A Prescription for Murder? Panorama


A Prescription for Murder?

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This programme contains some scenes which some

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The chances are, you or someone you know takes antidepressants.

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The chances are, you or someone you know has been helped by these pills.

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What are the chances, though, these widely prescribed drugs

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Did you have any doubt that you would end up

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Did antidepressants prompt a young man with no history of violence

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to attack a packed cinema are five years ago, killing 12

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With unique access to court material and expert witnesses,

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we revealed the possible link between antidepressants and one

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You can't believe that it's possible for anyone to cause that much harm,

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Could drugs which are safe for the majority who take them be,

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for a small minority, the prescription for murder?

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Just after midnight on the 20th July 2012.

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The latest Batman film, The Dark Knight Rises,

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is about to be shown in Theatre 9 of a local cinema

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Alex was one of the first people to walk into that

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And he had his choice of, you know, anywhere in there

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Tom Sullivan's son Alex is there with a group of friends.

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Alex's spot was twelve rows up, twelve seats in.

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He was right in the middle because that's

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We were four rows up and two seats in.

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Also there, Jansen Young, with her boyfriend, Jon Blunk.

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I was the third seat in and Jon was the fourth seat in.

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Outside, 24-year-old James Holmes arrives,

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intent on killing as many of the audience as he can.

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This is the car that he drove to scale, and he pulls

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And he walks the whole length around this movie theatre and he comes

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in to the lobby and we have video of him.

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six-year-old Veronica Moser-Sullivan.

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Soon to become the youngest of Holmes' victims.

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He goes across to Theatre Number 9 and he comes

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in and he walks down here and he takes this seat.

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And this seat is critical cos it's the one closest

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The randomness of everything, it just depended on where you were

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sitting and where you were at this particular time whether you lived

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He lets himself out this door and he comes out

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Now he's recently tinted the windows so no one can see in.

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He puts up a sun visor over the front windshield so no can see,

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Soon after the film starts, Holmes walks back into the theatre

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wearing bullet proof armour, a gas mask, armed with tear gas,

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a handgun, a shotgun and an assault rifle.

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I just watched this canister smoke the whole way

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it was in the air and it landed behind us in the back left

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corner of the movie theatre, and when it landed,

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He starts in with the 12 gauge shotgun,

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six rounds, boom, boom, boom, he kills three,

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Jon was so quick moving and he pushed me down behind

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the seat so we were kneeling down and he said,

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And then he said, "There's a man in the movie theatre shooting people."

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And that was the last thing he said to me.

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The next weapon he goes to, his main murder weapon, is this

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He has chosen armour-piercing rounds, well, actually, steel

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Alex Sullivan is next to his friend, Edgar.

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Alex looked over at him as the bullets are flying and said,

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and Edgar said, "We have to get down."

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That was it, that was the point in which Alex

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Now, this is a semi-automatic rifle, which means you only get one bullet

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Well, he pulled the trigger 65 times.

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At 65 trigger pulls it jams on him, so he walks up this way,

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Holmes can't clear his jammed weapon.

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He took that handgun and fired five more rounds.

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Holmes then walks back outside to his car,

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dropping the assault rifle on the ground.

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They take him down at gunpoint over here,

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They ask him a couple of questions, and one

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of the questions is, "Are you here by yourself?

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Holmes has also rigged his flat with bombs.

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James Holmes killed 12 and injured 70.

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Mass shooters tend to kill themselves or are killed.

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Taking him alive gave a unique opportunity to ask why.

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In custody, Holmes offered no answers.

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When Holmes' hands were later bagged up to secure forensic evidence,

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I knew just when I heard that the shooter had been taken

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alive behind the theatre, this was very likely going to turn

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into a trial, and that trial was very likely

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going to turn on the issue of mental health.

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It took three years for the case to come to trial.

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By then, Holmes' appearance had changed.

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James Holmes pleaded not guilty by reason

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A year before the trial started, Dr William Reid

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spoke to Holmes at length about his crimes.

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His responses, dulled by the medication he was now on.

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He's mentally ill but, in my view, when he did these

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things he wasn't what most people would call crazy.

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The case hinged on whether Holmes was so mentally

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ill he couldn't be held responsible for his actions.

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Jurors heard disturbing details of dark thoughts

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of killing which he'd had since he was a teenager.

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And they watched nearly 23 hours of Dr Reid's filmed interview.

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The jury decided he was responsible for his actions

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James Holmes was found guilty on all counts, and only narrowly

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12 life sentences plus 3,318 years in prison - one of the longest

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James Holmes is one of America's worst mass murderers - and I wanted

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to understand more about why he carried out the killings.

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The only reason explored in court was mental illness.

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But could there be another explanation?

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Holmes started taking the antidepressant Sertraline

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Could the drug - known in Britain as Lustral -

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It's either certainly a coincidence or there

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The timing of when he took the medication, when the medication

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was increased and his actions, it has to cause you to wonder

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whether the medication didn't play some sort of role

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The defence approached a UK-based antidepressant expert

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Professor David Healy has long urged caution with the class

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They are thought to work by boosting serotonin levels in the brain.

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Though helpful to many, for some, he says, they can do

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Professor Healy met James Holmes in prison.

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I think the thing that hit me most about the interview that I had

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Before the meeting, Professor Healy was sceptical

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But by the end of his visit, he had reached a controversial conclusion.

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I believe if he hadn't taken the Sertraline, he wouldn't

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You really think it's as strong as that?

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Professor Healy was not called to give evidence in court.

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Jurors are very suspicious of theories that

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a defence lawyer presents, even with mental illness, which is

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The defence thought the jury simply wouldn't buy the idea

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a prescription drug could have made Holmes plan and carry

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Prosecutor George Brauchler doesn't buy it either.

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You don't think the medication played any part whatsoever?

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Not one that is worthy of consideration for the purposes

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I'll tell you that, and you know who else agrees with me?

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The defence team that refused to put on any evidence of that nonsense.

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So that's what you think it is, nonsense?

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I had interviewed Professor Healy before for a series of Panorama

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films about the darker side of SSRIs.

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We showed the drugs, which have been prescribed

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for the last three decades, can cause withdrawal problems.

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In rare cases, they've been linked to suicide and violence.

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If they aren't the right drug for you,

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They can throw you into a state of mental turmoil.

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The programmes led to an official rethink of how

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doctors should prescribe the drugs, especially to children

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Since then, prescriptions for SSRIs have more than doubled.

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In the UK alone, there were over 40 million prescriptions last year.

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Even though we have all these negative effects, we are getting

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We are in fact prescribing more of these drugs

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We have got to look at these rare side effects much more closely.

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Professor Peter Tyrer has been evaluating the effectiveness

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of SSRI antidepressants since they were tested in the 1980s.

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He thinks they could, in rare cases, prompt people to kill.

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You can never be quite certain, with a rare side effect,

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whether it's linked to a drug or not, as it could be

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But it's happened just too frequently, with this class

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It's obviously related to the drug, but we don't know exactly why.

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He shot and killed both his grandparents and set

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I've spoken to families across the world who believe

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the drugs turned their loved ones into murderers.

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He stabbed her new boyfriend and he died.

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And he also stabbed his ex-girlfriend and a new

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And then he went out into the back garden

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We've discovered in the last three decades, the UK medicines regulator

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has received 28 reports associating SSRI's to murder and 32

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The regulator says these reports do not prove

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How convinced are you that the medication was to blame?

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I'm totally convinced that if Shane hadn't taken the antidepressant,

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If you are taking an SSRI these rare cases may sound alarming.

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Doctors say patients shouldn't change or stop

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taking their medication without first seeking

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In one disturbing case we heard from the killer himself.

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He's just been arrested for his son's murder

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and is calmly shaking the hand of the police officer.

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It incredible that I was ever in that state.

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David Carmichael from Toronto, Canada strangled his 11-year-old

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What do you think of this skate park?

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I put him on the bed and I strangled him and I,

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at three o'clock in the morning, I took off my hand

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from around his throat, put him in the middle of the bed,

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put his hands across his chest, kissed him on the lips and told him,

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"I love you, I am really going to miss you,

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And you remained calm, even after you did that?

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After I strangled Ian, I sat and watched telly for six

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hours and then I calmly called 911 and reported a homicide.

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David Carmichael was suffering from a psychotic delusion his son's

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life wasn't worth living because of brain damage.

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In reality, Ian had mild epilepsy and a learning disability.

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What I find the most difficult is what was going through his mind

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at that time, the person he loved and knew that loved him

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David Carmichael says the psychosis started soon after taking and SSRI

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David Carmichael says the psychosis started soon after taking an SSRI

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The only issue I may have is the fact that I have been

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on an antidepressant for the last three weeks.

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Paroxetine also goes by the brand names Seroxat or Paxil.

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I never, ever even contemplated anything like that before

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This was totally out of character for me.

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Just like the Holmes' case, the role of the drugs

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Unlike Holmes, David Carmichael was judged not criminally

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responsible due to mental illness and sent to a secure hospital.

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After four years he was thought no longer to be a danger and freed.

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It just completely changed his behaviour, it changed what he viewed

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the world as when he was on those antidepressants and then

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when he went off of them he was back to the man that he was,

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David Carmichael is suing the manufacturers of paroxetine,

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the UK pharmaceutical giant, GlaxoSmithKline.

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The role SSRI's have played in violent crime has rarely been

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But I wanted to investigate what part they could have played

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I've spent a year sifting through the evidence ? thousands

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of files and hundreds of hours of video.

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We never saw any signs of violence or troublesome things.

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James Holmes' parents, Arlene, a nurse, and Bob,

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a retired statistician have never spoken together on camera

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He was never interested in guns or really even a violent kid,

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that's why it was kind of surprising, it was that

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James Holmes was born in 1987 in California.

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On the surface, it was a normal childhood.

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Jim was quiet but he seemed happy enough, just pretty much normal

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Absolutely no interest in drinking or drugs, at all, ever.

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In retrospect I think he was too good and maybe I should have worried

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about the fact he was so good but as a mother you can

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Hi, and our next speaker is James Holme.

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In Personal life, he enjoys playing soccer and strategy games and his

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Here he is in front of an audience just after finishing High School.

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And the knowledge that's gained is then made available to the public

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and the scientific community through the web.

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He was academically bright and fascinated

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He's interested in how we perceive reality.

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Ever had a girlfriend in high school?

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His awkwardness didn't seem to hold him back.

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When he arrived in May 2011 to study a Ph.D.

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in neuroscience at the University of Colorado, Holmes made friends.

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He was nice, he was a little bit shy at first.

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I'd sit next to him every day in class and and we'd exchange

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But then in the halls when I would see him later,

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his head would be down and he wouldn't even say hello.

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Hillary Allen was one of six of the students on the same course.

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A little bit, but we were part of a group of scientists.

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Holmes says he studied neuroscience to gain insight into himself.

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He thought his social awkwardness was evidence of a broken brain.

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At college, Holmes was still awkward around women.

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But when fellow student Gargi Datta, asked him out, Holmes said yes.

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He even talked of buying a house in Colorado.

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When you hear something like that, the last thing in the world

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you would ever think is that something as bad as the shooting

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Back in Colorado after a family Christmas in California though,

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This and his social anxiety was starting to take its toll

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He said he couldn't give these presentations he wanted,

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He couldn't do this stand up talking.

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It was very, very hard on him and interacting with so many people

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all the time was, he said something to the effect of,

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The relationship with Gargi was also faltering,

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Gargi broke up with him a few days later.

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They continued a casual relationship for a while when she offered advice

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James Holmes came to the campus Student Wellness Centre and saw

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University psychiatrist Dr Lynne Fenton.

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The timeline of what happened over the next 17 weeks

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Dr Fenton talks to Holmes for around 45 minutes about his anxiety.

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And he tells her something he's never told his own family...

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He's having intrusive thoughts of killing people.

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After the killings, Holmes tells Dr Reid he's been imagining people

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dead as a strategy to cope with social anxiety since his teens.

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When he encountered any kind of confrontation with someone else,

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it may have been an imagined confrontation someone

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who was disagreeing or made him uncomfortable in some way,

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Alarming as this may sound, psychiatrist said these kind

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of intrusive thoughts are not uncommon.

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He wasn't talking about a vengeful hatred.

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He was talking about an aversion to mankind, being around much

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of mankind was uncomfortable to him and it wasn't very rewarding to him,

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so he wanted to avoid it, even though he couldn't avoid it.

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And it doesn't necessarily pinpoint you as a future killer?

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As Dr Fenton later said in court, she isn't

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Dr Fenton considers whether his thinking

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She prescribes, the antidepressant sertraline to ease his anxiety

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His symptoms were exactly right for giving sertraline,

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But his underlying personality, there's a certain

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They are almost like an alien species to him and that sort

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of person, it worries me a great deal when I'm prescribing.

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Why does that worry you, what effect would you anticipate

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Some of the underlying predispositions can come out more

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strongly and obviously in the case of Mr Holmes, these

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In a notebook found after the shootings,

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Holmes describes the effect of the drug on his dark thoughts.

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No more fear, no more fear of failure.

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He told you medication had played a part in that, in reducing

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I don't think of it as reducing the fear of consequences at all.

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To the extent that he was taking the medication at the time, one

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would expect him to be having less anxiety generally, but not becoming

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more focussed on a terrible task, or a potentially psychotic task.

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That doesn't occur to me, as a psychiatrist.

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But Professor Healy believes the loss of fear of consequences

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His awareness of the consequences seems to have been muted,

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and this is a point that he makes quite clearly

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when he began to keep a diary about how he was feeling.

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He made it clear that the anxieties that he would normally have expected

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to have in response to those kinds of thoughts he had

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Another psychiatrist, Dr Phillip Resnick from Cleveland,

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Ohio, was a prosecution expert, but wasn't called to give evidence.

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He has never spoken publicly about the case.

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He doesn't think the Sertraline was responsible for the shootings,

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but agrees it could have played a role in freeing Holmes

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With his particular combination of homicidal desires, the reduction

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in the anxiety may have facilitated other forces.

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But it obviously had quite a negative consequence as well,

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If we accept at face value that he made the decision to carry

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it out related to the reduced anxiety, yes, that would be true.

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Despite his dark thoughts, experts we spoke to felt

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until March, Holmes has no intent to actually kill.

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But days after starting Sertraline, his thinking appears

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It emerges in a very strange online chat he has with Gargi Datta.

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James Holmes tells Gargi he feels like doing something "evil".

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She asks him, "What do you feel like doing?"

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He replies, "Kill people, of course."

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This exchange is the first evidence of a bizarre theory

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Prior to that he had never said anything delusional,

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in your words, something irrational that didn't make sense.

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Holmes writes more about it in his notebook.

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He thinks he can earn points and increase his own

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Prior to expressing this human capital theory,

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do you think he actually really meant to kill anyone?

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Or were these just general abstract thoughts in his head?

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I think they were fantasies, and I don't think we have evidence

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of a plan to do it, with an intention to do it,

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So the human capital theory is quite a key

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It's clear that he began to voice thoughts about harming

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others, and thoughts that could be consistent with harming others,

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Six days after starting on Sertraline, Holmes meets

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Without going into any detail, he tells her he's still having

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She's aiming to get him to a therapeutic dose of 150mg.

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There's every evidence that if the drugs are suiting a person,

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that increasing the dose and keeping on with them might be helpful,

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and I use these drugs even though they can cause a problem,

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but when they are causing a problem, increasing the dose

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Hillary Allen studied alongside Holmes, but didn't

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Then, less than two weeks after the dose was doubled, she gets

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I got this text like oh, are you still sick, girl?

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And I'm like oh, who's, wait, who is this?

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Were you surprised that he contacted you like that?

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Yeah, I was because it was like that awkward social demeanour,

:35:01.:35:03.

Later, Holmes tells Hillary her shorts are distracting him in class.

:35:04.:35:15.

I remember receiving that and just like kind

:35:16.:35:16.

of blushing and kind of trying to laugh it off

:35:17.:35:19.

and just trying not to create an awkward situation because,

:35:20.:35:22.

you know, we're colleagues, in a sense.

:35:23.:35:25.

Aside from the fact that you have a guy who is now actively

:35:26.:35:30.

beginning to think and plan about harming others

:35:31.:35:34.

in a way that he just hadn't been doing before,

:35:35.:35:36.

James Holmes has his fourth appointment

:35:37.:35:44.

with Dr Fenton just a week after making a move

:35:45.:35:46.

By this stage, he's been on Sertraline for just

:35:47.:35:50.

Far from getting better on the pills, though,

:35:51.:35:57.

Doctor Fenton's notes of this appointment suggest

:35:58.:35:59.

Hostile thoughts he won't elaborate on

:36:00.:36:25.

Dr Fenton ups to dose once more - now to 150 milligrams.

:36:26.:36:31.

A spelling mistake on his prescription means

:36:32.:36:35.

He sends Dr Fenton an angry email with symbols she doesn't understand.

:36:36.:37:21.

Holmes never tells Dr Fenton the full truth

:37:22.:37:23.

And by now, they appear to have dangerously intensified.

:37:24.:37:30.

In his case, I think they became in effect pyschotic

:37:31.:37:33.

thoughts after a bit, they became delusional,

:37:34.:37:35.

but they were allowed free rein, and one can never be absolutely

:37:36.:37:39.

certain about this, but the whole history makes me feel that

:37:40.:37:43.

if in fact he wasn't taking the Sertraline, they wouldn't have

:37:44.:37:47.

You think this might not have happened?

:37:48.:37:51.

Should Dr Fenton have been more worried?

:37:52.:37:57.

It isn't on her radar that this drug could be causing the kinds

:37:58.:38:00.

So at the point that she notes in April

:38:01.:38:06.

that he appears to be psychotic she then increases the dose to 150

:38:07.:38:11.

milligrams, are you saying you think the psychosis was actually

:38:12.:38:16.

We asked Dr Fenton for an interview, but she declined.

:38:17.:38:26.

In a statement, the University of Colorado says doctor-patient

:38:27.:38:28.

confidentiality laws forbid her from talking about

:38:29.:38:32.

Holmes' care without his consent, which he has never given.

:38:33.:38:41.

Like all prescription drugs, Sertraline comes with a list

:38:42.:38:43.

Some of the "uncommon" or "rare" ones read like a roll-call

:38:44.:38:49.

Lack of caring, thinking abnormal, aggression, psychotic disorder...

:38:50.:39:02.

These warnings are based, in part, on case reports

:39:03.:39:04.

the manufacturer Pfizer has received about patients who had

:39:05.:39:07.

They're normally confidential, but I've seen some.

:39:08.:39:14.

Vivid stories of patients with psychotic symptoms,

:39:15.:39:17.

some strikingly similar to the Holmes case.

:39:18.:39:21.

"Patient began to verbalise feelings of killing

:39:22.:39:23.

"This 50-year-old female patient reported experiencing homicidal

:39:24.:39:30.

thoughts concerning family members two hours after taking

:39:31.:39:32.

The patient was hospitalised and Sertraline discontinued.

:39:33.:39:38.

According to these documents, by March of 1994, Pfizer had details

:39:39.:39:47.

of 13 reported cases of psychosis linked to Sertraline.

:39:48.:39:52.

Five of them were detailed enough to evaluate, and the company

:39:53.:39:55.

concluded there was no other obvious cause.

:39:56.:40:00.

This report about a ten-year-old boy is particularly disturbing.

:40:01.:40:05.

"Some time at the beginning of August 95, the patient's mental

:40:06.:40:08.

status began to deteriorate, and the patient took a loaded gun

:40:09.:40:11.

out of his grandfather's truck and shot his eight-year-old brother

:40:12.:40:15.

The documents make clear Pfizer told regulators

:40:16.:40:21.

what they found and the drug patient information leaflet

:40:22.:40:24.

was changed, but none of these cases were put into the public

:40:25.:40:28.

In Colorado, it's nearly the end of term

:40:29.:40:57.

These are representative images of dopaminergic neurons.

:40:58.:41:05.

On May 17th, Holmes has to face the class

:41:06.:41:07.

That was always daunting on our minds,

:41:08.:41:14.

this big oral examination that was basically, you could

:41:15.:41:17.

either move forward in the programme or not.

:41:18.:41:21.

It becomes painfully clear Holmes is not going to move forward.

:41:22.:41:29.

It was kind of apparent throughout the presentation

:41:30.:41:31.

that he just really wasn't into it, or just didn't

:41:32.:41:34.

It was quite uncomfortable to witness, actually.

:41:35.:41:39.

So that final presentation, that stood out

:41:40.:41:40.

Five days later, Holmes walks into a gun shop

:41:41.:41:47.

On 25th May, just three days after buying this handgun,

:41:48.:42:08.

James Holmes is pushing Dr Fenton for another Sertraline prescription.

:42:09.:42:15.

His bank records show on 28th May the money

:42:16.:42:18.

for the prescription comes out of his bank account.

:42:19.:42:20.

The records also show another transaction on that day.

:42:21.:42:31.

The purchase of the shotgun marks the start

:42:32.:42:33.

of what James Holmes calls the mission, the move

:42:34.:42:37.

towards putting his human capital theory into practice.

:42:38.:42:57.

Holmes wrote in his notebook how his obsession with killing evolves.

:42:58.:43:02.

Intense aversion of people, cause unknown.

:43:03.:43:05.

Began long ago, suppressed by greater fear of others.

:43:06.:43:09.

"Start small, buy stun gun and folding knife, buy handgun."

:43:10.:43:23.

His thoughts about potentially doing things begin to escalate

:43:24.:43:30.

as the dose of the drug escalates, and it also becomes clear

:43:31.:43:34.

that he ends up on a course of action that, once it gels in place,

:43:35.:43:39.

becomes very difficult for him to extricate himself from, again

:43:40.:43:45.

And this is critical to making the case that the drug played

:43:46.:43:52.

I think, at least in James Holmes' mind, he believed

:43:53.:43:59.

that while he was on the medication it had an effect on him

:44:00.:44:04.

and by reducing the anxiety helped to free him to carry out

:44:05.:44:08.

Well, I think that there may be some truth to that

:44:09.:44:18.

Holmes is now entirely focussed on his mission.

:44:19.:44:26.

Nothing else matters, especially not his end of year exams.

:44:27.:44:44.

I didn't really care if I passed or failed at that time.

:44:45.:44:48.

He goes through the motions knowing failure is inevitable.

:44:49.:44:50.

That same day, he buys an assault rifle.

:44:51.:44:58.

James Holmes fails his exams and then four days later

:44:59.:45:00.

Maybe he should have been more emotional about it but he just

:45:01.:45:08.

seemed really emotionally flat, not upset, not mad, just

:45:09.:45:11.

flat, that'd be the best way to describe him.

:45:12.:45:28.

Did he seem worried about his future?

:45:29.:45:30.

Before quitting his course, James Holmes has a final

:45:31.:45:33.

For the second time she brings in a colleague, thinking Holmes may

:45:34.:45:39.

Offers of an anti-psychotic drug and free treatment

:45:40.:45:43.

He couldn't see a reason to continue treatment if he was not gonna be

:45:44.:45:53.

Dr Fenton had the power to lock Holmes up but she felt

:45:54.:45:58.

She did contact the campus security team though to ask for criminal

:45:59.:46:04.

Knowing nothing of the weapons he's bought, Dr.

:46:05.:46:18.

Fenton phones Holmes' mother for more background.

:46:19.:46:20.

The doctor reveals little about his mental state.

:46:21.:46:24.

There was no hint in this conversation that she was concerned

:46:25.:46:27.

that your son might do something, harmful to himself

:46:28.:46:29.

I was reassured by her phone call rather than alarmed.

:46:30.:46:38.

James Holmes later tells Dr Healy he finishes his last

:46:39.:46:42.

prescription of sertraline and then abruptly stops.

:46:43.:46:49.

When you get a person like James Holmes halting them

:46:50.:46:51.

abruptly, the problems the drug has caused can endure for weeks

:46:52.:46:54.

Stopping them suddenly is very unwise.

:46:55.:46:59.

It's well established that you have a withdrawal problem

:47:00.:47:03.

and these adverse effects that you may have had even when starting

:47:04.:47:06.

the drugs they all come back with a vengeance.

:47:07.:47:08.

So the paranoid thoughts, hostile aggressive thoughts

:47:09.:47:09.

We can't be sure exactly when Holmes came off the drugs.

:47:10.:47:17.

But, the last prescription takes him to 26th June ? three weeks

:47:18.:47:20.

The fact that Mr Holmes was off it for three weeks even though

:47:21.:47:32.

he had the abrupt ending, means to me that it was unlikely

:47:33.:47:39.

or I can't say impossible but played a very small role rather

:47:40.:47:43.

Even if you've been on them for say six, seven weeks and you get

:47:44.:47:52.

to a high dose and then stop it can be six or seven weeks before

:47:53.:47:55.

the effects wear off and in some cases and this is one

:47:56.:48:01.

of the problems with these drugs, sometimes they last that even

:48:02.:48:04.

From this day on James Holmes starts doing things he's never done before:

:48:05.:48:14.

He dyes his hair bright red, He posts on a swinger's sex website.

:48:15.:48:17.

And crucially, he now visits the cinema and starts drawing

:48:18.:48:24.

detailed plans of the shootings in the notebook.

:48:25.:48:30.

There's another significant change in James Holmes' behaviour

:48:31.:48:34.

He starts to use the guns he's been buying.

:48:35.:48:40.

There's no evidence he's ever fired one until he comes to a shooting

:48:41.:48:45.

range in the Rocky Mountains, six days after his sertraline

:48:46.:48:48.

They have different kind of range areas, so one was for rifles,

:48:49.:49:00.

So I would just go and practice in each designated area.

:49:01.:49:13.

The manager here actually remembered James Holmes because of his badly

:49:14.:49:19.

dyed red hair but one of the other reasons he actually stood out

:49:20.:49:22.

In fact one of the people shooting alongside him complained

:49:23.:49:27.

She described the way he was shooting his pump action

:49:28.:49:31.

At this point Holmes appears acutely aware his mental

:49:32.:49:58.

Dysphoric mania is a profound state of mental turmoil.

:49:59.:50:11.

Thinking that's what he has, Holmes tells Hillary Allen to stay away.

:50:12.:50:34.

Holmes is now stockpiling bomb making equipment in his flat.

:50:35.:51:02.

But 1000 miles away in California, James Holmes' parents

:51:03.:51:04.

get no hint of anything wrong when they talk in early July.

:51:05.:51:08.

He never gave us any clues as to what was going on in his

:51:09.:51:12.

They offer to visit but he puts them off.

:51:13.:51:18.

Later they email to say they'll come in early August.

:51:19.:51:23.

He replies ? one line ?he has no plans that weekend.

:51:24.:51:36.

We had tickets to go to Denver on August 9th 2012.

:51:37.:51:39.

You're loading the car, you're getting stuff ready.

:51:40.:52:08.

In the hours before the shootings, James Holmes takes

:52:09.:52:10.

In many he's wearing contact lenses designed to look menacing.

:52:11.:52:45.

Alex was just, er a regular guy trying to have as much fun

:52:46.:52:50.

as he could and leave a mark and I always say that,

:52:51.:52:54.

if you had an encounter with Alex during the day,

:52:55.:52:58.

Jansen Young says her boyfriend Jon saved her life by shielding

:52:59.:53:05.

Had that bullet gone through that chair and through John I also

:53:06.:53:15.

So John is my true hero, I mean he truly did take a bullet for me.

:53:16.:53:24.

It's my first thought in the morning when I wake up,

:53:25.:53:39.

frequently during the day and the middle of the night

:53:40.:53:50.

that they can find some means or measures of comfort for how much

:53:51.:53:56.

Not just the people in the theatre but all the people in Aurora,

:53:57.:54:13.

all the first responders, all the medical people.

:54:14.:54:22.

We will never know for sure what turned James Holmes

:54:23.:54:25.

For some he will always be just plain evil.

:54:26.:54:34.

I don't think the medications caused these shootings,

:54:35.:54:38.

I think this guy with his evil thoughts, having concluded

:54:39.:54:43.

that he had no other alternative future, with the mental illness,

:54:44.:54:45.

led to this, that's what I think did it.

:54:46.:54:49.

For me as a psychiatrist it was a result of mental illness

:54:50.:54:55.

I can state with great confidence to myself that it was completely

:54:56.:54:58.

unrelated to the medication and of course another reason

:54:59.:55:02.

to believe that is, that he was as far as anyone knows

:55:03.:55:04.

not under the effect of the medication at

:55:05.:55:06.

But our investigatation of the timeline of events,

:55:07.:55:14.

joining the dots of what happened with his medication, suggests

:55:15.:55:17.

We've found no evidence Holmes planned to kill before

:55:18.:55:25.

the anti-depressants, and plenty to show how

:55:26.:55:27.

afterwards his mental state went rapidly downhill.

:55:28.:55:31.

No-one joined these dots up at his trial.

:55:32.:55:37.

Given that the nature of what happened to him and how

:55:38.:55:41.

he changed so dramatically just upon taking the drug I think

:55:42.:55:45.

they should have explored that further during the trial.

:55:46.:55:49.

If someone on an SSRI anti-depressant commits a violent

:55:50.:55:52.

crime, do you think the courts should take it into account?

:55:53.:55:57.

Yes, it should, no question about it and although it makes the whole

:55:58.:56:02.

process a bit more complicated I think that is going to become

:56:03.:56:05.

It's the kind of thing that everybody needs to get

:56:06.:56:13.

involved in thinking about, the prosecution, the defence,

:56:14.:56:16.

the victims, everyone in order to work out how we're generally

:56:17.:56:27.

And beyond the courts, there are calls for more

:56:28.:56:30.

awareness among patients, their families and doctors

:56:31.:56:32.

of the rare but potentially lethal side effects ? so people can watch

:56:33.:56:35.

Many doctors find it very hard to believe that a drug which is very

:56:36.:56:42.

effective in 99.9% of cases in people with depressions

:56:43.:56:45.

and phobias and obsessions could actually make someone

:56:46.:56:47.

It's certainly caused me to think that if I, or family and friends

:56:48.:56:58.

were prescribed an SSRI that I would make sure that the doctor

:56:59.:57:01.

paid very close attention to the person they're prescribing

:57:02.:57:05.

to because I wouldn't want this to happen to,

:57:06.:57:09.

this adverse drug reaction to happen to anyone really,

:57:10.:57:12.

All right, sherrif, get the defendant out

:57:13.:57:19.

James Holmes will spend the rest of his life in prison...

:57:20.:57:25.

..a place in history as one of America's most

:57:26.:57:30.

But as growing numbers of us take them, is it

:57:31.:57:41.

time to recognise that, for a few, they could do

:57:42.:57:43.

If you are concerned about any of the issues

:57:44.:57:59.

raised in this programme, please visit bbc.co.uk/actionline.

:58:00.:58:08.

You will find details of organisations for support.

:58:09.:58:14.

You should not stop or change any medical treatment without first

:58:15.:58:17.

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