Boy's Murder Case Entangled in Fight Over Antidepressants

In recent months, however, the federal Food and Drug Administration has been examining data from clinical trials indicating that some depressed children and adolescents taking antidepressants think more about suicide and attempt it more often than patients given placebos. The findings varied between drugs. The F.D.A. is scheduled to hold an advisory committee meeting on the issue next month.

Against that backdrop, the case of Christopher Pittman - an otherwise obscure small-town murder case that may go to trial this fall - has become a battleground, where the scientific threads of the F.D.A. debate have become entangled with courtroom arguments and a family's tragedy.

Pfizer, the maker of Zoloft, has helped the county solicitor who is prosecuting Christopher Pittman. Plaintiffs' lawyers from Houston and Los Angeles, who between them have brought numerous civil lawsuits against Pfizer and other antidepressant makers, have signed onto the defense team. Groups opposed to pediatric antidepressant use have also championed the boy's case, which is being played out in Chester, S.C., a small town near the North Carolina border.

Locally, some people involved in the Pittman case said they have been stunned by the rush of outsiders. Even a forensic psychiatrist, who testified at a hearing that she believed that Christopher committed the murders while in a psychotic state induced by Zoloft, said she worried that the publicity may frighten parents whose children could benefit from Zoloft and similar drugs.

"I wished it could be staying in Chester, S.C., with this one kid," said the psychiatrist, Dr. Lanette Atkins of nearby Columbia, S.C., who has been retained by Christopher's public defender.

While the pediatric antidepressant debate has focused on potential suicide risks, aggressive behavior can be a side effect of antidepressants. There have also been case reports of adults and children on antidepressants acting violently. But only a handful of psychiatrists have ever argued that such medications can unleash rages so uncontrollable as to overwhelm a person's ability to distinguish between right and wrong and commit murder.

With the Pittman case pending, Pfizer, based in New York, declined to make company executives or lawyers available to be interviewed for this article. The company has previously said that no regulatory agency has ever found a connection between Zoloft and suicidal or homicidal behavior.

Zoloft belongs to a class of medications known as selective serotonin reuptake inhibitors, or S.S.R.I.'s, which also includes other popular drugs like Paxil and Prozac. In the last year, federal drug regulators have issued cautionary statements about most S.S.R.I.'s and similar medications prescribed for the treatment of pediatric depression. The one exception has been Prozac, the only S.S.R.I. formally approved for pediatric use after it was shown to be effective in tests with children and adolescents.

Regulators issued their advisories after a re-examination of drug makers' test data, much of which had not been publicly released. The disclosure of the test results has spurred demands by doctors' groups and others that drug companies be required to list all drug tests publicly, and a few producers have announced plans to do so.

If for some doctors such controversies seemed to have sprung up suddenly, the issues behind them were already stirring about three years ago - right around the time that Christopher Pittman fired four shotgun blasts into his grandparents as they slept.

A Last Chance Goes Wrong

When Christopher Pittman arrived in Chester in October 2001 to live with his paternal grandparents, Joe and Joy Pittman, the move seemed like his last, best chance to find stability.

He felt abandoned by his mother, according to medical reports. And his relationship with his father, who raised him in Florida, was troubled. "I haven't had that good a life; my real mom left when I was 2," Christopher Pittman told a forensic psychiatrist with the South Carolina Department of Juvenile Justice.

Psychiatric reports suggest that Christopher's tailspin began when his parents revived their relationship in 2001, only to end it yet again. After his mother left this time, he threatened to kill himself and was hospitalized. His diagnosis, records show, was mild chronic depression accompanied by defiant and negative behavior. He was put on Paxil.

But after about a week, his father, also named Joe, decided to remove him from the hospital and send him to live with his grandparents. There, a doctor put Christopher on Zoloft, the most widely prescribed S.S.R.I. antidepressant for pediatric patients and adults alike.

Initially, Christopher Pittman appeared to thrive. After a few weeks in Chester, though, he got into a dispute on a school bus and his grandparents threatened to send him back to his father. By the next morning, they were dead.

Dr. Pamela M. Crawford, a forensic psychiatrist who was asked by the case's prosecutor to examine the boy, concluded in her report that Christopher knew what he was doing when he took his grandparents' lives.

He provided "nonpsychotic reasons" for killing his grandparents, setting fire to the house, taking money from his grandparents and then stealing their car, Dr. Crawford's report states. "Following his detention by police, Christopher made self-protective statements to avoid arrest prior to admitting his actions."

Citing the continuing case, both Dr. Crawford and Dr. Atkins, the other forensic psychiatrist, declined to answer questions about their reports or court testimony.

At the time of the murders, questions about the safety of antidepressants were focused on adults, not youngsters. Just a few months earlier, a plaintiff's lawyer, Arnold Vickery, who is known as Andy, had convinced a federal jury hearing a lawsuit in Cheyenne, Wyo., that Paxil had caused a man to go on a murderous rampage.

In June 2001, that jury ordered  GlaxoSmithKline, the maker of Paxil, to pay $6.5 million to the relatives of Donald Schell, who, two days after starting on the drug, murdered his wife, his daughter and his granddaughter before killing himself. The company appealed, before settling the case, for undisclosed terms.

It is hard to draw comparisons between civil lawsuits and criminal cases like the one involving Christopher Pittman. Still, the Wyoming verdict was significant because it was the first time, after more than a decade of litigation, that a jury had concluded that an S.S.R.I.-type antidepressant could make users so agitated and unbalanced that they could kill others or themselves.

The Wyoming award has not led to similar verdicts, and drug makers like Pfizer take the position that antidepressants do not cause suicide or homicide.

Contradictory Reports

Little is known about Christopher Pittman's response to Paxil, because he took the drug for only a few days. And reports about his reactions to Zoloft vary sharply.

He later told a psychiatrist that his mood changed on the medication, to the extent that he "didn't have any feelings."

The notes of the local doctor who prescribed the medication for Christopher paint a different picture, according to court records.

That physician, who saw Christopher just a few days before the killings, described him this way: "Lots of energy. No plans to harm self. Not flying off the handle.

Psychiatrists have long known that adult patients might experience increased suicidal thinking or agitation during the first weeks of treatment with S.S.R.I.-type antidepressants. But in May 2003 GlaxoSmithKline made a disclosure related to pediatric use of the drug, which would set off a cascade of events that are still in motion.

That month, the drug maker told the federal Food and Drug Administration and its British counterpart agency that its re-examination of published and unpublished test data showed that adolescents who took Paxil during clinical trials had more suicidal thoughts or attempted suicide more often than those who received a placebo. About six months earlier, a curious F.D.A. analyst had contacted the company seeking more safety information.

Within weeks, British drug regulators told doctors not to prescribe Paxil to new patients younger than 18. In June 2003, the F.D.A followed suit, and a month later the agency asked all antidepressant makers for more safety data about their pediatric tests. In the weeks leading up to an emotionally charged F.D.A. hearing this past February on antidepressant safety, doctors learned that the drug industry had not published all the data gathered during pediatric trials of the medications.

Dr. David G. Fassler, a child and adolescent psychiatrist in Burlington, Vt., who attended the meeting, recalled being struck by the number of pediatric studies he had never known about although he followed medical journals.

"This was a lot more data than I knew existed," said Dr. Fassler, who is an official of the American Academy of Child and Adolescent Psychiatry, a professional group. That hearing also served as a public forum for grieving parents to testify about children who had committed suicide soon after they had started on antidepressants. Joe Pittman, Christopher's father, was there, reading a letter written by his son in prison, in which he blamed Zoloft for his grandparents' deaths.

"Through the whole thing, it was like watching your favorite TV show," wrote Christopher, who is now 15. "You know what is going to happen but you can't do anything to stop it." A Gathering of Lawyers

By then, his case had become the center of a pitched legal struggle. Mr. Vickery, the plaintiffs' lawyer who had won the Wyoming trial, was contacted about the Pittman case by the International Coalition for Drug Awareness, a group based in Utah opposed to antidepressant use.

Over the past decade, the group's director, Ann Blake Tracy, has become involved in several murder cases in which a defendant has been on antidepressants or other drugs. Ms. Tracy maintains that antidepressants "overstimulate the brain stem and cause you to go into a sleep-walk state where you can act out the nightmares you have." Mr. Vickery, who has been suing antidepressant makers since the mid-1990's, soon joined the defense team, offering his services for free. So did another plaintiffs' lawyer who has filed similar lawsuits, Karen Barth Menzies of Los Angeles.

Lawyers for Pfizer have also gotten involved. The case's prosecutor, Chester County Solicitor John R. Justice, was recently hospitalized with a serious illness and has not been available to comment. But he stated at a court hearing that Pfizer had provided information to him last year to help him prepare for the trial, according to a published report in The Herald, a newspaper in Rock Hill, S.C.

Christopher Taylor, an assistant country solicitor, said he thought that Pfizer had contacted Mr. Justice. The material provided by Pfizer, the article reported, included F.D.A. reports about Zoloft and previous court testimony by a psychiatrist, Dr. Peter R. Breggin, who is scheduled to testify on Christopher Pittman's behalf. Dr. Breggin, who has campaigned against the use of psychotropic drugs in children, has testified in numerous lawsuits and criminal trials that a link exists between S.S.R.I.-type antidepressants and both suicide and violence - positions rejected by drug makers like Pfizer and by many other experts.

"I have been given advice on how to cross Breggin," Mr. Justice was quoted as saying, adding that he had "been schooled on how these drugs are supposed to work."

The involvement of a drug company like Pfizer in a criminal proceeding is not unusual. Jennifer Yoder, a spokeswoman for Eli Lilly & Company, the maker of Prozac, said that over the years, a "Prozac defense" had been raised about 75 times in criminal cases and that the company had worked with prosecutors at times. She said she was unaware of any case in which the Prozac defense succeeded.

Not long ago, Mr. Vickery and Ms. Menzies asked the case's presiding judge to order the release of scores of Pfizer company documents about pediatric trials of Zoloft, claiming they were critical to their client's case. Those records were reviewed in the past by Ms. Menzies, the plaintiffs' lawyer, as part of a 2002 civil lawsuit filed in a Los Angeles federal court against Pfizer by the widow of a man who committed suicide a week after starting on Zoloft. The case was dismissed before trial.

According to court filings, the documents include early drafts of a published positive pediatric report about Zoloft that was later criticized by researchers for its methodology. F.D.A. officials also did not find that the study provided convincing evidence of Zoloft's efficacy in children and adolescents. Both Mr. Vickery and Ms. Menzies said they were barred from speaking specifically about the Pfizer documents because they were covered by confidentially agreements they had signed during civil proceedings. But with the Pittman defense, "I am hopeful that this case is the one that all of Pfizer's dirty laundry comes out," Mr. Vickery said.

Pfizer's lawyers have argued in court papers in the Pittman case that the documents being sought have nothing to do with the boy's situation, also noting that a Florida judge struck down a request for company records in a similar case. In addition, they have effectively accused Mr. Vickery and Ms. Menzies of using the case to make a cynical end run in order to obtain documents they want for other Zoloft-related lawsuits they are pursuing.

A Case in Limbo

A Pfizer spokeswoman, Mariann Caprino, said in an e-mail message that Mr. Vickery had made a business out of suing antidepressant makers. "In his three cases against Pfizer that were decided by the court in which he claimed Zoloft caused suicide, each case was decided in Pfizer's favor and dismissed by the court," she stated.

The case's presiding judge has yet to rule on the document disclosure issue.

Christopher Pittman's trial, scheduled to begin this fall, may be delayed because of the illness of Mr. Justice, the prosecutor. The teenager's lawyers are trying to move his case to juvenile court, where if convicted, he would be released by age 21 from a juvenile facility.

Meanwhile, lawyers like Mr. Vickery have continued to file lawsuits. Although Mr. Vickery failed earlier this year in his first attempt use an S.S.R.I. defense to win an acquittal in a murder case, at a trial in Detroit, the calculus of such cases may be changing.

In April, a time of intense media publicity about the issue, a man was acquitted of attempted murder after a state jury in Santa Cruz, Calif., found that he was not liable for his actions because of a reaction to Zoloft.

The case's prosecutor, Barbara Rizzieri, an assistant district attorney for Santa Cruz County, said the growing debate about antidepressants had played a role in the outcome. "If this had happened a year ago," she said "it truly would have been different."