This article, written by forensic psychiatrist James L. Knoll, IV MD, and published in Psychiatric Times volume 30 November 2013, makes a significant contribution, through tongue in check, to laying to rest the false conclusion that antidepressant medication in general and selective serotonin re-uptake inhibitors (SSRIs) in particular cause aggressive behavior or even suicide. He quotes a major study by Yerevanian and Choi on the effects of psychotropic drugs on suicide and suicidal behaviors in patients with bipolar disorders. The study concluded that there is insufficient evidence that psychotropic medication has an adverse impact on suicide risk. Dr. Knoll stated, “The final advice regarding careful monitoring and assessment of patients at significant risk for suicide is not only prudent but also happens to be the standard of care. The enduring concern about psyhcotropics – particularly SSRI antidepressants – somehow ‘causing’ suicide gives me the opportunity to discuss a bit further the problem of mistaking subsequence for consequence.”
The reference to “mistaking subsequence for consequence” derives from a statement by the great English lexicographer and physician, Dr Samuel Johnson, in the course of a review of the Essay on Waters, by Dr Charles Lucas (Lucas C (1756) An essay on waters. 3 Vols. (A Millar, London).) Lucas extolled the healing powers of the waters at Bath (where he was physician) and elsewhere during an enforced hiatus in his political life in Dublin. Dr Johnson was evidently not persuaded: “It is incident to physicians, I am afraid, beyond all other men, to mistake subsequence for consequence.”(Johnson S (1756) Review of Dr Lucas’s essay on waters. Literary Magazine ii:39.)
Dr. Knoll’s article provides a superb exposition on this theme, indeed a formal error in logic that haunts far too many forensic psychiatric opinions.