point become a last resort.

The Army’s rejection of PAs is indefensible under the circumstances. It has all the

markings of a conscious effort to muddy the waters to ensure the role of antidepressants is

obfuscated in the suicide crisis.

The consensus principle in the scientific literature is that most suicides are

multifactorial.127 The PA penetrates the shell that otherwise pigeon holes conclusions by

medical examiners and law enforcement investigators. The latter reflect condensed and

narrowly tailored results that are more the products of bureaucratic convenience than

determining the “why” of a suicide.

If a soldier’s suicide is caused by mental health factors such as depression or PTSD, the

psychological autopsy will determine that. If the suicide is caused by antidepressant side

effects, the psychological autopsy will determine that too. Mixed motives and factors, too, will

be allocated by the mental health specialist conducting the PA in the degree each comparatively

caused the suicide.

Many examples can be cited in the PA’s ability to distinguish drug effect from other

causal factors in suicide. One is akathisia. Professor David Healy identifies akathisia as one

of three antidepressant induced conditions that cause suicidality, the other two being emotional

blunting and psychotic decompensation.128 The Army’s rejection of PAs ensures

antidepressant induced suicides, by design, will continue to be obfuscated in the morass of

mental health generalities having little meaning beyond numbers.

Akathisia is subjective inner restlessness. It manifests fidgety movements, swinging of

the legs, rocking from foot to foot, pacing to relieve restlessness, and/or the inability to sit or

stand still for several minutes.129 The suicide warning section of antidepressant labeling refers

to “akathisia (psychomotor restlessness).”130 It is sometimes discussed under the subject of

“serotonin syndrome.”131 It is “a potentially life threatening adverse drug reaction that results

from therapeutic drug use…or inadvertent interactions between drugs…anxiety and akathisia

may be misattributed to the patient’s mental state…the onset of symptoms is usually rapid with

clinical findings often occurring within minutes after a change in medication…the onset of

symptoms…usually rapid, with clinical findings often occurring within minutes after a change in medication.”132…

There is little chance that law enforcement or coroner’s investigation will conclude a suicide was medicated induced, even though it was–without the PA. One has to conclude after all these years of struggle that that is why the Army is opposed to PAs. Toxicology tests, by themselves, cannot answer the questions answered by the PA. Medical examiners do not routinely and thoroughly test for antidepressants. Normal screens for drugs of abuse often fail to detect antidepressants, but after focused testing often detect the antidepressant though at reduced amounts. Even if alerted to do alkaline screening associated with antidepressants, results are frequently inconclusive. Even if therapeutic dosage amounts are detected as the result of several days’ continuous dosage, that will not equate to causation in establishing the decedent’s intent. The inverse of that, e.g. the absence of detection and/or the detection of an amount less than what is considered a therapeutic mount is often, and erroneously presumed that the antidepressant had no role in the suicide. Indeed the antidepressant side effects inducing suicidality can occur virtually immediately, before reaching concentration levels toxicology tests would measure reliably.133

In the case of any symptom but particularly, for example, akathisia, the mental health

professional conducting the PA would talk to family, co-workers, and other individuals in the

victim’s unit to obtain an accurate time line of the symptoms juxtaposed on medication and

dosage. Taking the example of the SSRI user pacing the floor and becoming agitated the day

after starting medication, the mental health professional conducting the PA would tie these

factors together chronologically and, under this scenario, attempt to confirm other factors

pointing to the medication. Law enforcement and medical examiner investigators would almost

certainly not pick up this evidence given they don’t need it and are not seeking it.

“Challenge” and “dechallenge” aspects of taking and stopping the medication also

would apply in any PA and be weighed by the psychiatrist or psychologist conducting it.134

Competence and objectivity, e.g. the absence of bias, are essential to the integrity of the PA. It is questionable whether the structural composition of the Army as currently constituted in the Department of the Army and MEDCOM is capable of such objectivity. The Army’s singular focus on mental health and “13 continuous years of war” to explain the suicide crisis while disregarding antidepressants requires a change of Army leadership to impose a new perspective in solving this national tragedy.

Scientific reliability would be enhanced immediately by the Army’s initiation of PAs to determine its suicide problem. There is no excuse for not doing so.

Violence Towards Others

Specialist Lopez gunned down fellow soldiers and, when confronted by military police (“MP”), put a .45 caliber to his head and pulled the trigger. Suicide and murder are as dissimilar as two acts can be, but merge in certain individuals in terms of antidepressant side effects.  Ivan Lopez has to be a primary candidate for consideration in this grouping.

The FDA linked antidepressant induced suicidality with 3rd party violence from the beginning of the antidepressant controversy in 1991. In the initial hearing of its kind that year the FDA convened an expert’s panel and asked them to answer the compound question whether antidepressants “cause the emergence and/or intensification of suicidality and/or other violent behaviors.”135 That panel, meeting a dozen years before pharmaceutical claims to the contrary were finally dismissed, answered with a unanimous “no.”

In 2003 when the suicidal side effects of antidepressants were publicly divulged and the FDA hearings about to commence, the New York Times contacted the original panelists and reported “seven members from…(that)…panel…in recent interviews said newly unearthed information about some antidepressants might make them reconsider their 1991 votes…”136

Researchers have identified 1527 cases of 3rd party violence committed by patients taking antidepressants that have been disproportionally reported to the FDA’s Adverse Event Reporting System (“AERS”). The primary drug class reported, by far, was antidepressants. Moore et al identified therein reports on homicide, homicidal ideation, physical assault, physical abuse, and violence related symptoms.137

Adverse events experienced by patients taking antidepressants continue to be reported to the FDA in matters related to violence towards others. Other commonly reported adverse events experienced by antidepressant patients include hostility, aggression, agitation, and anger.138

Courts, that is to say judges and/or juries, after hearing technical evidence in individual cases have weighed the matter and determined that antidepressants caused or contributed to violence toward others.139  What should be the relevance of these cases is that, unlike unilateral processes, they were full blown adversarial proceedings where truth has its best chance to prevail. Any Army report, however well intended, cannot compete with the objectivity of adversarial trials in arriving at the truth.

Specialist Ivan Lopez

Fifteen year Army veteran Specialist Ivan Lopez was the perpetrator of the April 2nd

Fort Hood violence against his fellow soldiers and himself.

The press’ collective frenzy over the “motive” of the shooter began immediately. After

determining fairly quickly that Lopez had no apparent ties to terrorism as did the 2009 Fort

Hood shooter, Major Nidal Hasan, the press went here and there to poke at various keying events

that may have set Lopez off. To those having studied antidepressant induced suicide and

violence, the press’ frenzy over motive was proving, once again, the press either was ignorant

on antidepressant side effects or staying away from issue intentionally.

Press coverage on Lopez by the New York Times reported there was a verbal altercation

immediately before the shooting, that Lopez “had a clean record,” that he “was active in the

band” in his Puerto Rico high school, that he joined the National Guard in 1999 and in 2008

transferred to the regular Army, that he “was a very experienced soldier,” that Lopez’ wife “was

surprised and saw no clues coming in to this” that two of his earlier supervisors from the Puerto

Rico National Guard “said he had been an exemplary soldier” and that he was the most

responsible, obedient, humble person, and one of the most skillful guys on the line.”140

One presumes the press coverage was neither comprehensive nor current in terms of what

Army investigators discover on Lopez’ activities in his final days. It is clear enough already,

however, that Ivan Lopez was neither inherently insane nor a serial killer. He stands as a prime

candidate to be considered as suffering the effects of psychotropic medications.

Concluding

One has to bet that the Army will continue to obfuscate antidepressants and attribute

Fort Hood and Specialist Lopez to some combination on mental health, PTSD, and war related

No one will ever know with certainty why Lopez did what he did. One could be

completely wrong in presuming with the sketchy factual information available to date that

Lopez killed others and himself primarily as the result of a psychotropic drug. This paper

presumes no such thing, only that the U.S. Army has no chance of finding the truth by the

manner in which it seeks it.

The Army’s bad policies and liberal dispensing of drugs known to cause suicidal behavior could be at the heart of the Army’s prolonged tragedy of suicides. Institutions large and small have been guilty of bad policy throughout history. In the larger context of the Army’s suicide epidemic, however, there is no defense to ignoring the ramifications of suicidality-inducing drugs.

What one does know is that some science is on the side of those suggesting Army

suicides and violence is attributable to antidepressants—and that the Army has no science

supporting what amounts to idle speculation on “mental health” and “13 years of continuous

war.” The Army’s resort to the latter has nothing more than speculation, conjecture, and

unscientific opinion to sustain it.

Suicide is certainly a difficult dilemma, and scientifically complicated. But the Army’s

pattern must be broken; it must be stopped!. There are steps that can be taken to get to the

bottom of the problem. The best, immediately, is to investigate the last 5 years of Army

completed suicides through funding the necessary psychiatrists and psychologists to conduct

psychological autopsies on the victims. STARRS is somewhat beneficial even with its

limitations. STARRS, however, as currently conceived is not giving the Army or the public the

bang for the buck, and certainly is not putting an end to this tragedy anytime soon.

If psychological autopsies confirm that antidepressants are not a cause or a factor in the

suicides, the results of the PAs will nevertheless point the Army and nation to the best causal

explanations and rid the Army and nation of this plague.

The Army will never lead us to where we must go if it continues to ignore the

elephants in the room—whatever they are. First Secretary McHugh, please get off the

“Ambien” script and tell us what antidepressant Specialist Lopez was taking. That would be

a good start.

Footnotes:

1 “Selective Serotonin Reuptake Inhibitor” type antidepressant, and includes Prozac, Zoloft, and Paxil.

2 Fox News Live Coverage of Fort Hood News Conference April 2, 2014

3 Transcript April 3, 2014 Senate Armed Forces Committee Hearing

4 Army—Health Protection, Risk Reduction, Suicide Prevention, Report 2010 (hereafter “Army 2010 Suicide

Report”) page 11

5 BMJ 2014;348:g1987 doi: 10.1136/bmj.g1987 (Published 6 March 2014)

6 Official home page of the U.S. Army, Army News Service, February 3, 2014, http://www.army.mil/article/119301

7 97 L Ed 2nd 559.

8 http://en.wikipedia.org/wiki/Unethical_human_experimentation_in_the_United_States

9 (Soaring SSRI 1990s http://apps.who.int/medicinedocs/wn

10  Statement of FDA Psychopharmacologic Drugs’ Advisory Committee (“PDAC”) Chairman Matthew Rudorfer, MD to Associated Press, February 3, 2004 in wire story “Child Warnings for Adult Antidepressants Advised”: “We want to put a speed bump in the road…the…(antidepressant)… warnings as they exist in the current labeling are not adequate or are not being taken seriously.”

11 Testimony of Brigadier General L.K. Sutton, Medical Corps, U.S. Army, February 24, 2010 before the House Committee on Veterans Affairs, “Exploring the Relationship Between Medication and Veteran Suicide,” Serial No. 111-62;

12 http://cbsnews.com/news/study-shows–70-percent-of-Americans-take-prescription-drugs-

13 SFGate “Antidepressants—nation’s top prescription” by Kathryn Roethel,

http://sfgate.com/health/article/Antidepressants-nation-s-top-prescription-4034392.php

14 Chief of Staff, U.S. Army, testimony before House Armed Services Committee September 18, 2013

15 Sales for the top 3 antidepressants, all SSRIs, in 1999, totaled approximately $6.5 billion; Prozac $2.4 million (http://money.cnn.com/magazines/fortunes); Zoloft $2.034,000 http://www.uic.edu/classes/actg); Paxil $2.052,800, http://www.gsk.com/content/dam/GSK/globals/annual-report-2000.pdf.

16 New York Times, June 30, 2002 by Erica Goode, “Antidepressants Life Clouds, but lose ‘miracle drug’ Label.”

17 SmithKline Beecham Pharmaceuticals, in its promotional booklet PX5522 of July 1997 “Paxil…Patient Question & Answer Guide” asks “What Causes Depression?” then answering, in part, “Too often in the past, depression was mistakenly considered a sign of emotional weakness. The fact is depression is an illness with biological causes…Depression is not a weakness or a personality flaw…Research has shown that that the symptoms of depression are related to an imbalance of important natural substances called neurotransmitters, which act as ‘messengers’ between nerve cells in the brain…Paxil relieves the symptoms of depression by Increasing the amount of serotonin available to nerve cells in the brain.” Numerous experts debunked this claim (infra), but most significantly the Paxil project director at SmithKline Beecham when Paxil was FDA approved, though first  testifying on the chemical imbalance theory as causative of depression that “many people believe that, and I guess I believe it to some extent as well,” later upon questioning on whether the “chemical imbalance” came before or after the depression, testified he thought “both are equally speculative. We don’t really know the cause of depression or what is the underlying pathophysiology in depression. If we knew, we would have much more variability in the ways of managing and treating the illness.” (From deposition of Geoffrey Dunbar, MD, September 14, 2005 in Civil Action No. 3:05CV25WHB, U.S. District Court, Southern District of Mississippi.

18 “The Media and the Chemical Imbalance Theory of Depression” by Leo and Lacasse, Soc d(2008) 45:35-45, DOI 10.1007/s12115-007-9047-3 (Published online: 28 November 2007.

19 European Neuropsychopharmacology 5 (1995) 5-13; “Reduction of suicidal thoughts with paroxetine in comparison with reference antidepressants and placebo.”

20  The 1995 article, and other GlaxoSmithKline documents, listed “run-in” data, scientifically improper, against placebo’s record. The correct result was that Paxil induced more suicides and suicide attempts than placebo.  After much litigation over this falsehood, Senator Charles Grassley, (R, IA), among others, called the FDA’s attention to the discrepancy.  In a contorted response to Senator Grassley’s letter, Glaxo SmithKline made the best case it could to defend its false figures. (See GSK “Press Release” dated February 8, 2008 “GlaxoSmithKline Responds to Letter from Senator Grassley Regarding Paxil”

21 The APA’s representative to the FDA’s Feb. 2, 2004 PDAC, David Fassler, MD, stated at that forum: “(W)e are concerned that the publicity…(about antidepressant induced suicidality)…surrounding this issue may frighten some parents and discourage them from seeking help for their children. This would be a real tragedy since the reality is that we really can help most of these kids.” (From PDAC 2/2/04 transcript, page 226 line 25 to page 227 line 5). Dr. Fassler again appeared at the follow on PDAC September 13, 2004 following the FDA’s March 22, 2004 public health advisory ordering suicide warnings for adults as well as children. At the 9/13/04 forum, Fassler stated: “(W)e support the continuation of the current FDA warnings with respect to SSRI antidepressant. We believe the language is appropriate and consistent with our current knowledge, understanding and scientific data.” (From PDAC 9/13/04 transcript, pp 300-301).

22 In response to concerns like the APAs, in its addition of young adults to the BBW on May 2 2007, the FDA ordered that the BBW include the statement that failure to obtain treatment for depression also may cause suicidality, and that antidepressants showed a positive result for adults over 65.

23 Kirsch I, Deacon BJ, Huedo-Medina TB, Scoborio A, Moore, TJ, Johnson BT, PLoS Med 2008 Feb; 5(2):e45;

24 http://www.cbsnews.com/news/inside-6–minutes-placebo-story/

25 http://ncbi.nlm.nih.gov/pmc/articles/PMC2582668/, Mcgill J Med Nov 2008; 11(2); 219-222.

26 Yale J Biol Med Jun 2013; 86(2): 139-146 (Published online Jun. 13, 2013)

27 Army 2010 Suicide Report, page 4: “Lost Art of Leadership in Garrison—The Army’s institutional policies, processes, and programs have not kept pace with changes resulting from nearly a decade at war…Leaders are consciously and admittedly taking risk by not enforcing good order and discipline.”

28 In the FDA’s review of adult antidepressant trials for psychiatric indications, only eight (8) completed suicides occurred among 77,382 participating patients, a crude rate of “.0001” (see Table 19, page 47 FDA “Clinical Review: Relationship Between Antidepressant Drugs and Suicidality in Adults” November 16, 2006. In the FDA’s review of pediatric trials, there were no completed suicides in the 24 trials involving over 4,000 patients (Slide 6 and Thomas Laughren, MD PDAC Presentation 2/2/04 and Slide 10 Thomas Laughren, MD PDAC Presentation 9/14/04 .

29 See “Placebo Effects on Pharmacotherapy Outcomes in Major Depression” Psychiatric Times, September 15, 2007, by Aimee M. Hunter, PhD, e.g. “the beliefs and expectations of the patient and physician/clinician, as well as the nature of the patient-physician relationship, are of primary importance in the treatment context.”

30 Army 2010 Suicide Report, page 55

31 http://nationalguardmagazine.com/article…”The Guard Surge in Iraq” by Bog Haskell

32 Army Health Promotion, Risk Reduction, Suicide Prevention, 2010 (Hereafter “Army 2010 Suicide Report) top of page 36

33 Army 2010 Suicide Report, page 55

34 “Antidepressants and Suicide” British Medical Journal, Editorial, BMJ 2008;336:515

35 CNNMoney.com “The antidepressants to watch in ‘06” by Aaron Smith, January 4, 2006.

36 http://www.cdc.gov/nchs/data/hus/hus13.pdf page 22 of “Health, United States, 2013”

37 Fox News coverage of live news conference April 2, 2014, General Miley’s responses to questions: “he was currently under diagnosis for PTSD, but he had not yet been diagnosed with PTSD.”…. “he was not diagnosed as of today with PTSD, and that is a lengthy process to be confirmed…” “he was undergoing behavior health and psychiatric treatment for depression and anxiety and a variety of other psychological and psychiatric issues..” “I don’t know if he was diagnosed in the clinical sense; there are reports that he self-reported a traumatic brain injury, previously coming back from the Iraq War…”

38 Army Suicide Report 2010: Page 1 succinctly summarizes the Army’s theory on its suicides: “(T) he alarming rate of suicides in the Army…No one could have foreseen the impact of…(thirteen)….years of war on our leaders and Soldiers.” The original 2110 report stated “9” years to war (from 2001). We inserted “thirteen” above in keeping with that theory.

39 “Scientists have long speculated that the fast-paced tempo the Army was under at home and abroad during the war years was an overall strain that contributed to suicides and that deaths were not just a factor of combat duty.” USA Today by Gregg Zoroya, March 3, 2014 “Study: High Suicide Rates for soldiers in, out of war.”

40 “Suppose the requirements of command were many times as severe as you believe them to be—wouldn’t even this mild sickness disable Queeg?” “That’s absurdly hypothetical, because…” “Is it? Have you ever had sea duty, Doctor?” “No” “Have you ever been to sea?” “No.” (Wouk continues without quotes:…”Bird was losing his self-possessed look.”) “How long have you been in the Navy?” “Five months—no, six, I guess, now…” “Have you had any dealings with ships’ captains before this case?” “No.” “On what do you base your estimate of the stresses of command?” “Well, my general knowledge…” “Do you think command requires a highly gifted, exceptional person?” “Well, no—“ “It doesn’t?” “Not highly gifted, no. Adequate responses, fairly good intelligence, and sufficient training and experience, but—“ “Is that enough equipment for, say, a skilled psychiatrist?” “Well, not exactly—that is, it’s a different field—“ “In other words, it takes more ability to be a psychiatrist than the captain of a naval vessel?” (The lawyer looked toward…(the president of the court martial panel, a line captain)). “Doctor, you have admitted Commander Queeg is sick, which is more than Dr. Lundeen did. The only remaining question is, how sick. You don’t think he’s sick enough to b disabled for command. I suggest that since evidently you don’t know much about the requirements of command, you may be wrong in your conclusion.” The Caine Mutiny by Herman Wouk, pp 450-451

41 Washington Post, January 19, 2011, “Army Sees Suicide Decline Overall, Increase Among Guard and Reserve Soldiers,” by Greg Jaffe.

42 Ibid Jan. 19th Washington Post

43 New York Times, July 29, 2010, “Pentagon Report Places Blame for Suicides” by Elisabeth Bumiller: “’For us to blame this thing just on the war would be wrong,’ Gen. Peter W. Chiarellii…said at a news

conference…’That’s not what we’re trying to do here.’ Nonetheless…Chiarelli said that he believed…that the overall Army suicide rate had been driven up by the 21 percent of suicides committed by soldiers with multiple deployments, ‘That has just always been my concern, that they may be it, that may be the reason,’ he said ‘but I don’t have any data that I can tie that to.””

44 http://www.politico.com/news/stories/0912/81413.html

45 USA Today March 3, 2014 et al by Gregg Zoroya

46 http://www.ptsd.va.gov/professional/ “PTSD History and Overview”

47 The World Almanac and Book of Facts, 1985, Newspaper Enterprise Association, Inc. page 340

48 Ibid

49 Ibid.

50 www.defense.gov/new/casualty.pdt

51 http:///www.history.com/this-day-in-history/battle-of-the Kasserine-pass

52 www.u-s-history.com/pages /h1727.html

53 www.battlefieldhistorian.com/italian_campaign-1945-1945.asp

54 www.history.army.mil/broachures/anzio/72-19.htm

55 www.ddaymuseum.co.uk/d-day/d-day-and-the-battle-of-Normandy

56 Ibid

57 Ibid

58 Ibid

59 En.wikipedia.org/wiki/Battle-of-the-Bulge

60 www.pbs.org/wgbh/americanexperience/features/general-article/pacific-major battles

61 www.history.com/topics/world-war-II/bataan-death-march

62 www.militaryhistory.about.com/od/worldwarii/a/battle-of-guadalcanal_2.htm

63 www.history.army.mil/brochures/new-guinea/ng.htm

64 www.militaryhistory.about.com/od/worldwarii/p/World-War-II-battle-of-tarawa.htm

65 www.en.wikipedia.org//wiki/Gilbert_and_Marshall_Islands_campaign

66 www.en.wikipedia.org/wiki/Mariana_and_Palau_Islands_campaign

67 www.pbs.org/wgbh/americanexperience/features/general-article/pacific-major-battles

68 Ibid

69 www.pbs.org/wgbh/americanexperience/features/general-article/pacific-major battles

70 www.pbs.org/wgbh/americanexperience/features/general-article/pacific-major battles

71 www.nationalww2museum.org/learn/education/for-students.ww2-history/ww2-by-the-numbers/us-military.html

72 www.abcnews.go.com/Health/Vietnam-vets-highest-rates-suicide-alongside-baby boomers/story?id=19100593, “Suicide Rate Spikes in Vietnam Vets Who Won’t Seek Help” by Susan Donaldson James via Good Morning America

73 “At the result of the protracted and intense operational tempo, the Army has lost its former situational awareness and understanding of good order of discipline within its ranks.” Army 2110 Suicide Report, page 1.

74 The Army, rightfully proud over extending its stretched force into two theaters, proceeded to explain why Army troops were disenchanted, i.e. presumably turning to suicide: “On the other hand, we must now face the unintended consequences of leading an expeditionary Army that included involuntary enlistment extensions, accelerate promotions, extended deployment rotations, reduced dwell time and potentially divert

Judge: Hospital personnel can testify in Howard murder trial — (The Daily Herald)

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The Daily Herald

May 19, 2014

By Barbara Vitello

A Cook County judge ruled Monday that lawyers for D’Andre Howard may not introduce testimony from Department of Children and Family Services caseworkers about Howard’s mental state when his murder trial begins later this month.

However, Judge Ellen Mandletort ruled hospital personnel from Alexian Brothers Medical Center and Cermak Health Services who conducted psychiatric exams of Howard shortly after his arrest may testify about his mental state.

Howard is accused in the April 2009 murder of three members of a Hoffman Estates family.

“A jury will have to decide whether he suffered from a mental disease” and as a result “was unable to appreciate the criminality of his conduct,” Mandletort said in announcing her ruling.

Howard’s attorneys intend to pursue an insanity defense for their client, who was diagnosed as a child with post-traumatic stress disorder and has a history of mental illness and criminal arrests.

Defense attorneys say Howard, 25, was legally insane on April 17, 2009, when he stabbed to death 18-year-old Conant High School senior Laura Engelhardt; her father, 57-year-old Alan Engelhardt; and her maternal grandmother, Marlene Gacek, 73, in the family’s home.

Wounded in the attack was Shelly Engelhardt, Laura’s mother and Alan’s wife.

By law, a person is legally insane if — at the time of the event — he suffered from a “mental disease or defect” that made him unable to appreciate the criminality of his conduct.

Because defense attorneys have no expert testimony to support their claim of insanity, they’re seeking to introduce evidence through lay witnesses.

Mandletort found the DCFS caseworkers’ observations about Howard were “in the nature of mitigation testimony” that could be introduced in a sentencing hearing but were not admissible at trial.

Prosecutors dispute the insanity argument.

They say the attack stemmed from an argument over accusations of infidelity that occurred hours earlier between Howard and then-girlfriend Amanda Engelhardt, the mother of Howard’s child and daughter of Shelly and Alan Engelhardt.

Howard ordered Amanda out of their Hoffman Estates apartment, police said, and she returned to her family’s home with their then-8-month old daughter. Howard later followed her to the family’s home, where prosecutors say the argument escalated.

Also during Monday’s hearing, Cook County Assistant Public Defender Deana Binstock acknowledged that Howard is on several psychotropic medications, but they do not affect his fitness to stand trial.

Jury selection begins May 27 in Rolling Meadows.

Police confirm body found in creek is former Dallas assistant chief — (WFAA Dallas County News)

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May 18, 2014

Credit: Katrina Gutierrez / WFAA

A body matching the description of missing former Dallas assistant police chief Greg Holliday was found in a creek near Preston Trail Golf Club on May 17, 2014, five days after he was reported missing.

DALLAS — Dallas police confirmed Sunday that the body of their former assistant chief, Greg Holliday, was found in a North Dallas creek on Saturday.

Holliday hadn’t been seen in six days. The department issued a “critical missing” alert last week after family and friends expressed concern for his welfare.

The remains were found along a creek near Preston Trail Golf Club on Saturday morning.

“The Holliday family extends heartfelt gratitude to the community for all of the prayers offered on Greg’s behalf,” said a written statement released Sunday afternoon. “He served Dallas with distinction and with love. Our family will always be grateful to the men and women who worked so hard to find Greg and bring him back to us… the volunteers, the Parks and Wildlife officials, the Fire-Rescue workers and, especially, his Dallas Police Department family.”

Police Chief David Brown communicated with Holliday’s family on Saturday after the discovery. “Having spoken with the wife this morning, it’s very tragic,” Brown said at a Saturday news conference.

The search for the former police department executive was narrowed down with the help of boats and sonar. Dallas police had enlisted the help of game wardens at the Texas Parks and Wildlife Department.

“Soon after they began to search, they discovered the body using the sonar on the boat going down the creek,” Brown said.

News 8 spoke with one of Holiday’s old friends, former assistant chief Ron Waldrop. He was heartbroken about the news of his former associate. “He was a very highly principled person. He had a passion for DPD, and not just DPD — he had a passion for Dallas,” Waldrop said.

A lot of what happened remains unclear. Holliday was said to be depressed and grieving over the anniversary of his daughter’s death. News 8 also learned that Holliday was weaning himself off anti-depressants, inner battles that even a good friend didn’t know about.

“He was a fairly private person,” Waldrop said. “He didn’t talk a lot about that part of his life.”

Friends and family desperate to hear any news about their loved one will have to wait a little longer to hear from the medical examiner’s office for positive identification.

It is also unclear how Holliday died, but Chief Brown did say the body was found submerged in the creek with a high slope suggesting possible “slippage.” Brown said that theory is bolstered by the torrential rains that swept through that part of the city in the days prior to to Holliday’s disappearance.