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This is a mirrored article
 
 

Boy's Murder Case Entangled in Fight Over Antidepressants

By BARRY MEIER
August 23, 2004
The New York Times

Christopher Pittman said he remembered everything
about that night in late 2001 when he killed his
grandparents: the blood, the shotgun blasts, the
voices urging him on, even the smoke detectors that
screamed as he drove away from their rural South
Carolina home after setting it on fire.

"Something kept telling me to do it," he later told a
forensic psychiatrist.

Now, Christopher, who was 12 years old at the time of
the killings, faces charges of first-degree murder.
The decision by a local prosecutor to try him as an
adult could send him to prison for life. While
prosecutors portray him as a troubled killer, his
defenders say the killings occurred for a reason
beyond the boy's control - a reaction to the
antidepressant Zoloft, a drug he had started taking
for depression not long before the slayings.

Such defenses, which have been used before, have
rarely succeeded. And most medical experts do not
believe there is a link between antidepressants and
acts of extreme violence.

But the Pittman case has attracted special attention
because it is among the first to arise amid a national
debate over the safety of antidepressant use in
children and teenagers. Depression is a complex
condition, and antidepressants like Zoloft have helped
countless children and adults.

In recent months, however, the federal Food and Drug
Administration has been examining data from clinical
trials indicating that some depressed children and
adolescents taking antidepressants think more about
suicide and attempt it more often than patients given
placebos. The findings varied between drugs. The
F.D.A. is scheduled to hold an advisory committee
meeting on the issue next month.

Against that backdrop, the case of Christopher Pittman
- an otherwise obscure small-town murder case that may
go to trial this fall - has become a battleground,
where the scientific threads of the F.D.A. debate have
become entangled with courtroom arguments and a
family's tragedy.

Pfizer, the maker of Zoloft, has helped the county
solicitor who is prosecuting Christopher Pittman.
Plaintiffs' lawyers from Houston and Los Angeles, who
between them have brought numerous civil lawsuits
against Pfizer and other antidepressant makers, have
signed onto the defense team. Groups opposed to
pediatric antidepressant use have also championed the
boy's case, which is being played out in Chester,
S.C., a small town near the North Carolina border.

Locally, some people involved in the Pittman case said
they have been stunned by the rush of outsiders. Even
a forensic psychiatrist, who testified at a hearing
that she believed that Christopher committed the
murders while in a psychotic state induced by Zoloft,
said she worried that the publicity may frighten
parents whose children could benefit from Zoloft and
similar drugs.

"I wished it could be staying in Chester, S.C., with
this one kid," said the psychiatrist, Dr. Lanette
Atkins of nearby Columbia, S.C., who has been retained
by Christopher's public defender.

While the pediatric antidepressant debate has focused
on potential suicide risks, aggressive behavior can be
a side effect of antidepressants. There have also been
case reports of adults and children on antidepressants
acting violently. But only a handful of psychiatrists
have ever argued that such medications can unleash
rages so uncontrollable as to overwhelm a person's
ability to distinguish between right and wrong and
commit murder.

With the Pittman case pending, Pfizer, based in New
York, declined to make company executives or lawyers
available to be interviewed for this article. The
company has previously said that no regulatory agency
has ever found a connection between Zoloft and
suicidal or homicidal behavior.

Zoloft belongs to a class of medications known as
selective serotonin reuptake inhibitors, or
S.S.R.I.'s, which also includes other popular drugs
like Paxil and Prozac. In the last year, federal drug
regulators have issued cautionary statements about
most S.S.R.I.'s and similar medications prescribed for
the treatment of pediatric depression. The one
exception has been Prozac, the only S.S.R.I. formally
approved for pediatric use after it was shown to be
effective in tests with children and adolescents.

Regulators issued their advisories after a
re-examination of drug makers' test data, much of
which had not been publicly released. The disclosure
of the test results has spurred demands by doctors'
groups and others that drug companies be required to
list all drug tests publicly, and a few producers have
announced plans to do so.

If for some doctors such controversies seemed to have
sprung up suddenly, the issues behind them were
already stirring about three years ago - right around
the time that Christopher Pittman fired four shotgun
blasts into his grandparents as they slept.

A Last Chance Goes Wrong

When Christopher Pittman arrived in Chester in October
2001 to live with his paternal grandparents, Joe and
Joy Pittman, the move seemed like his last, best
chance to find stability.

He felt abandoned by his mother, according to medical
reports. And his relationship with his father, who
raised him in Florida, was troubled. "I haven't had
that good a life; my real mom left when I was 2,"
Christopher Pittman told a forensic psychiatrist with
the South Carolina Department of Juvenile Justice.

Psychiatric reports suggest that Christopher's
tailspin began when his parents revived their
relationship in 2001, only to end it yet again. After
his mother left this time, he threatened to kill
himself and was hospitalized. His diagnosis, records
show, was mild chronic depression accompanied by
defiant and negative behavior. He was put on Paxil.

But after about a week, his father, also named Joe,
decided to remove him from the hospital and send him
to live with his grandparents. There, a doctor put
Christopher on Zoloft, the most widely prescribed
S.S.R.I. antidepressant for pediatric patients and
adults alike.

Initially, Christopher Pittman appeared to thrive.
After a few weeks in Chester, though, he got into a
dispute on a school bus and his grandparents
threatened to send him back to his father. By the next
morning, they were dead.

Dr. Pamela M. Crawford, a forensic psychiatrist who
was asked by the case's prosecutor to examine the boy,
concluded in her report that Christopher knew what he
was doing when he took his grandparents' lives.

He provided "nonpsychotic reasons" for killing his
grandparents, setting fire to the house, taking money
from his grandparents and then stealing their car, Dr.
Crawford's report states. "Following his detention by
police, Christopher made self-protective statements to
avoid arrest prior to admitting his actions."

Citing the continuing case, both Dr. Crawford and Dr.
Atkins, the other forensic psychiatrist, declined to
answer questions about their reports or court
testimony.

At the time of the murders, questions about the safety
of antidepressants were focused on adults, not
youngsters. Just a few months earlier, a plaintiff's
lawyer, Arnold Vickery, who is known as Andy, had
convinced a federal jury hearing a lawsuit in
Cheyenne, Wyo., that Paxil had caused a man to go on a
murderous rampage.

In June 2001, that jury ordered GlaxoSmithKline, the
maker of Paxil, to pay $6.5 million to the relatives
of Donald Schell, who, two days after starting on the
drug, murdered his wife, his daughter and his
granddaughter before killing himself. The company
appealed, before settling the case, for undisclosed
terms.

It is hard to draw comparisons between civil lawsuits
and criminal cases like the one involving Christopher
Pittman. Still, the Wyoming verdict was significant
because it was the first time, after more than a
decade of litigation, that a jury had concluded that
an S.S.R.I.-type antidepressant could make users so
agitated and unbalanced that they could kill others or
themselves.

The Wyoming award has not led to similar verdicts, and
drug makers like Pfizer take the position that
antidepressants do not cause suicide or homicide.

Contradictory Reports

Little is known about Christopher Pittman's response
to Paxil, because he took the drug for only a few
days. And reports about his reactions to Zoloft vary
sharply.

He later told a psychiatrist that his mood changed on
the medication, to the extent that he "didn't have any
feelings."

The notes of the local doctor who prescribed the
medication for Christopher paint a different picture,
according to court records.

That physician, who saw Christopher just a few days
before the killings, described him this way: "Lots of
energy. No plans to harm self. Not flying off the
handle."

Psychiatrists have long known that adult patients
might experience increased suicidal thinking or
agitation during the first weeks of treatment with
S.S.R.I.-type antidepressants. But in May 2003
GlaxoSmithKline made a disclosure related to pediatric
use of the drug, which would set off a cascade of
events that are still in motion.

That month, the drug maker told the federal Food and
Drug Administration and its British counterpart agency
that its re-examination of published and unpublished
test data showed that adolescents who took Paxil
during clinical trials had more suicidal thoughts or
attempted suicide more often than those who received a
placebo. About six months earlier, a curious F.D.A.
analyst had contacted the company seeking more safety
information.

Within weeks, British drug regulators told doctors not
to prescribe Paxil to new patients younger than 18. In
June 2003, the F.D.A followed suit, and a month later
the agency asked all antidepressant makers for more
safety data about their pediatric tests. In the weeks
leading up to an emotionally charged F.D.A. hearing
this past February on antidepressant safety, doctors
learned that the drug industry had not published all
the data gathered during pediatric trials of the
medications.

Dr. David G. Fassler, a child and adolescent
psychiatrist in Burlington, Vt., who attended the
meeting, recalled being struck by the number of
pediatric studies he had never known about although he
followed medical journals.

"This was a lot more data than I knew existed," said
Dr. Fassler, who is an official of the American
Academy of Child and Adolescent Psychiatry, a
professional group. That hearing also served as a
public forum for grieving parents to testify about
children who had committed suicide soon after they had
started on antidepressants. Joe Pittman, Christopher's
father, was there, reading a letter written by his son
in prison, in which he blamed Zoloft for his
grandparents' deaths.

"Through the whole thing, it was like watching your
favorite TV show," wrote Christopher, who is now 15.
"You know what is going to happen but you can't do
anything to stop it."

A Gathering of Lawyers

By then, his case had become the center of a pitched
legal struggle. Mr. Vickery, the plaintiffs' lawyer
who had won the Wyoming trial, was contacted about the
Pittman case by the International Coalition for Drug
Awareness, a group based in Utah opposed to
antidepressant use.

Over the past decade, the group's director, Ann Blake
Tracy, has become involved in several murder cases in
which a defendant has been on antidepressants or other
drugs. Ms. Tracy maintains that antidepressants
"overstimulate the brain stem and cause you to go into
a sleep-walk state where you can act out the
nightmares you have." Mr. Vickery, who has been suing
antidepressant makers since the mid-1990's, soon
joined the defense team, offering his services for
free. So did another plaintiffs' lawyer who has filed
similar lawsuits, Karen Barth Menzies of Los Angeles.

Lawyers for Pfizer have also gotten involved. The
case's prosecutor, Chester County Solicitor John R.
Justice, was recently hospitalized with a serious
illness and has not been available to comment. But he
stated at a court hearing that Pfizer had provided
information to him last year to help him prepare for
the trial, according to a published report in The
Herald, a newspaper in Rock Hill, S.C.

Christopher Taylor, an assistant country solicitor,
said he thought that Pfizer had contacted Mr. Justice.
The material provided by Pfizer, the article reported,
included F.D.A. reports about Zoloft and previous
court testimony by a psychiatrist, Dr. Peter R.
Breggin, who is scheduled to testify on Christopher
Pittman's behalf. Dr. Breggin, who has campaigned
against the use of psychotropic drugs in children, has
testified in numerous lawsuits and criminal trials
that a link exists between S.S.R.I.-type
antidepressants and both suicide and violence -
positions rejected by drug makers like Pfizer and by
many other experts.

"I have been given advice on how to cross Breggin,"
Mr. Justice was quoted as saying, adding that he had
"been schooled on how these drugs are supposed to
work."

The involvement of a drug company like Pfizer in a
criminal proceeding is not unusual. Jennifer Yoder, a
spokeswoman for Eli Lilly & Company, the maker of
Prozac, said that over the years, a "Prozac defense"
had been raised about 75 times in criminal cases and
that the company had worked with prosecutors at times.
She said she was unaware of any case in which the
Prozac defense succeeded.

Not long ago, Mr. Vickery and Ms. Menzies asked the
case's presiding judge to order the release of scores
of Pfizer company documents about pediatric trials of
Zoloft, claiming they were critical to their client's
case. Those records were reviewed in the past by Ms.
Menzies, the plaintiffs' lawyer, as part of a 2002
civil lawsuit filed in a Los Angeles federal court
against Pfizer by the widow of a man who committed
suicide a week after starting on Zoloft. The case was
dismissed before trial.

According to court filings, the documents include
early drafts of a published positive pediatric report
about Zoloft that was later criticized by researchers
for its methodology. F.D.A. officials also did not
find that the study provided convincing evidence of
Zoloft's efficacy in children and adolescents. Both
Mr. Vickery and Ms. Menzies said they were barred from
speaking specifically about the Pfizer documents
because they were covered by confidentially agreements
they had signed during civil proceedings. But with the
Pittman defense, "I am hopeful that this case is the
one that all of Pfizer's dirty laundry comes out," Mr.
Vickery said.

Pfizer's lawyers have argued in court papers in the
Pittman case that the documents being sought have
nothing to do with the boy's situation, also noting
that a Florida judge struck down a request for company
records in a similar case. In addition, they have
effectively accused Mr. Vickery and Ms. Menzies of
using the case to make a cynical end run in order to
obtain documents they want for other Zoloft-related
lawsuits they are pursuing.

A Case in Limbo

A Pfizer spokeswoman, Mariann Caprino, said in an
e-mail message that Mr. Vickery had made a business
out of suing antidepressant makers. "In his three
cases against Pfizer that were decided by the court in
which he claimed Zoloft caused suicide, each case was
decided in Pfizer's favor and dismissed by the court,"
she stated.

The case's presiding judge has yet to rule on the
document disclosure issue.

Christopher Pittman's trial, scheduled to begin this
fall, may be delayed because of the illness of Mr.
Justice, the prosecutor. The teenager's lawyers are
trying to move his case to juvenile court, where if
convicted, he would be released by age 21 from a
juvenile facility.

Meanwhile, lawyers like Mr. Vickery have continued to
file lawsuits. Although Mr. Vickery failed earlier
this year in his first attempt use an S.S.R.I. defense
to win an acquittal in a murder case, at a trial in
Detroit, the calculus of such cases may be changing.

In April, a time of intense media publicity about the
issue, a man was acquitted of attempted murder after a
state jury in Santa Cruz, Calif., found that he was
not liable for his actions because of a reaction to
Zoloft.

The case's prosecutor, Barbara Rizzieri, an assistant
district attorney for Santa Cruz County, said the
growing debate about antidepressants had played a role
in the outcome. "If this had happened a year ago," she
said "it truly would have been different."

END REPORT


original located @
http://nytimes.com/2004/08/23/business/23drug.html?hp
 


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