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Two years ago, we investigated the suicide of a 7-year-old Florida foster child five years after his death, to find out whether officially recommended changes to the state's foster care program had been implemented following the tragedy. Based on records obtained from the Department of Children and Families (DCF) spanning the five-year period after the child's suicide, we concluded nothing had changed. After reviewing the DCF records, psychiatrist and child advocate Dr. Peter Breggin warned then about the foster program's ongoing and dangerous practice of psychotropic polypharmacy: “Whenever you put children on multiple psychiatric drugs you are creating an experiment that is doomed to do more harm than good... We need to stop experimenting on America's children.”


We had hoped by calling attention to the lack of real progress overhauling the Florida foster care program's over-reliance on pills to cure all ills, further tragedies might be prevented. Mission failed.


Recently, a 14-year-old Florida foster child, prescribed a psychotropic cocktail similar to the 7-year-old foster child, committed suicide in a nearly identical manner, only this time streamed live on Facebook.


In 2009, 7-year-old Gabriel Myers hanged himself in the bathroom of his Florida foster home. Toxicology detected amphetamine, fluoxetine and olanzapine in his system. Medical records indicated psychiatrist Dr. Sohail Punjwani prescribed young Gabriel 50mg of the ADHD drug Vyvanse (lisdexamfetamine dimesylate), and 25mg of the antidepressant and antipsychotic combination drug Symbyax (fluoxetine, olanzapine). Although there was was no doubt Gabriel died at his own hand, Broward Deputy Chief Medical Examiner Dr. Stephen Cina did not rule his death a suicide, stating: “It is unclear whether these drugs contributed to this fatality or not.” Dr. Cina noted in his report that neither Symbyax, nor one of its key ingredients olanzapine, also known by the brand name Zyprexa, was approved for use in children; and that “fluoxetine [Prozac] and olanzapine can increase the risk of suicidal ideation in children taking this drug.”


It also came to light that Gabriel was among Florida foster children being used as guinea pigs for pharmaceutical clinical trials. After an investigation into his clinical trial practices, the Food and Drug Administration (FDA) issued a warning letter to Dr. Punjwani, citing violations including failure to protect the rights, safety and welfare of human test subjects; doses exceeding protocol-specified limits; and failure to follow clinical trial plans. Through an executive order, then DCF Secretary George Sheldon instituted a limited prohibition of the shady practice of conducting drug experiments on Florida's foster children.


A recent Canadian study found youth prescribed ADHD drugs were thirteen times more likely to be prescribed antipsychotic medications, and almost four times more likely to be prescribed antidepressant medications than children who were not prescribed ADHD drugs. The study's authors argued that children with ADHD have more psychiatric comordibities than children without ADHD, omitting the exceedingly relevant fact that psychosis and depression are labeled side effects of ADHD drugs. Clearly, the possibility eluded the authors that the increased rates of psychosis and depression observed may not be linked at all to so-called comorbidities of ADHD, but rather to the drugs prescribed to treat ADHD.


Indeed, the Vyvanse label warns: “Vyvanse at recommended doses may cause psychotic or manic symptoms even in patients without prior history of psychotic symptoms or mania.” According to the DSM-5, up to twenty-five percent of all first episodes of psychosis are substance/medication-induced. Likewise, the label for the stimulant drug also warns: “Fatigue and depression usually follow the central nervous system stimulation.”


Research suggests drug treatment of ADHD unleashes a domino effect, triggering more psychiatric diagnoses, which in turn lead to risky polypharmacy. The cascading reactions associated with drug treatment of ADHD are especially disturbing, considering many children have been misdiagnosed with ADHD in the first place.


Which leads us to the tragic case of Naika Venant, the 14-year-old Florida foster child who recently hanged herself in the bathroom of her Florida foster home, witnessed in real-time on Facebook Live. Medical records from a medication management visit the month prior to her suicide indicate psychiatrist Dr. Scott Segal increased Naika's doses of Vyvanse and Zoloft (sertraline) to 50mg each.


Like Gabriel, Naika was prescribed 50mg of Vyvanse. Like Gabriel, Naika was also prescribed an antidepressant. Like Gabriel, Naika also hanged herself in the bathroom of a Florida foster home. Almost inconceivably, the medical offices where Gabriel and Naika were treated have the same street address, too. Which leads to an obvious question: Was Naika involved at some point in a clinical drug trial, like Gabriel?


Centers for Medicare and Medicaid Services (CMS) records indicate Shire, the manufacturer of Vyvanse, paid the Segal Institute for Clinical Research over three hundred seventy thousand dollars from 2013 to 2015. In response to a complaint alleging Dr. Segal enrolled a subject with a diagnosis of bipolar disorder in a schizophrenia study, the FDA previously inspected the site, initially classifying the inspection in the field as requiring voluntary corrective action, a classification subsequently amended at headquarters based on evidence of a dual diagnosis later supplied by Dr. Segal.


Even so, the DCF incident report in response to Naika's suicide does not reflect as favorably on the doctor(s) who prescribed her drugs for ADHD and depression, going so far as to question whether she even had ADHD in the first place, and noting the cascading effect of such a diagnosis:


Lastly, there was a noted concern regarding possible inaccurate and multiple diagnoses. Naika’s primary diagnosis consistently remained Attention Deficit Hyperactivity Disorder (ADHD). An ADHD diagnosis for a child who has suffered trauma, however, comes with its challenges, including how often symptoms of trauma in young children mimic those with ADHD. A psychological evaluation conducted with Naika stated that there is much concern that her attention problems are due to anxiety and trauma rather than ADHD symptomatology and recommended further evaluation to clarify the ADHD diagnosis. However, it does not appear that further evaluation was conducted. In addition to the ADHD diagnosis, Major Depression, Post Traumatic Stress Disorder and Disruptive Mood Dysregulation Disorder were given by various treating mental health professionals over the course of Naika’s life. However, limited documentation within the assessments does not appear to support these diagnoses or the medication prescribed [emphasis added]. An additional consideration is the cascading effect of a diagnosis, which drives the development of the treatment plan.


With respect to other suicides noted in its recent Vyvanse pediatric safety review, the FDA seemed to trivialize fatal adverse event reports associated with the drug, chalking them up to comorbidities and teen angst: “It is difficult to perform a causality assessment of suicide-related events and lisdexamfetamine from the postmarketing cases, because of the comorbid conditions... and the prevalence of youth suicides.” Readers familiar with our research published on Mad in America will recognize this FDA Vyvanse pediatric review as the same document the agency retroactively redacted to cover up the homicide of an infant by a child prescribed the stimulant – a day after Shire submitted a New Drug Application (NDA) for a chewable formulation of the drug intended for young children. Nothing to see here, move along.


Children are our most precious resource, and foster kids are among the most vulnerable of them to whom our society owes a special duty of care. As Dr. Breggin pointed out: “These children need to be treasured and protected, and to be given wrap-around loving care. They do not need psychiatric drug interventions, which inflict more neglect and abuse by suppressing their mental functions in order to make them more manageable.”


If the FDA will not fulfill its mandate to seriously investigate pediatric psychotropic fatalities and adequately warn the public of elevated polypharmacy risks, then it's up to us as parents to spread the word ourselves.

Piecing Together Polypharmacy Regimen of Mass Shooter Despite Heavy Report Redaction

On January 23, 2015, the Army released its long anticipated report on the second fatal mass shootings at Fort Hood that occurred on April 2, 2014. In support of the report, the Army simultaneously released five appendices contained in nineteen other files pertaining to Specialist Ivan Lopez's deadly shooting rampage.

In its findings, the Army concluded, "There was no evidence that any medication, or combination of medications, caused suicidal and/or homicidal thoughts in SPC Lopez-Lopez."  The Army continued: "There was no evidence that SPC Lopez-Lopez’s polypharmacy positive status would have triggered a high-risk flagging..."




In a very literal sense, there was no evidence contained in the report that any medication or combination of medications, known as polypharmacy, caused suicidal or homicidal ideation in Spc Lopez - because the Army made sure of it, seemingly redacting from its report every shred of evidence that could possibly point to such a conclusion.  Or did they?

Names of prescribed medications are obscured in the section of the report discussing Spc Lopez's behavioral health, with entire paragraphs blacked out.  As with Spc Lopez's medication history, the Army did not want to reveal which medications showed up in Spc Lopez's toxicology results.  Rather than stating that there were no medications present in Spc Lopez's post-mortem, the Army stated that the presence of medications was not abnormal, ie. expected and at therapeutic levels: "The autopsy results did not reveal any illegal drugs or the abnormal presence of any other medications in SPC Lopez-Lopez's blood."



In addition to large portions of the report and accompanying appendices being blacked out, notably missing from the redacted evidence was the entire Exhibits Tab "H" of Appendix 4, relating to Spc Ivan Lopez's psychiatric diagnosis, mental health treatment, and prescribed medications.



Undoubtedly, Exhibits Tab "H" contains evidence related to Spc Lopez's prescribed medications, since Exhibit H-14 is referred to in a footnote as "Lopez-Lopez Prescriptions (Recent to Oldest)."



Likewise, Exhibit H-11 is referred to in a footnote as "Lopez-Lopez Polypharmacy Timeline."



From comments by Lt. Gen. Mark Milley in a press conference shortly after the shootings, we know that Spc Lopez had been diagnosed with depression and anxiety, and had been prescribed and was taking Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants.  Given Lt. Gen. Milley's loose lips in the immediate aftermath of the tragedy, it is unclear why the Army would then go to such lengths to conceal - from the families of the fallen, the survivors, our brave military personnel, and the American public - which, what combination of, and what doses of psychotropic medications Ivan Lopez was taking leading up to and at the time of his shooting rampage.

Regardless of the Army's motivation for going to such lengths to hide information that people living in a free country have a right to know, one conclusion is unavoidable: the Army was not exhaustive enough in its efforts to suppress the facts behind the second Fort Hood shootings.

From footnotes in the report and a supporting appendix, concerned parents intent on unveiling the hidden temporal link between psychotropics and mass shootings in America have pieced together the polypharmacy regimen prescribed to Spc Ivan Lopez.

Army records indicate that Spc Lopez was prescribed the following four psychotropic medications: Celexa (citralopram hydrobromide), Wellbutrin (bupropion hydrochloride), Ambien (zolpidem tartrate), and Lunesta (eszopiclone).

Perhaps not unlike a criminal who subconsciously wants to get caught, the Army left a bread crumb trail of clues for anyone bothering to sift through thousands of pages of evidence (which apparently excludes most, if not all, of the media).

Four footnotes in the section of the Army's report discussing Spc Ivan Lopez's Behavioral Health (BH) refer to Exhibits H-7 through H-10, describing the exhibits as FDA labels for drugs.

Exhibit H-7 is referred to as "FDA Label - Celexa."



Exhibit H-8 is referred to as "FDA Label -" followed by the first letter "W" or "V" with the remainder of the drug name redacted.  So now we know to keep an eye out for a second medication that starts with either a "W" or a "V".  Exhibits H-9 and H-10, respectively, are referred to as "FDA Label -" with the names of the medications completely redacted.



In Appendix 3, the Army painstakingly defined the plethora of terms used elsewhere in the report.  Among the definitions include descriptions of Ambien, Ambien CR, Bupropion, Celexa, Citalopram, Lunesta, Polypharmacy (ya think?), Wellbutrin, and Zolpidem.

The appearance of Celexa/Citalopram in the list of definitions is consistent with the footnote referring to Exhibit H-7 as "FDA Label - Celexa."  The appearance of Wellbutrin (bupropion) in the list of definitions is consistent with the footnote referring to H-8 as "FDA Label -" followed by a mostly redacted medication name starting with the letter "W" or "V".  Not surprisingly, there are only two other psychotropic medications, Ambien and Lunesta, appearing in the list of definitions, corresponding presumably to Exhibits H-9 and H-10, FDA drug labels for the two other unnamed drugs.









In addition to inadvertently divulging, despite significant black ink expended, how many and which psychotropic medications Spc Lopez was prescribed and taking (remember the toxicology results revealed the normal/expected, ie. not abnormal, presence of medications plural), the Army perhaps again unwittingly disclosed in Appendix 5 just how extensive Spc Lopez's mental health treatment actually was, and the myriad of Army mental health providers who examined and/or treated Spc Lopez.

Appendix 5 indicates that investigators reviewed "[m]edical records notes by the following providers constitut[ing] the majority of Specialist Lopez-Lopez's significant medical events," then lists a number of mental health providers at Fort Bliss, Fort Leonard Wood and Fort Hood, and footnotes the dates from medical records notes corresponding to when Spc Lopez met with each of the respective mental health providers.

Over a ten month period from June 14, 2013 to March 10, 2014, Spc Lopez appears to have met with a half dozen mental health providers on at least ten occasions, possibly meeting with two providers on the same date on two of those occasions.  Records show Spc Lopez met with a Social Worker therapist, four psychiatrists, and a nurse practitioner who refilled prescriptions. 

Army records indicate Spc Lopez visited an Embedded Behavioral Health (EBH) Social Worker therapist at Fort Bliss on June 14, 2013, July 31, 2013, October 2, 2013, and October 28, 2013; an EBH psychiatrist at Fort Bliss on June 20, 2013; an EBH psychiatrist at Fort Bliss on July 31, 2013, and August 27, 2013; an EBH psychiatrist at Fort Bliss on September 24, 2013, October 28, 2013, November 15, 2013, and November 19, 2013; a nurse practitioner at Fort Leonard Wood on 24 January 2014 to refill prescriptions; and a psychiatrist at Fort Hood on March 10, 2014 to evidently request more medication.  At the time of the shootings, Spc Lopez had a follow-up BH appointment scheduled for May 19, 2014.







During his last BH appointment on March 10, 2014, according to the Fort Hood psychiatrist interviewed as part of the investigation, Spc Lopez "requested [redacted] and [redacted]."  Predictably, the Army blacked out what medications Spc Lopez requested and was provided during this last visit only two weeks prior to his shooting rampage.



Army records demonstrate that Spc Lopez sought mental health care of his own accord, followed up with mental health treatment as prescribed (both on a scheduled and walk-in basis), and requested refills of prescribed medications. 

These facts run counter to the narrative oft posited by Pharma-funded politicians whereby mass shooting tragedies are preventable - if only the shooters had access to mental health care, cooperated with their treatment, and complied with prescribed medications. 

What also emerges from the Army's selective redaction of its report and appendices is that they were only concerned with redacting a certain type of PHI - Pharma Harmful Information, as opposed to Protected Health Information.  In Appendix Tab "E," for example, SPC Lopez's wife stated that he "had a physical profile which expired, but he still suffered from pain on his back and he would still have to conduct physical training per the chain of command's orders."
  


It says a lot about how invested the Army is in its close relationship with Big Pharma when it does not bother redacting references to Spc Lopez's physical injury and pain, but does everything in its power to conceal Spc Lopez's mental health diagnoses and prescribed medications.

The Army's findings, based on thousands of pages of evidence, are a stinging indictment of the failings of medicalized psychiatry in America, which could alternatively be referred to as chemical mood/behavior management.  The Army's conclusion that Spc Ivan Lopez received the best possible mental health care was emphatic: "After an independent review of the medical and behavioral health care and treatment provided to SPC Lopez-Lopez, no deviation from standard care occurred in any component of the medical treatment continuum."

 

In other words (ATTENTION TAXPAYERS): Psychiatry's standard of care cannot prevent mass shooting tragedies. 

If the determination of independent psychiatrists that no deviation from the standard of care occurred in the case of Spc Lopez is correct, then it must also follow logically that psychiatry's standard of care cannot prevent mass shooting tragedies. 

The fact that American psychiatry - with its almost singular reliance on chemical mood/behavior management - cannot prevent mass shootings has not prevented Rep. Tim Murphy (R-PA) and other Pharma-funded politicians from attempting to force American taxpayers to part with billions of dollars under just such a false promise.  With the pharmaceutical lobby now the largest by far in the U.S., spending over $230M last year to pitch their agenda to Congress, some have begun to question whether we're now living in the United States of Pharma. 

In addition to revealing the impotence of psychiatry and its chemical mood/behavior management to prevent mass shootings, the Army's report and appendices shed more light on who Ivan Lopez was as a person.

Spc Lopez's wife described her husband as "a calmed person who was always quiet and she was the one in the relationship who was outspoken... [She] stated that SPC Lopez-Lopez was not confrontational and when he was mad he just kept it to himself."  Spc Lopez's wife further stated that her husband "was not a violent person.  [She] stated in one occasion she punched him after an argument and he did not hit her.  She stated he was a calmed person."



A childhood friend who knew Ivan Lopez since the seventh grade told investigators that "he did not think Specialist Lopez-Lopez would do something like this.  He said on multiple occasions that Specialist Lopez-Lopez never joked about hurting himself or others... [He] did not see anything that would suggest Specialist Lopez-Lopez would take the actions he did."



When asked to describe Ivan Lopez, another person who knew him since he was fourteen years old described him as "Humble, honest, kind, good father, loving, for me he was like a son."



A Private at Fort Hood who was friends with Spc Lopez told investigators: "He was always a happy guy.  Every time I talked to him, he never had anything bad to say.  I never saw him angry and he never talked about violence."



A Sergeant who got to know Spc Lopez during a reclassification course at Fort Leonard Wood told investigators: "To me, nothing stood out about Spc Lopez that would make him a high risk Soldier.  I never saw him get mad or angry during our time together. Sometimes I would ask if everything was alright, but he never seemed angry.  He did not seem depressed."



According to people who lived and worked with him, Ivan Lopez was not an angry, violent, or depressed person, but rather a decent human being.

So what could compel an even-tempered individual to go on a deadly shooting rampage?

A peek inside Ivan Lopez's medicine cabinet tells the story...

Spc Lopez took bupropion hydrochloride, better known by its brand name Wellbutrin, which is prescribed for depression and off-label for smoking cessation.  The label for Wellbutrin contains a black-box warning of increased risk of suicidal thinking and suicidal behavior, lists agitation and hostility as being among the most common adverse reactions, and warns families and caregivers to immediately report emerging agitation or irritability to healthcare providers.

Bupropion hydrochloride, when prescribed for smoking cessation under the lesser-known brand name Zyban, also carries an FDA-mandated warning of homicidal ideation.

It was reported that former Assistant District Attorney Myron May was also prescribed a cocktail of psychotropic drugs including the antidepressant Wellbutrin prior to his mass shooting rampage on the campus of Florida State University on November 20, 2014.

Andrea Yates was also on a cocktail of psychotropic drugs including the antidepressant Wellbutrin when she drowned her five children -John, Paul, Luke, Mary, and Noah - on June 20, 2001.

Homicide has been reported to the FDA as a side-effect of Wellbutrin and bupropion hydrochloride seventeen times.

Likewise, the label for citalopram hydrobromide, better known by the brand name Celexa, which Spc Lopez was prescribed, carries a black-box warning of increased risk of suicidal thinking and suicidal behavior, agitation, aggressiveness, hostility and impulsivity.

Homicide has been reported to the FDA as a side-effect of Celexa and citalopram fifty-eight times.  There have also been forty-three reports to the FDA of homicide as a side-effect of its chemical cousin, escitalopram oxalate, better known as Lexapro.

Spc Lopez was also prescribed zolpidem tartrate, better known as Ambien, to treat insomnia.  The Ambien label states that "worsening of depression and suicidal thinking may occur."  According to the Ambien label, other reported side-effects include agitation, hallucination, abnormal thinking, and aggressiveness.

Homicide has been reported to the FDA as a side-effect of Ambien and zolpidem tartrate over one hundred times.

In addition to Ambien, Spc Lopez was also prescribed the sleep-aid eszopiclone, better known as Lunesta.  Like Ambien, the Lunesta label warns that "worsening of depression and suicidal thinking may occur."  The Lunesta label also contains the following chilling warning: "A variety of abnormal thinking and behavior changes have been reported to occur in association with the use of sedative/hypnotics.  Some of these changes may be characterized by decreased inhibition (e.g., aggressiveness and extroversion that seem out of character)... Other reported behavioral changes have included bizarre behavior, agitation, hallucinations, and depersonalization."

Homicide has been reported to the FDA as a side-effect of Lunesta and zopiclone five times.

Three of the four drugs prescribed to Spc Lopez (Celexa, Wellbutrin, Ambien) appear on a list of 31 drugs Harvard and Wake Forest doctors identified as being associated with an elevated risk of violence based on a study of FDA Adverse Event Reporting System (AERS) reports.

Each of the psychotropic drugs prescribed to and taken by Spc Lopez carry warnings of increased risk of suicidal behavior and suicidal thinking, depression, agitation, aggressiveness, irritability, hostility, etc.  If any one of the aforementioned psychotropic drugs could cause someone to act aggressively out of character and/or suicidally, one can only imagine what they could drive a person to do if taken concomitantly.

The fact of the matter is that we are left to our imagination as to the possible adverse effects of such reckless polypharmacy, because these psychotropic drugs have never been tested to see if they can be taken together safely.  What the Army is doing effectively amounts to experimentation on our soldiers.

From the Army's report and appendices, there is no doubt that Spc Lopez was on a multi-drug regimen qualifying as polypharmacy by their own definition.  The most conservative interpretation of the available data would be that Spc Lopez was on at least one antidepressant and one sleep medication at a time, and that the Army either prescribed a different antidepressant and a different sleep aid because the first ones prescribed were not achieving the desired results, or worse that the Army prescribes different drugs in the same class (e.g. antidepressants or sleep aids) interchangeably. 

In either of the above two scenarios, there would be a period of increased risk withdrawing from the old antidepressant and the old sleep aid while starting a new antidepressant and a new sleep aid, since both stopping and starting a psychotropic drug increases the patient's risk profile.  Of course, the increased risk is further multiplied with the stopping and starting of multiple psychotropic drugs.

Another nightmare scenario is that the Army doubled up on the antidepressants and/or sleep aids when they were not working by themselves.

Odds are that we will never know which of the above three scenarios produced the horrific tragedy that occurred at Fort Hood on April 2, 2014, due to the Army's lack of transparency.

What we do know for sure is that the Army's management of psychotropic polypharmacy is haphazard at best.  "After the shooting incident," wrote a psychiatrist and Program Director of the Center for Forensic Behavioral Sciences, "only two commanders recalled having ever seen a polypharmacy list of names.  The hospital is again short staffed on managing the polypharmacy project because the pharmacist in charge deployed."  

  
 
Classic.  A psychiatrist blaming polypharmacy mismanagement on a pharmacist.  Can pharmacists write prescriptions?  Don't think so. 

Our fighting men and women deserve better than a whitewash and psychiatric blame-shifting. 

Parents Against Pharmaceutical Abuse (PAPA) calls on the U.S. Army to release Exhibits Tab "H" of Appendix 4.

RIP: SFC Daniel M. Ferguson,
SSG Carlos A. Lazaney-Rodriguez, SGT Timothy W. Owens, SPC Ivan A. Lopez-Lopez