RFK Jr. Misleads About Antidepressants and School Shootings – FactCheck.org

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A day after a shooting at a school in Minnesota, Health and Human Services Secretary Robert F. Kennedy Jr. claimed, as he has before, that certain antidepressant drugs, known as SSRIs, “might be contributing to violence” in such cases. Experts say there is no direct evidence linking SSRIs to mass shootings. He also falsely claimed SSRIs have black box warnings for homicidal ideation.

On Aug. 27, an assailant fired through the windows of the Annunciation Catholic School in Minneapolis, Minnesota, killing two students and injuring 21 others, before dying of a self-inflicted gunshot wound. The suspect, identified as Robin Westman, was a 23-year-old former student of the school who in 2020 legally changed their name to reflect a female gender identity. Authorities have not yet identified a motive, although the Minneapolis police chief said Westman “clearly had a deranged obsession with previous mass shooters.”

The day after the shooting, Kennedy appeared on “Fox & Friends,” and when asked whether he was looking into whether gender-affirming drugs might be behind the shooting, the secretary pivoted to SSRIs, or selective serotonin reuptake inhibitors.

“We’re launching studies on the potential contribution of some of the SSRI drugs and some of the other psychiatric drugs that might be contributing to violence,” Kennedy said. “You know, many of them … have black box warnings that warn of suicidal ideation and homicidal ideation. So we need — we can’t exclude those as a culprit.”

“This kind of violence is very recent. It’s a new thing in human history,” he added. “There was no time in the past when people would walk into a church or a classroom and start shooting people. And it’s not really happening in other countries. It’s happening here. And we need to look at all of the potential culprits that might be contributing to that.”

On Sept. 9, Kennedy again spoke of psychiatric drugs being a potential cause of school shootings and said it was being studied by the National Institutes of Health, although he did not single out SSRIs.

We asked HHS for details on the studies Kennedy said were being started, and what data supports a link between SSRIs and school shootings, but we did not receive a response. 

SSRIs, which are not gender-affirming drugs, do have black box warnings cautioning of an increased risk of suicidality, or suicidal thinking and behavior, in young people. But the warning is not the same as an increased risk of suicide — and doesn’t extend to homicidal thoughts or behavior. Depression and other mental health conditions raise the risk of suicide, and treatment can help.

Regardless, experts told us there is no evidence to support the notion that SSRI use is why America has so many mass shooting events. (To date, there is no information about whether Westman was taking an SSRI or any other psychiatric drug.)

“There’s no relationship between SSRIs and mass shootings,” Dr. Ragy Girgis, a clinical psychiatrist at Columbia University and the New York State Psychiatric Institute who is an expert in mass murder and violence in mental illness, told us.

Dr. Paul S. Appelbaum, a psychiatrist also at Columbia, agreed. “If you think about the profile of typical mass shooters (young, male, socially isolated, nurturing grievances), it’s not surprising that some of them would be taking SSRIs for depression and/or anxiety,” he told us in an email. “But the available data do not suggest that SSRIs make them more likely to engage in mass shootings. Indeed, to the extent that SSRIs alleviate their distress, they may reduce the risk of violence.”

“There is no credible evidence that SSRIs or other antidepressants cause school or mass shootings,” James Densley, co-founder of the Violence Prevention Project Research Center at Hamline University in Minnesota, told us in an email.

Kennedy has repeatedly invoked SSRIs in the past as an explanation for school shootings, as we’ve noted before. 

Speaking to Elon Musk in 2023 about school shootings, for example, Kennedy claimed there is “tremendous circumstantial evidence” that “SSRIs and benzos and other drugs are doing this.”

“Prior to the introduction of Prozac, we had almost none of these events in our country,” he continued, referring to the first SSRI approved in the U.S., in 1987. “The one thing that we have that’s different than anybody in the world is the amount of psychiatric drugs our children are taking.”

“There’s no time in American history or human history that kids were going to schools and shooting their classmates,” he also told comedian Bill Maher on a podcast that same year. “It really started happening coterminous with the introduction of these drugs, with Prozac and the other drugs.”

Kennedy has made similar remarks on other occasions.

Mass shootings, including at schools, have in fact occurred prior to 1987, although it’s true that the events have become more common over time. (The statistics depend on how a mass shooting is defined; one definition requires at least four people other than the shooter to be injured or killed.)

Densley, who is also a professor and chair of criminology and criminal justice at Metropolitan State University in Minnesota, said Kennedy’s claim that there were almost no school shootings before Prozac “is historically and demonstrably false.”

“Countries with the highest antidepressant use based on OECD Health Data (e.g., Iceland, Canada, etc.) also have very low rates of gun homicide and virtually no mass shootings, further undercutting the ‘more SSRIs = more shootings’ claim,” he added, referring to data from the Organization for Economic Cooperation and Development.

Database Data Doesn’t Support Link

Several databases of mass shootings fail to show a connection to SSRI usage.

Girgis, who is a curator of the Columbia Mass Murder Database, told us that in his database, only about 4% of mass shooters in the U.S. over the last three decades had a history of ever taking antidepressants, and only 7% had a history of ever taking any kind of psychotropic medication.

“We discovered psychotropic medication use among perpetrators of mass shootings to be far below rates in the general population,” Girgis and co-authors wrote in a letter to the editor published in Psychiatry Research in September, sharing an analysis of those results. “In most cases, they were either not actively taking psychotropic medication(s) at the time of, or anytime proximate to, the shootings, or medication appeared to play no causal role.”

While acknowledging some inherent limitations in the database information, which may not be complete, the authors concluded that the “scientific evidence strongly suggests that antidepressant medications, such as SSRIs, do not directly cause people to commit mass murders and suicide.”

While the percentages are different, the Violence Project’s database also does not support a link between antidepressant medications and mass shootings. In the database, which covers 1966 through 2024, 24% of mass shooters took some prescribed psychiatric medication at some point in their lives, Densely said, and among those with known medication status, “the share with a recorded SSRI tracks the background rate of antidepressant use in the U.S. general population. Specifically, 22 perpetrators in our database were known to have taken SSRI medications, which is 11% of mass shooters. The CDC says that about 13% of U.S. adults (and 8% of adult men) reported antidepressant use in the past 30 days (among adolescents, it’s ~3–4%).”

Densley noted that “people in acute crisis are more likely to be prescribed medication, so simple yes/no comparisons overstate any drug–violence link.”

These results are consistent with a 2019 review of publicly available information about school shootings between 2000 and 2017, which found that “most school shooters were not previously treated with psychotropic medications – and even when they were, no direct or causal association was found.”

SSRIs and Violence

There are some studies that have identified associations between SSRI treatment and violence. A 2020 study, for example, used registry data in Sweden and found an association between being convicted of a violent crime and being dispensed SSRI medication, when comparing periods of use versus non-use in the same individuals.

However, because the studies are observational, and cannot control for all of the factors that might have also contributed to violence, such as disease severity, it does not mean that the SSRIs necessarily caused the violence. 

“Given that a vast majority of individuals taking SSRIs will not commit violent crimes, our results should also not be used as reason to withhold SSRI treatment from patients who may benefit from it, especially as causality remains unclear,” the authors of the 2020 paper cautioned.

In the study, fewer than 3% of SSRI users committed a violent crime, and young men and those with a history of violent crime drove most of the observed association.

Girgis, who was not involved in the study, noted that some of the violent crimes in the paper would not necessarily involve physical violence, but instead would be classified as aggression in the scientific literature.

“Aggression is an important construct and is horrible, but it is not violence,” he said.

In his view, all the Swedish study shows “is that people with more severe depression receive antidepressants.”

Regardless, the paper does not say anything about SSRIs and mass shootings.

Dr. Seena Fazel, a professor of forensic psychiatry at the University of Oxford, who was a co-author of the Swedish paper, told us that the study “will not be directly relevant to mass shootings. It’s based in Sweden, where guns are highly regulated (and for hunting purposes primarily).” He said he was “not aware of this having been studied in a way that would allow definitive conclusions.”

SSRIs and Suicidality

As for suicidality, Kennedy is correct that there are black box warnings on SSRIs that caution that the drugs could raise the risk of suicidal thinking or behavior in people below the age of 24. That, however, is not the same as an increase in suicide. And the labels, which have been controversial, also note that depression and other mental health conditions “are themselves associated with increases in the risk of suicide.” Experts told us that the issue is nuanced and is not as simple as it might appear. 

The Food and Drug Administration first applied black box warnings to all antidepressants in 2004 for children and teens. The warnings were based on an FDA-commissioned meta-analysis, which went back and scoured two dozen randomized pediatric clinical trials for suicide-related adverse events, after a report to the FDA indicated there could be a concern with one SSRI.

As the FDA’s website explains, the meta-analysis “showed a greater risk of suicidality during the first few months of treatment in those receiving antidepressants,” at a rate of about 4% compared with the placebo risk of 2%. There were, however, no suicides recorded in the trials. 

The FDA recommended that patients starting the drugs “should be observed closely for clinical worsening, suicidality, or unusual changes in behavior” and that families “should be advised to closely observe the patient and to communicate with the prescriber.”

In 2007, the agency extended the warnings up to the age of 24. As the black box warning explains, studies have not found an increased risk of suicidality in adults above the age of 24, and in older adults above the age of 65, there is a reduced risk.

Some experts do not agree with the warnings, arguing that they have done more harm than good when the overall data doesn’t suggest that SSRIs increase the risk of suicide.

“These studies aren’t linking SSRIs with suicide,” Girgis said. “They suggest links with suicidal thoughts and suicidal behavior that does not lead to suicide. And there’s a big difference.”

Girgis explained that one possibility is that antidepressant treatment allows depressed patients to report their suicidal thoughts more. 

“In studies, when we see that suicidal thoughts increase after someone receives a medication, it’s not because the medication is causing suicidal thoughts,” he said. “It’s because the person is improving. The suicidal thoughts are now becoming disagreeable to them, and they’re reporting them to their clinicians because they want help.”

A 2021 review about depression in teens notes that a 2007 meta-analysis that included more trials than the FDA analysis “showed a small but still significant risk difference of 0.7 percentage points … for suicidal ideation or attempted suicide between adolescents receiving a drug and those receiving placebo.” But data “from more recent trials of antidepressant treatment in the pediatric population show no significant difference in suicide risk … possibly because these trials included suicide-specific measures, whereas the previous trials relied on reported adverse events,” it said.

Experts have also pointed to data that show a decline in teen and young adult suicides when SSRIs first came out, as well as a rise in suicides for those groups after the FDA warnings, which studies have found did not increase monitoring for suicidal thoughts or behaviors, but did reduce prescribing and other treatment for depression.

“In the most rigorous studies on mental healthcare, suicide attempts and suicide deaths, the black box warnings consistently backfired because they reduced care and increased all adverse outcomes through increased stigma and fear,” Stephen Soumerai, a professor of population medicine at Harvard Pilgrim Health Care Institute who has co-authored several of those studies, told us.

“Taken as a whole (i.e., not cherry-picking individual studies) the available data do not show an increased risk of either suicide or homicide with SSRIs,” Columbia’s Appelbaum said. “Indeed, if you look at the rates of SSRI use internationally, you will see that there are a number of countries with higher rates than or equivalent rates to the US that have nowhere near our incidence of mass shootings. But in none of them are guns as readily available as in the US.”

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