An answer from Peter Kramer.

Asked about the killings in Minnesota, Robert F. Kennedy Jr., the Secretary of Health and Human Services, said on Fox that the department is “launching studies on the potential contribution of some of the SSRI drugs and some of the other psychiatric drugs that might be contributing to violence.”

I asked Peter Kramer, the author of Listening to Prozac (now out in a 30th anniversary edition that discusses developments since its initial publication), what he thought. His email:

“There is an old discussion, going back to before I wrote Listening to Prozac, about whether SSRIs can cause suicidality or violent impulses in people who never had that sort of impulse before. The answer is probably yes, but rarely. That’s where I came down in 1993.

“As to what is going on with people who are already suffering from substantial mental illness or who are making plans, gathering guns, or hoarding drugs in advance — there, the attribution of cause gets much more specific and complex. Did the person have bipolar disorder that was made worse by medication? And so on.

“These are meds given often in at-risk populations, so you are likely to see antidepressants in the picture when mentally ill people are violent.

“You’d need to know a lot to know whether SSRIs played a role in a given case, but statistically, the phenomenon is still rare and is probably rare in instances where the meds and mental illness are both present. You would start with the diagnosis, time course of the person’s fantasies, the arc of the illness, and the timing of prescribing and prescribing changes. As to how much of that information RFK, Jr. has accessed in this case — I’m guessing not a ton. We may or may not learn more later.

“The data from the current WashPost piece are probably about right:

An analysis of Columbia University’s Mass Murder Database shows that the lifetime prevalence of antidepressant use for perpetrators of mass shootings over the past 30 years is lower than the average number for Americans as a whole at 4 percent and for all psychiatric medications it is 7 percent, according to researcher Ragy R. Girgis, lead author of a study that is under review for publication.

In comparison, antidepressants are some of the most widely used drugs on the market, with national surveys estimating that 11.4 percent of Americans 18 years and older were on them in 2023.

“There’s a broader discussion about whether on balance the meds prevent these behaviors more often than they cause them. There, I think that the answer is clearly yes. That conclusion, about large populations, can coexist with the belief that sometimes prescribing causes harm.

“Hoping that this overview is helpful.”

I think it is very much so, and thank Professor Kramer for sharing it.