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This programme contains some scenes which some | :00:44. | :00:45. | |
The chances are, you or someone you know takes antidepressants. | :00:46. | :00:52. | |
The chances are, you or someone you know has been helped by these pills. | :00:53. | :00:55. | |
What are the chances, though, these widely prescribed drugs | :00:56. | :00:57. | |
Did you have any doubt that you would end up | :00:58. | :01:01. | |
Did antidepressants prompt a young man with no history of violence | :01:02. | :01:07. | |
to attack a packed cinema are five years ago, killing 12 | :01:08. | :01:10. | |
With unique access to court material and expert witnesses, | :01:11. | :01:20. | |
we revealed the possible link between antidepressants and one | :01:21. | :01:23. | |
You can't believe that it's possible for anyone to cause that much harm, | :01:24. | :01:41. | |
Could drugs which are safe for the majority who take them be, | :01:42. | :01:46. | |
for a small minority, the prescription for murder? | :01:47. | :01:59. | |
Just after midnight on the 20th July 2012. | :02:00. | :02:10. | |
The latest Batman film, The Dark Knight Rises, | :02:11. | :02:13. | |
is about to be shown in Theatre 9 of a local cinema | :02:14. | :02:16. | |
Alex was one of the first people to walk into that | :02:17. | :02:23. | |
And he had his choice of, you know, anywhere in there | :02:24. | :02:28. | |
Tom Sullivan's son Alex is there with a group of friends. | :02:29. | :02:37. | |
Alex's spot was twelve rows up, twelve seats in. | :02:38. | :02:41. | |
He was right in the middle because that's | :02:42. | :02:44. | |
We were four rows up and two seats in. | :02:45. | :02:52. | |
Also there, Jansen Young, with her boyfriend, Jon Blunk. | :02:53. | :02:58. | |
I was the third seat in and Jon was the fourth seat in. | :02:59. | :03:06. | |
Outside, 24-year-old James Holmes arrives, | :03:07. | :03:10. | |
intent on killing as many of the audience as he can. | :03:11. | :03:16. | |
This is the car that he drove to scale, and he pulls | :03:17. | :03:19. | |
And he walks the whole length around this movie theatre and he comes | :03:20. | :03:24. | |
in to the lobby and we have video of him. | :03:25. | :03:29. | |
six-year-old Veronica Moser-Sullivan. | :03:30. | :03:34. | |
Soon to become the youngest of Holmes' victims. | :03:35. | :03:38. | |
He goes across to Theatre Number 9 and he comes | :03:39. | :03:40. | |
in and he walks down here and he takes this seat. | :03:41. | :03:44. | |
And this seat is critical cos it's the one closest | :03:45. | :03:46. | |
The randomness of everything, it just depended on where you were | :03:47. | :03:53. | |
sitting and where you were at this particular time whether you lived | :03:54. | :03:55. | |
He lets himself out this door and he comes out | :03:56. | :04:00. | |
Now he's recently tinted the windows so no one can see in. | :04:01. | :04:05. | |
He puts up a sun visor over the front windshield so no can see, | :04:06. | :04:08. | |
Soon after the film starts, Holmes walks back into the theatre | :04:09. | :04:15. | |
wearing bullet proof armour, a gas mask, armed with tear gas, | :04:16. | :04:19. | |
a handgun, a shotgun and an assault rifle. | :04:20. | :04:25. | |
I just watched this canister smoke the whole way | :04:26. | :04:31. | |
it was in the air and it landed behind us in the back left | :04:32. | :04:34. | |
corner of the movie theatre, and when it landed, | :04:35. | :04:36. | |
He starts in with the 12 gauge shotgun, | :04:37. | :04:44. | |
six rounds, boom, boom, boom, he kills three, | :04:45. | :04:46. | |
Jon was so quick moving and he pushed me down behind | :04:47. | :04:53. | |
the seat so we were kneeling down and he said, | :04:54. | :04:55. | |
And then he said, "There's a man in the movie theatre shooting people." | :04:56. | :05:00. | |
And that was the last thing he said to me. | :05:01. | :05:04. | |
The next weapon he goes to, his main murder weapon, is this | :05:05. | :05:07. | |
He has chosen armour-piercing rounds, well, actually, steel | :05:08. | :05:13. | |
Alex Sullivan is next to his friend, Edgar. | :05:14. | :05:29. | |
Alex looked over at him as the bullets are flying and said, | :05:30. | :05:34. | |
and Edgar said, "We have to get down." | :05:35. | :05:41. | |
That was it, that was the point in which Alex | :05:42. | :05:52. | |
Now, this is a semi-automatic rifle, which means you only get one bullet | :05:53. | :06:05. | |
Well, he pulled the trigger 65 times. | :06:06. | :06:15. | |
At 65 trigger pulls it jams on him, so he walks up this way, | :06:16. | :06:19. | |
Holmes can't clear his jammed weapon. | :06:20. | :06:25. | |
He took that handgun and fired five more rounds. | :06:26. | :06:36. | |
Holmes then walks back outside to his car, | :06:37. | :06:39. | |
dropping the assault rifle on the ground. | :06:40. | :06:49. | |
They take him down at gunpoint over here, | :06:50. | :07:00. | |
They ask him a couple of questions, and one | :07:01. | :07:06. | |
of the questions is, "Are you here by yourself? | :07:07. | :07:08. | |
Holmes has also rigged his flat with bombs. | :07:09. | :07:23. | |
James Holmes killed 12 and injured 70. | :07:24. | :07:38. | |
Mass shooters tend to kill themselves or are killed. | :07:39. | :07:42. | |
Taking him alive gave a unique opportunity to ask why. | :07:43. | :08:01. | |
In custody, Holmes offered no answers. | :08:02. | :08:03. | |
When Holmes' hands were later bagged up to secure forensic evidence, | :08:04. | :08:17. | |
I knew just when I heard that the shooter had been taken | :08:18. | :08:24. | |
alive behind the theatre, this was very likely going to turn | :08:25. | :08:27. | |
into a trial, and that trial was very likely | :08:28. | :08:29. | |
going to turn on the issue of mental health. | :08:30. | :08:33. | |
It took three years for the case to come to trial. | :08:34. | :08:48. | |
By then, Holmes' appearance had changed. | :08:49. | :08:57. | |
James Holmes pleaded not guilty by reason | :08:58. | :08:58. | |
A year before the trial started, Dr William Reid | :08:59. | :09:12. | |
spoke to Holmes at length about his crimes. | :09:13. | :09:16. | |
His responses, dulled by the medication he was now on. | :09:17. | :09:33. | |
He's mentally ill but, in my view, when he did these | :09:34. | :09:36. | |
things he wasn't what most people would call crazy. | :09:37. | :09:41. | |
The case hinged on whether Holmes was so mentally | :09:42. | :09:43. | |
ill he couldn't be held responsible for his actions. | :09:44. | :09:47. | |
Jurors heard disturbing details of dark thoughts | :09:48. | :09:50. | |
of killing which he'd had since he was a teenager. | :09:51. | :09:54. | |
And they watched nearly 23 hours of Dr Reid's filmed interview. | :09:55. | :10:09. | |
The jury decided he was responsible for his actions | :10:10. | :10:11. | |
James Holmes was found guilty on all counts, and only narrowly | :10:12. | :10:17. | |
12 life sentences plus 3,318 years in prison - one of the longest | :10:18. | :10:33. | |
James Holmes is one of America's worst mass murderers - and I wanted | :10:34. | :10:56. | |
to understand more about why he carried out the killings. | :10:57. | :11:00. | |
The only reason explored in court was mental illness. | :11:01. | :11:04. | |
But could there be another explanation? | :11:05. | :11:07. | |
Holmes started taking the antidepressant Sertraline | :11:08. | :11:10. | |
Could the drug - known in Britain as Lustral - | :11:11. | :11:15. | |
It's either certainly a coincidence or there | :11:16. | :11:23. | |
The timing of when he took the medication, when the medication | :11:24. | :11:28. | |
was increased and his actions, it has to cause you to wonder | :11:29. | :11:32. | |
whether the medication didn't play some sort of role | :11:33. | :11:34. | |
The defence approached a UK-based antidepressant expert | :11:35. | :11:44. | |
Professor David Healy has long urged caution with the class | :11:45. | :11:52. | |
They are thought to work by boosting serotonin levels in the brain. | :11:53. | :11:57. | |
Though helpful to many, for some, he says, they can do | :11:58. | :12:00. | |
Professor Healy met James Holmes in prison. | :12:01. | :12:08. | |
I think the thing that hit me most about the interview that I had | :12:09. | :12:11. | |
Before the meeting, Professor Healy was sceptical | :12:12. | :12:19. | |
But by the end of his visit, he had reached a controversial conclusion. | :12:20. | :12:27. | |
I believe if he hadn't taken the Sertraline, he wouldn't | :12:28. | :12:30. | |
You really think it's as strong as that? | :12:31. | :12:35. | |
Professor Healy was not called to give evidence in court. | :12:36. | :12:43. | |
Jurors are very suspicious of theories that | :12:44. | :12:47. | |
a defence lawyer presents, even with mental illness, which is | :12:48. | :12:51. | |
The defence thought the jury simply wouldn't buy the idea | :12:52. | :12:59. | |
a prescription drug could have made Holmes plan and carry | :13:00. | :13:02. | |
Prosecutor George Brauchler doesn't buy it either. | :13:03. | :13:09. | |
You don't think the medication played any part whatsoever? | :13:10. | :13:12. | |
Not one that is worthy of consideration for the purposes | :13:13. | :13:15. | |
I'll tell you that, and you know who else agrees with me? | :13:16. | :13:21. | |
The defence team that refused to put on any evidence of that nonsense. | :13:22. | :13:24. | |
So that's what you think it is, nonsense? | :13:25. | :13:26. | |
I had interviewed Professor Healy before for a series of Panorama | :13:27. | :13:35. | |
films about the darker side of SSRIs. | :13:36. | :13:39. | |
We showed the drugs, which have been prescribed | :13:40. | :13:42. | |
for the last three decades, can cause withdrawal problems. | :13:43. | :13:44. | |
In rare cases, they've been linked to suicide and violence. | :13:45. | :13:46. | |
If they aren't the right drug for you, | :13:47. | :13:50. | |
They can throw you into a state of mental turmoil. | :13:51. | :13:57. | |
The programmes led to an official rethink of how | :13:58. | :14:02. | |
doctors should prescribe the drugs, especially to children | :14:03. | :14:04. | |
Since then, prescriptions for SSRIs have more than doubled. | :14:05. | :14:11. | |
In the UK alone, there were over 40 million prescriptions last year. | :14:12. | :14:16. | |
Even though we have all these negative effects, we are getting | :14:17. | :14:21. | |
We are in fact prescribing more of these drugs | :14:22. | :14:25. | |
We have got to look at these rare side effects much more closely. | :14:26. | :14:31. | |
Professor Peter Tyrer has been evaluating the effectiveness | :14:32. | :14:35. | |
of SSRI antidepressants since they were tested in the 1980s. | :14:36. | :14:38. | |
He thinks they could, in rare cases, prompt people to kill. | :14:39. | :14:47. | |
You can never be quite certain, with a rare side effect, | :14:48. | :14:49. | |
whether it's linked to a drug or not, as it could be | :14:50. | :14:52. | |
But it's happened just too frequently, with this class | :14:53. | :14:55. | |
It's obviously related to the drug, but we don't know exactly why. | :14:56. | :15:01. | |
He shot and killed both his grandparents and set | :15:02. | :15:04. | |
I've spoken to families across the world who believe | :15:05. | :15:11. | |
the drugs turned their loved ones into murderers. | :15:12. | :15:15. | |
He stabbed her new boyfriend and he died. | :15:16. | :15:19. | |
And he also stabbed his ex-girlfriend and a new | :15:20. | :15:24. | |
And then he went out into the back garden | :15:25. | :15:28. | |
We've discovered in the last three decades, the UK medicines regulator | :15:29. | :15:36. | |
has received 28 reports associating SSRI's to murder and 32 | :15:37. | :15:39. | |
The regulator says these reports do not prove | :15:40. | :15:45. | |
How convinced are you that the medication was to blame? | :15:46. | :15:50. | |
I'm totally convinced that if Shane hadn't taken the antidepressant, | :15:51. | :15:58. | |
If you are taking an SSRI these rare cases may sound alarming. | :15:59. | :16:04. | |
Doctors say patients shouldn't change or stop | :16:05. | :16:08. | |
taking their medication without first seeking | :16:09. | :16:10. | |
In one disturbing case we heard from the killer himself. | :16:11. | :16:18. | |
He's just been arrested for his son's murder | :16:19. | :16:20. | |
and is calmly shaking the hand of the police officer. | :16:21. | :16:25. | |
It incredible that I was ever in that state. | :16:26. | :16:35. | |
David Carmichael from Toronto, Canada strangled his 11-year-old | :16:36. | :16:41. | |
What do you think of this skate park? | :16:42. | :16:46. | |
I put him on the bed and I strangled him and I, | :16:47. | :16:51. | |
at three o'clock in the morning, I took off my hand | :16:52. | :16:56. | |
from around his throat, put him in the middle of the bed, | :16:57. | :16:59. | |
put his hands across his chest, kissed him on the lips and told him, | :17:00. | :17:03. | |
"I love you, I am really going to miss you, | :17:04. | :17:06. | |
And you remained calm, even after you did that? | :17:07. | :17:20. | |
After I strangled Ian, I sat and watched telly for six | :17:21. | :17:22. | |
hours and then I calmly called 911 and reported a homicide. | :17:23. | :17:25. | |
David Carmichael was suffering from a psychotic delusion his son's | :17:26. | :17:30. | |
life wasn't worth living because of brain damage. | :17:31. | :17:35. | |
In reality, Ian had mild epilepsy and a learning disability. | :17:36. | :17:44. | |
What I find the most difficult is what was going through his mind | :17:45. | :17:47. | |
at that time, the person he loved and knew that loved him | :17:48. | :17:50. | |
David Carmichael says the psychosis started soon after taking and SSRI | :17:51. | :18:16. | |
David Carmichael says the psychosis started soon after taking an SSRI | :18:17. | :18:18. | |
The only issue I may have is the fact that I have been | :18:19. | :18:23. | |
on an antidepressant for the last three weeks. | :18:24. | :18:24. | |
Paroxetine also goes by the brand names Seroxat or Paxil. | :18:25. | :18:29. | |
I never, ever even contemplated anything like that before | :18:30. | :18:31. | |
This was totally out of character for me. | :18:32. | :18:35. | |
Just like the Holmes' case, the role of the drugs | :18:36. | :18:37. | |
Unlike Holmes, David Carmichael was judged not criminally | :18:38. | :18:43. | |
responsible due to mental illness and sent to a secure hospital. | :18:44. | :18:47. | |
After four years he was thought no longer to be a danger and freed. | :18:48. | :18:57. | |
It just completely changed his behaviour, it changed what he viewed | :18:58. | :19:01. | |
the world as when he was on those antidepressants and then | :19:02. | :19:04. | |
when he went off of them he was back to the man that he was, | :19:05. | :19:08. | |
David Carmichael is suing the manufacturers of paroxetine, | :19:09. | :19:14. | |
the UK pharmaceutical giant, GlaxoSmithKline. | :19:15. | :19:19. | |
The role SSRI's have played in violent crime has rarely been | :19:20. | :19:45. | |
But I wanted to investigate what part they could have played | :19:46. | :19:50. | |
I've spent a year sifting through the evidence ? thousands | :19:51. | :19:55. | |
of files and hundreds of hours of video. | :19:56. | :19:59. | |
We never saw any signs of violence or troublesome things. | :20:00. | :20:06. | |
James Holmes' parents, Arlene, a nurse, and Bob, | :20:07. | :20:08. | |
a retired statistician have never spoken together on camera | :20:09. | :20:12. | |
He was never interested in guns or really even a violent kid, | :20:13. | :20:19. | |
that's why it was kind of surprising, it was that | :20:20. | :20:22. | |
James Holmes was born in 1987 in California. | :20:23. | :20:30. | |
On the surface, it was a normal childhood. | :20:31. | :20:34. | |
Jim was quiet but he seemed happy enough, just pretty much normal | :20:35. | :20:37. | |
Absolutely no interest in drinking or drugs, at all, ever. | :20:38. | :20:47. | |
In retrospect I think he was too good and maybe I should have worried | :20:48. | :20:51. | |
about the fact he was so good but as a mother you can | :20:52. | :20:55. | |
Hi, and our next speaker is James Holme. | :20:56. | :21:01. | |
In Personal life, he enjoys playing soccer and strategy games and his | :21:02. | :21:04. | |
Here he is in front of an audience just after finishing High School. | :21:05. | :21:13. | |
And the knowledge that's gained is then made available to the public | :21:14. | :21:16. | |
and the scientific community through the web. | :21:17. | :21:18. | |
He was academically bright and fascinated | :21:19. | :21:20. | |
He's interested in how we perceive reality. | :21:21. | :21:28. | |
Ever had a girlfriend in high school? | :21:29. | :21:54. | |
His awkwardness didn't seem to hold him back. | :21:55. | :21:57. | |
When he arrived in May 2011 to study a Ph.D. | :21:58. | :22:03. | |
in neuroscience at the University of Colorado, Holmes made friends. | :22:04. | :22:06. | |
He was nice, he was a little bit shy at first. | :22:07. | :22:08. | |
I'd sit next to him every day in class and and we'd exchange | :22:09. | :22:11. | |
But then in the halls when I would see him later, | :22:12. | :22:24. | |
his head would be down and he wouldn't even say hello. | :22:25. | :22:26. | |
Hillary Allen was one of six of the students on the same course. | :22:27. | :22:30. | |
A little bit, but we were part of a group of scientists. | :22:31. | :22:33. | |
Holmes says he studied neuroscience to gain insight into himself. | :22:34. | :22:40. | |
He thought his social awkwardness was evidence of a broken brain. | :22:41. | :23:01. | |
At college, Holmes was still awkward around women. | :23:02. | :23:04. | |
But when fellow student Gargi Datta, asked him out, Holmes said yes. | :23:05. | :23:37. | |
He even talked of buying a house in Colorado. | :23:38. | :23:42. | |
When you hear something like that, the last thing in the world | :23:43. | :23:50. | |
you would ever think is that something as bad as the shooting | :23:51. | :23:53. | |
Back in Colorado after a family Christmas in California though, | :23:54. | :24:02. | |
This and his social anxiety was starting to take its toll | :24:03. | :24:12. | |
He said he couldn't give these presentations he wanted, | :24:13. | :24:19. | |
He couldn't do this stand up talking. | :24:20. | :24:26. | |
It was very, very hard on him and interacting with so many people | :24:27. | :24:34. | |
all the time was, he said something to the effect of, | :24:35. | :24:37. | |
The relationship with Gargi was also faltering, | :24:38. | :24:40. | |
Gargi broke up with him a few days later. | :24:41. | :25:04. | |
They continued a casual relationship for a while when she offered advice | :25:05. | :25:23. | |
James Holmes came to the campus Student Wellness Centre and saw | :25:24. | :25:50. | |
University psychiatrist Dr Lynne Fenton. | :25:51. | :25:58. | |
The timeline of what happened over the next 17 weeks | :25:59. | :26:01. | |
Dr Fenton talks to Holmes for around 45 minutes about his anxiety. | :26:02. | :26:08. | |
And he tells her something he's never told his own family... | :26:09. | :26:10. | |
He's having intrusive thoughts of killing people. | :26:11. | :26:20. | |
After the killings, Holmes tells Dr Reid he's been imagining people | :26:21. | :26:26. | |
dead as a strategy to cope with social anxiety since his teens. | :26:27. | :26:32. | |
When he encountered any kind of confrontation with someone else, | :26:33. | :26:34. | |
it may have been an imagined confrontation someone | :26:35. | :26:38. | |
who was disagreeing or made him uncomfortable in some way, | :26:39. | :26:41. | |
Alarming as this may sound, psychiatrist said these kind | :26:42. | :27:02. | |
of intrusive thoughts are not uncommon. | :27:03. | :27:06. | |
He wasn't talking about a vengeful hatred. | :27:07. | :27:11. | |
He was talking about an aversion to mankind, being around much | :27:12. | :27:23. | |
of mankind was uncomfortable to him and it wasn't very rewarding to him, | :27:24. | :27:26. | |
so he wanted to avoid it, even though he couldn't avoid it. | :27:27. | :27:29. | |
And it doesn't necessarily pinpoint you as a future killer? | :27:30. | :27:31. | |
As Dr Fenton later said in court, she isn't | :27:32. | :27:35. | |
Dr Fenton considers whether his thinking | :27:36. | :27:48. | |
She prescribes, the antidepressant sertraline to ease his anxiety | :27:49. | :27:54. | |
His symptoms were exactly right for giving sertraline, | :27:55. | :28:01. | |
But his underlying personality, there's a certain | :28:02. | :28:07. | |
They are almost like an alien species to him and that sort | :28:08. | :28:13. | |
of person, it worries me a great deal when I'm prescribing. | :28:14. | :28:16. | |
Why does that worry you, what effect would you anticipate | :28:17. | :28:23. | |
Some of the underlying predispositions can come out more | :28:24. | :28:29. | |
strongly and obviously in the case of Mr Holmes, these | :28:30. | :28:32. | |
In a notebook found after the shootings, | :28:33. | :28:39. | |
Holmes describes the effect of the drug on his dark thoughts. | :28:40. | :28:45. | |
No more fear, no more fear of failure. | :28:46. | :28:52. | |
He told you medication had played a part in that, in reducing | :28:53. | :29:47. | |
I don't think of it as reducing the fear of consequences at all. | :29:48. | :29:54. | |
To the extent that he was taking the medication at the time, one | :29:55. | :29:58. | |
would expect him to be having less anxiety generally, but not becoming | :29:59. | :30:05. | |
more focussed on a terrible task, or a potentially psychotic task. | :30:06. | :30:11. | |
That doesn't occur to me, as a psychiatrist. | :30:12. | :30:16. | |
But Professor Healy believes the loss of fear of consequences | :30:17. | :30:19. | |
His awareness of the consequences seems to have been muted, | :30:20. | :30:27. | |
and this is a point that he makes quite clearly | :30:28. | :30:30. | |
when he began to keep a diary about how he was feeling. | :30:31. | :30:34. | |
He made it clear that the anxieties that he would normally have expected | :30:35. | :30:39. | |
to have in response to those kinds of thoughts he had | :30:40. | :30:41. | |
Another psychiatrist, Dr Phillip Resnick from Cleveland, | :30:42. | :30:49. | |
Ohio, was a prosecution expert, but wasn't called to give evidence. | :30:50. | :30:53. | |
He has never spoken publicly about the case. | :30:54. | :30:57. | |
He doesn't think the Sertraline was responsible for the shootings, | :30:58. | :31:00. | |
but agrees it could have played a role in freeing Holmes | :31:01. | :31:03. | |
With his particular combination of homicidal desires, the reduction | :31:04. | :31:18. | |
in the anxiety may have facilitated other forces. | :31:19. | :31:23. | |
But it obviously had quite a negative consequence as well, | :31:24. | :31:28. | |
If we accept at face value that he made the decision to carry | :31:29. | :31:34. | |
it out related to the reduced anxiety, yes, that would be true. | :31:35. | :31:41. | |
Despite his dark thoughts, experts we spoke to felt | :31:42. | :31:44. | |
until March, Holmes has no intent to actually kill. | :31:45. | :31:49. | |
But days after starting Sertraline, his thinking appears | :31:50. | :31:52. | |
It emerges in a very strange online chat he has with Gargi Datta. | :31:53. | :32:02. | |
James Holmes tells Gargi he feels like doing something "evil". | :32:03. | :32:08. | |
She asks him, "What do you feel like doing?" | :32:09. | :32:11. | |
He replies, "Kill people, of course." | :32:12. | :32:15. | |
This exchange is the first evidence of a bizarre theory | :32:16. | :32:18. | |
Prior to that he had never said anything delusional, | :32:19. | :32:31. | |
in your words, something irrational that didn't make sense. | :32:32. | :32:38. | |
Holmes writes more about it in his notebook. | :32:39. | :32:40. | |
He thinks he can earn points and increase his own | :32:41. | :32:43. | |
Prior to expressing this human capital theory, | :32:44. | :33:24. | |
do you think he actually really meant to kill anyone? | :33:25. | :33:26. | |
Or were these just general abstract thoughts in his head? | :33:27. | :33:30. | |
I think they were fantasies, and I don't think we have evidence | :33:31. | :33:33. | |
of a plan to do it, with an intention to do it, | :33:34. | :33:38. | |
So the human capital theory is quite a key | :33:39. | :33:42. | |
It's clear that he began to voice thoughts about harming | :33:43. | :33:49. | |
others, and thoughts that could be consistent with harming others, | :33:50. | :33:52. | |
Six days after starting on Sertraline, Holmes meets | :33:53. | :34:00. | |
Without going into any detail, he tells her he's still having | :34:01. | :34:08. | |
She's aiming to get him to a therapeutic dose of 150mg. | :34:09. | :34:18. | |
There's every evidence that if the drugs are suiting a person, | :34:19. | :34:22. | |
that increasing the dose and keeping on with them might be helpful, | :34:23. | :34:28. | |
and I use these drugs even though they can cause a problem, | :34:29. | :34:31. | |
but when they are causing a problem, increasing the dose | :34:32. | :34:33. | |
Hillary Allen studied alongside Holmes, but didn't | :34:34. | :34:42. | |
Then, less than two weeks after the dose was doubled, she gets | :34:43. | :34:48. | |
I got this text like oh, are you still sick, girl? | :34:49. | :34:55. | |
And I'm like oh, who's, wait, who is this? | :34:56. | :34:58. | |
Were you surprised that he contacted you like that? | :34:59. | :35:00. | |
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. |