SSRIs and School Shootings: Unraveling the Claim and the Complex Reality, By Mrs. (Dr) Abigail Knight (Florida)

Dr. Bryan Ardis, a chiropractor known for controversial health claims, has asserted that 100% of US teenage school shooters over the past 52 years were on antidepressants or barbiturates for anxiety, linking these drugs to violent behaviour via FDA black box warnings and studies on suicidality and crime. This narrative gained traction after incidents like the August 27th shooting by Robert Westman, a 23-year-old trans male whose manifesto revealed deep mental turmoil. But is there solid evidence tying SSRIs (selective serotonin reuptake inhibitors) to school shootings? A closer look reveals a far more nuanced picture: while some studies show SSRIs may elevate risks of aggression or suicidality in youth, the vast majority of school shooters weren't on these meds, and no causal link to mass violence exists. The problem is much deeper.

Ardis's bold assertion, that every teenage school shooter since the 1970s was medicated with antidepressants or barbiturates, stems from anecdotal compilations by groups like the International Coalition for Drug Awareness. He ties this to FDA black box warnings on SSRIs, which highlight increased risks of suicidal thoughts and behaviours in those under 24. Some extend this to aggression, citing case reports of "behavioural toxicity" or "Hitler syndrome," where SSRIs allegedly induce overconfidence, lack of empathy, and violent impulses.

However, a USA Today investigation found no proven link between antidepressants and school shootings, noting the claim exaggerates usage rates. The Violence Project's Mass Shooter Database shows only 23% of mass shooters were on psychiatric meds. Psychologist Peter Langman's analysis of 68 school shooters revealed just eight were using psych meds at the time, with many having stopped beforehand. A 2019 National Library of Medicine study reviewed news reports, court records, and FBI data, concluding most school shooters weren't on psychotropics, and no direct causal association exists.

Columbia University's 2022 study on 82 mass murders in academic settings found severe mental illness absent in most perpetrators, and when present, it was more linked to non-firearm methods. Experts like Dr. Ragy Girgis emphasise correlation isn't causation: Many shooters had untreated mental health issues, and SSRI usage mirrors general population rates (13.2% of U.S. adults take antidepressants).

While the 100% claim crumbles, SSRIs aren't risk-free, especially for youth. The FDA's black box warning stems from a 2006 meta-analysis led by Columbia University suicidologists, reviewing 24 trials involving over 4,400 paediatric patients. It found antidepressants doubled the risk of suicidality (from 2% to 4%), though no completed suicides occurred. This aligns with the Columbia Classification Algorithm of Suicide Assessment (C-CASA), which reclassified adverse events from paediatric trials, confirming elevated risks.

On violence, a 2020 Swedish register-based study of 785,337 SSRI users found an increased hazard of violent crime during treatment, particularly in 15-24-year-olds (HR 1.43), but lower risks in older groups. The authors cautioned this might reflect underlying conditions or selection bias, not causation. A 2015 PLoS Medicine study echoed this, linking low-dose SSRIs to violence in youth, but higher doses reduced risk, suggesting undertreatment as the culprit.

Mechanistically, SSRIs can cause agitation, akathisia (restlessness), or disinhibition in some, potentially exacerbating aggressive impulses in vulnerable individuals. However, experts like Dr. David Rettew call claims of SSRIs causing mass shootings a "political diversionary tactic," as evidence points to underlying mental health issues, not the meds themselves.

In conclusion, it is likely pre-existing mental illness that is the true cause of the shootings, with SSRIs being an incidental contributing factor.

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