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