Samuel Gershon: The trazodone cntrovery and its potential fatal consequences

By Samuel Gershon

In mid-September 2013, 12 people were murdered in a rampage of violence at the Washington Navy Yard by Aaron Alexis, an US Navy veteran. As one learns from Dr.  Charles Krauthammer’s article in Toronto’s National Post, one month prior to the incident Alexis had called police for protection from “three people” he thought “were following him, sending microwaves through walls,  making his skin vibrate and preventing him from sleeping”;  he had also visited twice during the month the emergency room of the Veterans Administration Hospital, and was prescribed “trazodone”, an “antidepressant”, known to be effective for some patients with insomnia. Dr. Krauthammer, a trained psychiatrist, who became a syndicated columnist, recognized that Alexis’ diagnosis was missed and had he been given an “antipsychotic” instead of an antidepressant, the incident could have probably been prevented.

The Washington Navy Yard incident was also noted in the September issue of RxISK’s website Newsletter, without any details, by Dr. David Healy, a professor of psychiatry. For Healy, the simple fact that Alexis had been on trazodone, at the time of the incident “re-emphasized the adverse effects all prescription drugs can have and why it is so inappropriate for companies to hide effects that might have contributed to this and other tragedies.”

Trazodone, the substance under scrutiny is an old drug. It was synthesized, in 1966, by G. Palazzo (1973), and it was primarily on the basis of Bruno Silvestrini‘s  (1967)  pharmacological studies that it was qualified as a psychotropic. The First International Symposium on Trazodone was held in Montreal, Canada, in 1973 (Ban and Silvestrini 1974).

Working with trazodone, I have not seen or experienced any such violent behavior in any patient on any dose, and there is no good evidence in its pharmacology that could explain it. Further, I concur with Dr. Krauthammer that the incidence may have been prevented by proper pharmacological treatment.  

Ban TA, Silvestrini B, editors. Trazodone. Proceeding of the First Interantional Smposium Montreal 1973. Basel: Karger; 1974.

Healy D. “RxISK.org” info(at)rxisk.org September 21, 2013.

Krauthammer  Ch. The real  Navy Yard scandal. Th National Post. September 23, 2013. 

Palazzo G. Chemistry of trazodone. Current Therapeutic Research 1973; 15: 745-8. 

Silvestrini B. Pharmacological outline of a new psychodrug. Presented at the First National Meeting of the Italian Society of Neuropsychopharmcology. Naples, 1967.

Samuel Gershon

July 31, 2014