:00:44. > :00:45.This programme contains some scenes which some
:00:46. > :00:52.The chances are, you or someone you know takes antidepressants.
:00:53. > :00:55.The chances are, you or someone you know has been helped by these pills.
:00:56. > :00:57.What are the chances, though, these widely prescribed drugs
:00:58. > :01:01.Did you have any doubt that you would end up
:01:02. > :01:07.Did antidepressants prompt a young man with no history of violence
:01:08. > :01:10.to attack a packed cinema are five years ago, killing 12
:01:11. > :01:20.With unique access to court material and expert witnesses,
:01:21. > :01:23.we revealed the possible link between antidepressants and one
:01:24. > :01:41.You can't believe that it's possible for anyone to cause that much harm,
:01:42. > :01:46.Could drugs which are safe for the majority who take them be,
:01:47. > :01:59.for a small minority, the prescription for murder?
:02:00. > :02:10.Just after midnight on the 20th July 2012.
:02:11. > :02:13.The latest Batman film, The Dark Knight Rises,
:02:14. > :02:16.is about to be shown in Theatre 9 of a local cinema
:02:17. > :02:23.Alex was one of the first people to walk into that
:02:24. > :02:28.And he had his choice of, you know, anywhere in there
:02:29. > :02:37.Tom Sullivan's son Alex is there with a group of friends.
:02:38. > :02:41.Alex's spot was twelve rows up, twelve seats in.
:02:42. > :02:44.He was right in the middle because that's
:02:45. > :02:52.We were four rows up and two seats in.
:02:53. > :02:58.Also there, Jansen Young, with her boyfriend, Jon Blunk.
:02:59. > :03:06.I was the third seat in and Jon was the fourth seat in.
:03:07. > :03:10.Outside, 24-year-old James Holmes arrives,
:03:11. > :03:16.intent on killing as many of the audience as he can.
:03:17. > :03:19.This is the car that he drove to scale, and he pulls
:03:20. > :03:24.And he walks the whole length around this movie theatre and he comes
:03:25. > :03:29.in to the lobby and we have video of him.
:03:30. > :03:34.six-year-old Veronica Moser-Sullivan.
:03:35. > :03:38.Soon to become the youngest of Holmes' victims.
:03:39. > :03:40.He goes across to Theatre Number 9 and he comes
:03:41. > :03:44.in and he walks down here and he takes this seat.
:03:45. > :03:46.And this seat is critical cos it's the one closest
:03:47. > :03:53.The randomness of everything, it just depended on where you were
:03:54. > :03:55.sitting and where you were at this particular time whether you lived
:03:56. > :04:00.He lets himself out this door and he comes out
:04:01. > :04:05.Now he's recently tinted the windows so no one can see in.
:04:06. > :04:08.He puts up a sun visor over the front windshield so no can see,
:04:09. > :04:15.Soon after the film starts, Holmes walks back into the theatre
:04:16. > :04:19.wearing bullet proof armour, a gas mask, armed with tear gas,
:04:20. > :04:25.a handgun, a shotgun and an assault rifle.
:04:26. > :04:31.I just watched this canister smoke the whole way
:04:32. > :04:34.it was in the air and it landed behind us in the back left
:04:35. > :04:36.corner of the movie theatre, and when it landed,
:04:37. > :04:44.He starts in with the 12 gauge shotgun,
:04:45. > :04:46.six rounds, boom, boom, boom, he kills three,
:04:47. > :04:53.Jon was so quick moving and he pushed me down behind
:04:54. > :04:55.the seat so we were kneeling down and he said,
:04:56. > :05:00.And then he said, "There's a man in the movie theatre shooting people."
:05:01. > :05:04.And that was the last thing he said to me.
:05:05. > :05:07.The next weapon he goes to, his main murder weapon, is this
:05:08. > :05:13.He has chosen armour-piercing rounds, well, actually, steel
:05:14. > :05:29.Alex Sullivan is next to his friend, Edgar.
:05:30. > :05:34.Alex looked over at him as the bullets are flying and said,
:05:35. > :05:41.and Edgar said, "We have to get down."
:05:42. > :05:52.That was it, that was the point in which Alex
:05:53. > :06:05.Now, this is a semi-automatic rifle, which means you only get one bullet
:06:06. > :06:15.Well, he pulled the trigger 65 times.
:06:16. > :06:19.At 65 trigger pulls it jams on him, so he walks up this way,
:06:20. > :06:25.Holmes can't clear his jammed weapon.
:06:26. > :06:36.He took that handgun and fired five more rounds.
:06:37. > :06:39.Holmes then walks back outside to his car,
:06:40. > :06:49.dropping the assault rifle on the ground.
:06:50. > :07:00.They take him down at gunpoint over here,
:07:01. > :07:06.They ask him a couple of questions, and one
:07:07. > :07:08.of the questions is, "Are you here by yourself?
:07:09. > :07:23.Holmes has also rigged his flat with bombs.
:07:24. > :07:38.James Holmes killed 12 and injured 70.
:07:39. > :07:42.Mass shooters tend to kill themselves or are killed.
:07:43. > :08:01.Taking him alive gave a unique opportunity to ask why.
:08:02. > :08:03.In custody, Holmes offered no answers.
:08:04. > :08:17.When Holmes' hands were later bagged up to secure forensic evidence,
:08:18. > :08:24.I knew just when I heard that the shooter had been taken
:08:25. > :08:27.alive behind the theatre, this was very likely going to turn
:08:28. > :08:29.into a trial, and that trial was very likely
:08:30. > :08:33.going to turn on the issue of mental health.
:08:34. > :08:48.It took three years for the case to come to trial.
:08:49. > :08:57.By then, Holmes' appearance had changed.
:08:58. > :08:58.James Holmes pleaded not guilty by reason
:08:59. > :09:12.A year before the trial started, Dr William Reid
:09:13. > :09:16.spoke to Holmes at length about his crimes.
:09:17. > :09:33.His responses, dulled by the medication he was now on.
:09:34. > :09:36.He's mentally ill but, in my view, when he did these
:09:37. > :09:41.things he wasn't what most people would call crazy.
:09:42. > :09:43.The case hinged on whether Holmes was so mentally
:09:44. > :09:47.ill he couldn't be held responsible for his actions.
:09:48. > :09:50.Jurors heard disturbing details of dark thoughts
:09:51. > :09:54.of killing which he'd had since he was a teenager.
:09:55. > :10:09.And they watched nearly 23 hours of Dr Reid's filmed interview.
:10:10. > :10:11.The jury decided he was responsible for his actions
:10:12. > :10:17.James Holmes was found guilty on all counts, and only narrowly
:10:18. > :10:33.12 life sentences plus 3,318 years in prison - one of the longest
:10:34. > :10:56.James Holmes is one of America's worst mass murderers - and I wanted
:10:57. > :11:00.to understand more about why he carried out the killings.
:11:01. > :11:04.The only reason explored in court was mental illness.
:11:05. > :11:07.But could there be another explanation?
:11:08. > :11:10.Holmes started taking the antidepressant Sertraline
:11:11. > :11:15.Could the drug - known in Britain as Lustral -
:11:16. > :11:23.It's either certainly a coincidence or there
:11:24. > :11:28.The timing of when he took the medication, when the medication
:11:29. > :11:32.was increased and his actions, it has to cause you to wonder
:11:33. > :11:34.whether the medication didn't play some sort of role
:11:35. > :11:44.The defence approached a UK-based antidepressant expert
:11:45. > :11:52.Professor David Healy has long urged caution with the class
:11:53. > :11:57.They are thought to work by boosting serotonin levels in the brain.
:11:58. > :12:00.Though helpful to many, for some, he says, they can do
:12:01. > :12:08.Professor Healy met James Holmes in prison.
:12:09. > :12:11.I think the thing that hit me most about the interview that I had
:12:12. > :12:19.Before the meeting, Professor Healy was sceptical
:12:20. > :12:27.But by the end of his visit, he had reached a controversial conclusion.
:12:28. > :12:30.I believe if he hadn't taken the Sertraline, he wouldn't
:12:31. > :12:35.You really think it's as strong as that?
:12:36. > :12:43.Professor Healy was not called to give evidence in court.
:12:44. > :12:47.Jurors are very suspicious of theories that
:12:48. > :12:51.a defence lawyer presents, even with mental illness, which is
:12:52. > :12:59.The defence thought the jury simply wouldn't buy the idea
:13:00. > :13:02.a prescription drug could have made Holmes plan and carry
:13:03. > :13:09.Prosecutor George Brauchler doesn't buy it either.
:13:10. > :13:12.You don't think the medication played any part whatsoever?
:13:13. > :13:15.Not one that is worthy of consideration for the purposes
:13:16. > :13:21.I'll tell you that, and you know who else agrees with me?
:13:22. > :13:24.The defence team that refused to put on any evidence of that nonsense.
:13:25. > :13:26.So that's what you think it is, nonsense?
:13:27. > :13:35.I had interviewed Professor Healy before for a series of Panorama
:13:36. > :13:39.films about the darker side of SSRIs.
:13:40. > :13:42.We showed the drugs, which have been prescribed
:13:43. > :13:44.for the last three decades, can cause withdrawal problems.
:13:45. > :13:46.In rare cases, they've been linked to suicide and violence.
:13:47. > :13:50.If they aren't the right drug for you,
:13:51. > :13:57.They can throw you into a state of mental turmoil.
:13:58. > :14:02.The programmes led to an official rethink of how
:14:03. > :14:04.doctors should prescribe the drugs, especially to children
:14:05. > :14:11.Since then, prescriptions for SSRIs have more than doubled.
:14:12. > :14:16.In the UK alone, there were over 40 million prescriptions last year.
:14:17. > :14:21.Even though we have all these negative effects, we are getting
:14:22. > :14:25.We are in fact prescribing more of these drugs
:14:26. > :14:31.We have got to look at these rare side effects much more closely.
:14:32. > :14:35.Professor Peter Tyrer has been evaluating the effectiveness
:14:36. > :14:38.of SSRI antidepressants since they were tested in the 1980s.
:14:39. > :14:47.He thinks they could, in rare cases, prompt people to kill.
:14:48. > :14:49.You can never be quite certain, with a rare side effect,
:14:50. > :14:52.whether it's linked to a drug or not, as it could be
:14:53. > :14:55.But it's happened just too frequently, with this class
:14:56. > :15:01.It's obviously related to the drug, but we don't know exactly why.
:15:02. > :15:04.He shot and killed both his grandparents and set
:15:05. > :15:11.I've spoken to families across the world who believe
:15:12. > :15:15.the drugs turned their loved ones into murderers.
:15:16. > :15:19.He stabbed her new boyfriend and he died.
:15:20. > :15:24.And he also stabbed his ex-girlfriend and a new
:15:25. > :15:28.And then he went out into the back garden
:15:29. > :15:36.We've discovered in the last three decades, the UK medicines regulator
:15:37. > :15:39.has received 28 reports associating SSRI's to murder and 32
:15:40. > :15:45.The regulator says these reports do not prove
:15:46. > :15:50.How convinced are you that the medication was to blame?
:15:51. > :15:58.I'm totally convinced that if Shane hadn't taken the antidepressant,
:15:59. > :16:04.If you are taking an SSRI these rare cases may sound alarming.
:16:05. > :16:08.Doctors say patients shouldn't change or stop
:16:09. > :16:10.taking their medication without first seeking
:16:11. > :16:18.In one disturbing case we heard from the killer himself.
:16:19. > :16:20.He's just been arrested for his son's murder
:16:21. > :16:25.and is calmly shaking the hand of the police officer.
:16:26. > :16:35.It incredible that I was ever in that state.
:16:36. > :16:41.David Carmichael from Toronto, Canada strangled his 11-year-old
:16:42. > :16:46.What do you think of this skate park?
:16:47. > :16:51.I put him on the bed and I strangled him and I,
:16:52. > :16:56.at three o'clock in the morning, I took off my hand
:16:57. > :16:59.from around his throat, put him in the middle of the bed,
:17:00. > :17:03.put his hands across his chest, kissed him on the lips and told him,
:17:04. > :17:06."I love you, I am really going to miss you,
:17:07. > :17:20.And you remained calm, even after you did that?
:17:21. > :17:22.After I strangled Ian, I sat and watched telly for six
:17:23. > :17:25.hours and then I calmly called 911 and reported a homicide.
:17:26. > :17:30.David Carmichael was suffering from a psychotic delusion his son's
:17:31. > :17:35.life wasn't worth living because of brain damage.
:17:36. > :17:44.In reality, Ian had mild epilepsy and a learning disability.
:17:45. > :17:47.What I find the most difficult is what was going through his mind
:17:48. > :17:50.at that time, the person he loved and knew that loved him
:17:51. > :18:16.David Carmichael says the psychosis started soon after taking and SSRI
:18:17. > :18:18.David Carmichael says the psychosis started soon after taking an SSRI
:18:19. > :18:23.The only issue I may have is the fact that I have been
:18:24. > :18:24.on an antidepressant for the last three weeks.
:18:25. > :18:29.Paroxetine also goes by the brand names Seroxat or Paxil.
:18:30. > :18:31.I never, ever even contemplated anything like that before
:18:32. > :18:35.This was totally out of character for me.
:18:36. > :18:37.Just like the Holmes' case, the role of the drugs
:18:38. > :18:43.Unlike Holmes, David Carmichael was judged not criminally
:18:44. > :18:47.responsible due to mental illness and sent to a secure hospital.
:18:48. > :18:57.After four years he was thought no longer to be a danger and freed.
:18:58. > :19:01.It just completely changed his behaviour, it changed what he viewed
:19:02. > :19:04.the world as when he was on those antidepressants and then
:19:05. > :19:08.when he went off of them he was back to the man that he was,
:19:09. > :19:14.David Carmichael is suing the manufacturers of paroxetine,
:19:15. > :19:19.the UK pharmaceutical giant, GlaxoSmithKline.
:19:20. > :19:45.The role SSRI's have played in violent crime has rarely been
:19:46. > :19:50.But I wanted to investigate what part they could have played
:19:51. > :19:55.I've spent a year sifting through the evidence ? thousands
:19:56. > :19:59.of files and hundreds of hours of video.
:20:00. > :20:06.We never saw any signs of violence or troublesome things.
:20:07. > :20:08.James Holmes' parents, Arlene, a nurse, and Bob,
:20:09. > :20:12.a retired statistician have never spoken together on camera
:20:13. > :20:19.He was never interested in guns or really even a violent kid,
:20:20. > :20:22.that's why it was kind of surprising, it was that
:20:23. > :20:30.James Holmes was born in 1987 in California.
:20:31. > :20:34.On the surface, it was a normal childhood.
:20:35. > :20:37.Jim was quiet but he seemed happy enough, just pretty much normal
:20:38. > :20:47.Absolutely no interest in drinking or drugs, at all, ever.
:20:48. > :20:51.In retrospect I think he was too good and maybe I should have worried
:20:52. > :20:55.about the fact he was so good but as a mother you can
:20:56. > :21:01.Hi, and our next speaker is James Holme.
:21:02. > :21:04.In Personal life, he enjoys playing soccer and strategy games and his
:21:05. > :21:13.Here he is in front of an audience just after finishing High School.
:21:14. > :21:16.And the knowledge that's gained is then made available to the public
:21:17. > :21:18.and the scientific community through the web.
:21:19. > :21:20.He was academically bright and fascinated
:21:21. > :21:28.He's interested in how we perceive reality.
:21:29. > :21:54.Ever had a girlfriend in high school?
:21:55. > :21:57.His awkwardness didn't seem to hold him back.
:21:58. > :22:03.When he arrived in May 2011 to study a Ph.D.
:22:04. > :22:06.in neuroscience at the University of Colorado, Holmes made friends.
:22:07. > :22:08.He was nice, he was a little bit shy at first.
:22:09. > :22:11.I'd sit next to him every day in class and and we'd exchange
:22:12. > :22:24.But then in the halls when I would see him later,
:22:25. > :22:26.his head would be down and he wouldn't even say hello.
:22:27. > :22:30.Hillary Allen was one of six of the students on the same course.
:22:31. > :22:33.A little bit, but we were part of a group of scientists.
:22:34. > :22:40.Holmes says he studied neuroscience to gain insight into himself.
:22:41. > :23:01.He thought his social awkwardness was evidence of a broken brain.
:23:02. > :23:04.At college, Holmes was still awkward around women.
:23:05. > :23:37.But when fellow student Gargi Datta, asked him out, Holmes said yes.
:23:38. > :23:42.He even talked of buying a house in Colorado.
:23:43. > :23:50.When you hear something like that, the last thing in the world
:23:51. > :23:53.you would ever think is that something as bad as the shooting
:23:54. > :24:02.Back in Colorado after a family Christmas in California though,
:24:03. > :24:12.This and his social anxiety was starting to take its toll
:24:13. > :24:19.He said he couldn't give these presentations he wanted,
:24:20. > :24:26.He couldn't do this stand up talking.
:24:27. > :24:34.It was very, very hard on him and interacting with so many people
:24:35. > :24:37.all the time was, he said something to the effect of,
:24:38. > :24:40.The relationship with Gargi was also faltering,
:24:41. > :25:04.Gargi broke up with him a few days later.
:25:05. > :25:23.They continued a casual relationship for a while when she offered advice
:25:24. > :25:50.James Holmes came to the campus Student Wellness Centre and saw
:25:51. > :25:58.University psychiatrist Dr Lynne Fenton.
:25:59. > :26:01.The timeline of what happened over the next 17 weeks
:26:02. > :26:08.Dr Fenton talks to Holmes for around 45 minutes about his anxiety.
:26:09. > :26:10.And he tells her something he's never told his own family...
:26:11. > :26:20.He's having intrusive thoughts of killing people.
:26:21. > :26:26.After the killings, Holmes tells Dr Reid he's been imagining people
:26:27. > :26:32.dead as a strategy to cope with social anxiety since his teens.
:26:33. > :26:34.When he encountered any kind of confrontation with someone else,
:26:35. > :26:38.it may have been an imagined confrontation someone
:26:39. > :26:41.who was disagreeing or made him uncomfortable in some way,
:26:42. > :27:02.Alarming as this may sound, psychiatrist said these kind
:27:03. > :27:06.of intrusive thoughts are not uncommon.
:27:07. > :27:11.He wasn't talking about a vengeful hatred.
:27:12. > :27:23.He was talking about an aversion to mankind, being around much
:27:24. > :27:26.of mankind was uncomfortable to him and it wasn't very rewarding to him,
:27:27. > :27:29.so he wanted to avoid it, even though he couldn't avoid it.
:27:30. > :27:31.And it doesn't necessarily pinpoint you as a future killer?
:27:32. > :27:35.As Dr Fenton later said in court, she isn't
:27:36. > :27:48.Dr Fenton considers whether his thinking
:27:49. > :27:54.She prescribes, the antidepressant sertraline to ease his anxiety
:27:55. > :28:01.His symptoms were exactly right for giving sertraline,
:28:02. > :28:07.But his underlying personality, there's a certain
:28:08. > :28:13.They are almost like an alien species to him and that sort
:28:14. > :28:16.of person, it worries me a great deal when I'm prescribing.
:28:17. > :28:23.Why does that worry you, what effect would you anticipate
:28:24. > :28:29.Some of the underlying predispositions can come out more
:28:30. > :28:32.strongly and obviously in the case of Mr Holmes, these
:28:33. > :28:39.In a notebook found after the shootings,
:28:40. > :28:45.Holmes describes the effect of the drug on his dark thoughts.
:28:46. > :28:52.No more fear, no more fear of failure.
:28:53. > :29:47.He told you medication had played a part in that, in reducing
:29:48. > :29:54.I don't think of it as reducing the fear of consequences at all.
:29:55. > :29:58.To the extent that he was taking the medication at the time, one
:29:59. > :30:05.would expect him to be having less anxiety generally, but not becoming
:30:06. > :30:11.more focussed on a terrible task, or a potentially psychotic task.
:30:12. > :30:16.That doesn't occur to me, as a psychiatrist.
:30:17. > :30:19.But Professor Healy believes the loss of fear of consequences
:30:20. > :30:27.His awareness of the consequences seems to have been muted,
:30:28. > :30:30.and this is a point that he makes quite clearly
:30:31. > :30:34.when he began to keep a diary about how he was feeling.
:30:35. > :30:39.He made it clear that the anxieties that he would normally have expected
:30:40. > :30:41.to have in response to those kinds of thoughts he had
:30:42. > :30:49.Another psychiatrist, Dr Phillip Resnick from Cleveland,
:30:50. > :30:53.Ohio, was a prosecution expert, but wasn't called to give evidence.
:30:54. > :30:57.He has never spoken publicly about the case.
:30:58. > :31:00.He doesn't think the Sertraline was responsible for the shootings,
:31:01. > :31:03.but agrees it could have played a role in freeing Holmes
:31:04. > :31:18.With his particular combination of homicidal desires, the reduction
:31:19. > :31:23.in the anxiety may have facilitated other forces.
:31:24. > :31:28.But it obviously had quite a negative consequence as well,
:31:29. > :31:34.If we accept at face value that he made the decision to carry
:31:35. > :31:41.it out related to the reduced anxiety, yes, that would be true.
:31:42. > :31:44.Despite his dark thoughts, experts we spoke to felt
:31:45. > :31:49.until March, Holmes has no intent to actually kill.
:31:50. > :31:52.But days after starting Sertraline, his thinking appears
:31:53. > :32:02.It emerges in a very strange online chat he has with Gargi Datta.
:32:03. > :32:08.James Holmes tells Gargi he feels like doing something "evil".
:32:09. > :32:11.She asks him, "What do you feel like doing?"
:32:12. > :32:15.He replies, "Kill people, of course."
:32:16. > :32:18.This exchange is the first evidence of a bizarre theory
:32:19. > :32:31.Prior to that he had never said anything delusional,
:32:32. > :32:38.in your words, something irrational that didn't make sense.
:32:39. > :32:40.Holmes writes more about it in his notebook.
:32:41. > :32:43.He thinks he can earn points and increase his own
:32:44. > :33:24.Prior to expressing this human capital theory,
:33:25. > :33:26.do you think he actually really meant to kill anyone?
:33:27. > :33:30.Or were these just general abstract thoughts in his head?
:33:31. > :33:33.I think they were fantasies, and I don't think we have evidence
:33:34. > :33:38.of a plan to do it, with an intention to do it,
:33:39. > :33:42.So the human capital theory is quite a key
:33:43. > :33:49.It's clear that he began to voice thoughts about harming
:33:50. > :33:52.others, and thoughts that could be consistent with harming others,
:33:53. > :34:00.Six days after starting on Sertraline, Holmes meets
:34:01. > :34:08.Without going into any detail, he tells her he's still having
:34:09. > :34:18.She's aiming to get him to a therapeutic dose of 150mg.
:34:19. > :34:22.There's every evidence that if the drugs are suiting a person,
:34:23. > :34:28.that increasing the dose and keeping on with them might be helpful,
:34:29. > :34:31.and I use these drugs even though they can cause a problem,
:34:32. > :34:33.but when they are causing a problem, increasing the dose
:34:34. > :34:42.Hillary Allen studied alongside Holmes, but didn't
:34:43. > :34:48.Then, less than two weeks after the dose was doubled, she gets
:34:49. > :34:55.I got this text like oh, are you still sick, girl?
:34:56. > :34:58.And I'm like oh, who's, wait, who is this?
:34:59. > :35:00.Were you surprised that he contacted you like that?
:35:01. > :35:03.Yeah, I was because it was like that awkward social demeanour,
:35:04. > :35:15.Later, Holmes tells Hillary her shorts are distracting him in class.
:35:16. > :35:16.I remember receiving that and just like kind
:35:17. > :35:19.of blushing and kind of trying to laugh it off
:35:20. > :35:22.and just trying not to create an awkward situation because,
:35:23. > :35:25.you know, we're colleagues, in a sense.
:35:26. > :35:30.Aside from the fact that you have a guy who is now actively
:35:31. > :35:34.beginning to think and plan about harming others
:35:35. > :35:36.in a way that he just hadn't been doing before,
:35:37. > :35:44.James Holmes has his fourth appointment
:35:45. > :35:46.with Dr Fenton just a week after making a move
:35:47. > :35:50.By this stage, he's been on Sertraline for just
:35:51. > :35:57.Far from getting better on the pills, though,
:35:58. > :35:59.Doctor Fenton's notes of this appointment suggest
:36:00. > :36:25.Hostile thoughts he won't elaborate on
:36:26. > :36:31.Dr Fenton ups to dose once more - now to 150 milligrams.
:36:32. > :36:35.A spelling mistake on his prescription means
:36:36. > :37:21.He sends Dr Fenton an angry email with symbols she doesn't understand.
:37:22. > :37:23.Holmes never tells Dr Fenton the full truth
:37:24. > :37:30.And by now, they appear to have dangerously intensified.
:37:31. > :37:33.In his case, I think they became in effect pyschotic
:37:34. > :37:35.thoughts after a bit, they became delusional,
:37:36. > :37:39.but they were allowed free rein, and one can never be absolutely
:37:40. > :37:43.certain about this, but the whole history makes me feel that
:37:44. > :37:47.if in fact he wasn't taking the Sertraline, they wouldn't have
:37:48. > :37:51.You think this might not have happened?
:37:52. > :37:57.Should Dr Fenton have been more worried?
:37:58. > :38:00.It isn't on her radar that this drug could be causing the kinds
:38:01. > :38:06.So at the point that she notes in April
:38:07. > :38:11.that he appears to be psychotic she then increases the dose to 150
:38:12. > :38:16.milligrams, are you saying you think the psychosis was actually
:38:17. > :38:26.We asked Dr Fenton for an interview, but she declined.
:38:27. > :38:28.In a statement, the University of Colorado says doctor-patient
:38:29. > :38:32.confidentiality laws forbid her from talking about
:38:33. > :38:41.Holmes' care without his consent, which he has never given.
:38:42. > :38:43.Like all prescription drugs, Sertraline comes with a list
:38:44. > :38:49.Some of the "uncommon" or "rare" ones read like a roll-call
:38:50. > :39:02.Lack of caring, thinking abnormal, aggression, psychotic disorder...
:39:03. > :39:04.These warnings are based, in part, on case reports
:39:05. > :39:07.the manufacturer Pfizer has received about patients who had
:39:08. > :39:14.They're normally confidential, but I've seen some.
:39:15. > :39:17.Vivid stories of patients with psychotic symptoms,
:39:18. > :39:21.some strikingly similar to the Holmes case.
:39:22. > :39:23."Patient began to verbalise feelings of killing
:39:24. > :39:30."This 50-year-old female patient reported experiencing homicidal
:39:31. > :39:32.thoughts concerning family members two hours after taking
:39:33. > :39:38.The patient was hospitalised and Sertraline discontinued.
:39:39. > :39:47.According to these documents, by March of 1994, Pfizer had details
:39:48. > :39:52.of 13 reported cases of psychosis linked to Sertraline.
:39:53. > :39:55.Five of them were detailed enough to evaluate, and the company
:39:56. > :40:00.concluded there was no other obvious cause.
:40:01. > :40:05.This report about a ten-year-old boy is particularly disturbing.
:40:06. > :40:08."Some time at the beginning of August 95, the patient's mental
:40:09. > :40:11.status began to deteriorate, and the patient took a loaded gun
:40:12. > :40:15.out of his grandfather's truck and shot his eight-year-old brother
:40:16. > :40:21.The documents make clear Pfizer told regulators
:40:22. > :40:24.what they found and the drug patient information leaflet
:40:25. > :40:28.was changed, but none of these cases were put into the public
:40:29. > :40:57.In Colorado, it's nearly the end of term
:40:58. > :41:05.These are representative images of dopaminergic neurons.
:41:06. > :41:07.On May 17th, Holmes has to face the class
:41:08. > :41:14.That was always daunting on our minds,
:41:15. > :41:17.this big oral examination that was basically, you could
:41:18. > :41:21.either move forward in the programme or not.
:41:22. > :41:29.It becomes painfully clear Holmes is not going to move forward.
:41:30. > :41:31.It was kind of apparent throughout the presentation
:41:32. > :41:34.that he just really wasn't into it, or just didn't
:41:35. > :41:39.It was quite uncomfortable to witness, actually.
:41:40. > :41:40.So that final presentation, that stood out
:41:41. > :41:47.Five days later, Holmes walks into a gun shop
:41:48. > :42:08.On 25th May, just three days after buying this handgun,
:42:09. > :42:15.James Holmes is pushing Dr Fenton for another Sertraline prescription.
:42:16. > :42:18.His bank records show on 28th May the money
:42:19. > :42:20.for the prescription comes out of his bank account.
:42:21. > :42:31.The records also show another transaction on that day.
:42:32. > :42:33.The purchase of the shotgun marks the start
:42:34. > :42:37.of what James Holmes calls the mission, the move
:42:38. > :42:57.towards putting his human capital theory into practice.
:42:58. > :43:02.Holmes wrote in his notebook how his obsession with killing evolves.
:43:03. > :43:05.Intense aversion of people, cause unknown.
:43:06. > :43:09.Began long ago, suppressed by greater fear of others.
:43:10. > :43:23."Start small, buy stun gun and folding knife, buy handgun."
:43:24. > :43:30.His thoughts about potentially doing things begin to escalate
:43:31. > :43:34.as the dose of the drug escalates, and it also becomes clear
:43:35. > :43:39.that he ends up on a course of action that, once it gels in place,
:43:40. > :43:45.becomes very difficult for him to extricate himself from, again
:43:46. > :43:52.And this is critical to making the case that the drug played
:43:53. > :43:59.I think, at least in James Holmes' mind, he believed
:44:00. > :44:04.that while he was on the medication it had an effect on him
:44:05. > :44:08.and by reducing the anxiety helped to free him to carry out
:44:09. > :44:18.Well, I think that there may be some truth to that
:44:19. > :44:26.Holmes is now entirely focussed on his mission.
:44:27. > :44:44.Nothing else matters, especially not his end of year exams.
:44:45. > :44:48.I didn't really care if I passed or failed at that time.
:44:49. > :44:50.He goes through the motions knowing failure is inevitable.
:44:51. > :44:58.That same day, he buys an assault rifle.
:44:59. > :45:00.James Holmes fails his exams and then four days later
:45:01. > :45:08.Maybe he should have been more emotional about it but he just
:45:09. > :45:11.seemed really emotionally flat, not upset, not mad, just
:45:12. > :45:28.flat, that'd be the best way to describe him.
:45:29. > :45:30.Did he seem worried about his future?
:45:31. > :45:33.Before quitting his course, James Holmes has a final
:45:34. > :45:39.For the second time she brings in a colleague, thinking Holmes may
:45:40. > :45:43.Offers of an anti-psychotic drug and free treatment
:45:44. > :45:53.He couldn't see a reason to continue treatment if he was not gonna be
:45:54. > :45:58.Dr Fenton had the power to lock Holmes up but she felt
:45:59. > :46:04.She did contact the campus security team though to ask for criminal
:46:05. > :46:18.Knowing nothing of the weapons he's bought, Dr.
:46:19. > :46:20.Fenton phones Holmes' mother for more background.
:46:21. > :46:24.The doctor reveals little about his mental state.
:46:25. > :46:27.There was no hint in this conversation that she was concerned
:46:28. > :46:29.that your son might do something, harmful to himself
:46:30. > :46:38.I was reassured by her phone call rather than alarmed.
:46:39. > :46:42.James Holmes later tells Dr Healy he finishes his last
:46:43. > :46:49.prescription of sertraline and then abruptly stops.
:46:50. > :46:51.When you get a person like James Holmes halting them
:46:52. > :46:54.abruptly, the problems the drug has caused can endure for weeks
:46:55. > :46:59.Stopping them suddenly is very unwise.
:47:00. > :47:03.It's well established that you have a withdrawal problem
:47:04. > :47:06.and these adverse effects that you may have had even when starting
:47:07. > :47:08.the drugs they all come back with a vengeance.
:47:09. > :47:09.So the paranoid thoughts, hostile aggressive thoughts
:47:10. > :47:17.We can't be sure exactly when Holmes came off the drugs.
:47:18. > :47:20.But, the last prescription takes him to 26th June ? three weeks
:47:21. > :47:32.The fact that Mr Holmes was off it for three weeks even though
:47:33. > :47:39.he had the abrupt ending, means to me that it was unlikely
:47:40. > :47:43.or I can't say impossible but played a very small role rather
:47:44. > :47:52.Even if you've been on them for say six, seven weeks and you get
:47:53. > :47:55.to a high dose and then stop it can be six or seven weeks before
:47:56. > :48:01.the effects wear off and in some cases and this is one
:48:02. > :48:04.of the problems with these drugs, sometimes they last that even
:48:05. > :48:14.From this day on James Holmes starts doing things he's never done before:
:48:15. > :48:17.He dyes his hair bright red, He posts on a swinger's sex website.
:48:18. > :48:24.And crucially, he now visits the cinema and starts drawing
:48:25. > :48:30.detailed plans of the shootings in the notebook.
:48:31. > :48:34.There's another significant change in James Holmes' behaviour
:48:35. > :48:40.He starts to use the guns he's been buying.
:48:41. > :48:45.There's no evidence he's ever fired one until he comes to a shooting
:48:46. > :48:48.range in the Rocky Mountains, six days after his sertraline
:48:49. > :49:00.They have different kind of range areas, so one was for rifles,
:49:01. > :49:13.So I would just go and practice in each designated area.
:49:14. > :49:19.The manager here actually remembered James Holmes because of his badly
:49:20. > :49:22.dyed red hair but one of the other reasons he actually stood out
:49:23. > :49:27.In fact one of the people shooting alongside him complained
:49:28. > :49:31.She described the way he was shooting his pump action
:49:32. > :49:58.At this point Holmes appears acutely aware his mental
:49:59. > :50:11.Dysphoric mania is a profound state of mental turmoil.
:50:12. > :50:34.Thinking that's what he has, Holmes tells Hillary Allen to stay away.
:50:35. > :51:02.Holmes is now stockpiling bomb making equipment in his flat.
:51:03. > :51:04.But 1000 miles away in California, James Holmes' parents
:51:05. > :51:08.get no hint of anything wrong when they talk in early July.
:51:09. > :51:12.He never gave us any clues as to what was going on in his
:51:13. > :51:18.They offer to visit but he puts them off.
:51:19. > :51:23.Later they email to say they'll come in early August.
:51:24. > :51:36.He replies ? one line ?he has no plans that weekend.
:51:37. > :51:39.We had tickets to go to Denver on August 9th 2012.
:51:40. > :52:08.You're loading the car, you're getting stuff ready.
:52:09. > :52:10.In the hours before the shootings, James Holmes takes
:52:11. > :52:45.In many he's wearing contact lenses designed to look menacing.
:52:46. > :52:50.Alex was just, er a regular guy trying to have as much fun
:52:51. > :52:54.as he could and leave a mark and I always say that,
:52:55. > :52:58.if you had an encounter with Alex during the day,
:52:59. > :53:05.Jansen Young says her boyfriend Jon saved her life by shielding
:53:06. > :53:15.Had that bullet gone through that chair and through John I also
:53:16. > :53:24.So John is my true hero, I mean he truly did take a bullet for me.
:53:25. > :53:39.It's my first thought in the morning when I wake up,
:53:40. > :53:50.frequently during the day and the middle of the night
:53:51. > :53:56.that they can find some means or measures of comfort for how much
:53:57. > :54:13.Not just the people in the theatre but all the people in Aurora,
:54:14. > :54:22.all the first responders, all the medical people.
:54:23. > :54:25.We will never know for sure what turned James Holmes
:54:26. > :54:34.For some he will always be just plain evil.
:54:35. > :54:38.I don't think the medications caused these shootings,
:54:39. > :54:43.I think this guy with his evil thoughts, having concluded
:54:44. > :54:45.that he had no other alternative future, with the mental illness,
:54:46. > :54:49.led to this, that's what I think did it.
:54:50. > :54:55.For me as a psychiatrist it was a result of mental illness
:54:56. > :54:58.I can state with great confidence to myself that it was completely
:54:59. > :55:02.unrelated to the medication and of course another reason
:55:03. > :55:04.to believe that is, that he was as far as anyone knows
:55:05. > :55:06.not under the effect of the medication at
:55:07. > :55:14.But our investigatation of the timeline of events,
:55:15. > :55:17.joining the dots of what happened with his medication, suggests
:55:18. > :55:25.We've found no evidence Holmes planned to kill before
:55:26. > :55:27.the anti-depressants, and plenty to show how
:55:28. > :55:31.afterwards his mental state went rapidly downhill.
:55:32. > :55:37.No-one joined these dots up at his trial.
:55:38. > :55:41.Given that the nature of what happened to him and how
:55:42. > :55:45.he changed so dramatically just upon taking the drug I think
:55:46. > :55:49.they should have explored that further during the trial.
:55:50. > :55:52.If someone on an SSRI anti-depressant commits a violent
:55:53. > :55:57.crime, do you think the courts should take it into account?
:55:58. > :56:02.Yes, it should, no question about it and although it makes the whole
:56:03. > :56:05.process a bit more complicated I think that is going to become
:56:06. > :56:13.It's the kind of thing that everybody needs to get
:56:14. > :56:16.involved in thinking about, the prosecution, the defence,
:56:17. > :56:27.the victims, everyone in order to work out how we're generally
:56:28. > :56:30.And beyond the courts, there are calls for more
:56:31. > :56:32.awareness among patients, their families and doctors
:56:33. > :56:35.of the rare but potentially lethal side effects ? so people can watch
:56:36. > :56:42.Many doctors find it very hard to believe that a drug which is very
:56:43. > :56:45.effective in 99.9% of cases in people with depressions
:56:46. > :56:47.and phobias and obsessions could actually make someone
:56:48. > :56:58.It's certainly caused me to think that if I, or family and friends
:56:59. > :57:01.were prescribed an SSRI that I would make sure that the doctor
:57:02. > :57:05.paid very close attention to the person they're prescribing
:57:06. > :57:09.to because I wouldn't want this to happen to,
:57:10. > :57:12.this adverse drug reaction to happen to anyone really,
:57:13. > :57:19.All right, sherrif, get the defendant out
:57:20. > :57:25.James Holmes will spend the rest of his life in prison...
:57:26. > :57:30...a place in history as one of America's most
:57:31. > :57:41.But as growing numbers of us take them, is it
:57:42. > :57:43.time to recognise that, for a few, they could do
:57:44. > :57:59.If you are concerned about any of the issues
:58:00. > :58:08.raised in this programme, please visit bbc.co.uk/actionline.
:58:09. > :58:14.You will find details of organisations for support.
:58:15. > :58:17.You should not stop or change any medical treatment without first