Stephen Paddock, the man behind America’s worst ever mass shooting, was prescribed Valium months before the massacre
In the wake of the devastating shooting in Las Vegas, it has emerged that gunman Stephen Paddock was taking diazepam, the generic form of Valium.
The revelation has sparked a debate surrounding the powerful anti-anxiety medication and its side effects.
For the majority of users who take the medication under close supervision, side effects are akin to alcohol: drowsiness, dizziness, memory issues, and even sexual dysfunction.
However, in some rare cases the drug can trigger suicidal thoughts, aggressiveness, panic attacks, impulsive thoughts, and a lack of empathy.
On Wednesday, as the Twittersphere rushed to attribute Paddock’s shooting spree to his medication, doctors cautioned that it is highly unlikely – if not impossible – for diazepam alone to drive a person to shoot more than 500 people.
But the debate has thrown the anti-anxiety medication into the spotlight – with many questioning the regulation of prescriptions.
‘Aggression is one of the side effects in rare cases,’ Dr Daniel Amen, a psychiatrist at Amen Clinics in Chicago, told Daily Mail Online.
Dr Amen, a staunch critic of medication to treat psychiatric disorders, admitted that it is not common side effect – the common side effects are drowsiness, grogginess.
‘But like alcohol,’ he said, ‘for the vulnerable brain it can cause aggression.’
Dr. Joanna Gedzior, an assistant clinical professor of psychiatry at the Fresno Medical Education Program of the University of California, San Francisco, warns many doctors will be driven to prescribe more of a psychotropic drug if their patient’s symptoms are not easing.
‘We have to be very careful about this and ask, “Is it something I’m giving the patient that’s causing this?”,’ Dr Gedzior told the New York Times.
Diazepam is part of a family of drugs called benzodiazepines, which were first developed by a chemist in New Jersey in the 1960s.
They all act as tranquilizers to treat anxiety by dulling down the GABA receptors in the pre-frontal lobe. These receptors are thought to be overactive in people with clinical anxiety. As such, targeting them produces a calming effect.
The drugs can also act a muscle relaxant for pain.
They can be very effective in the short-term.
However, they are highly addictive, and official guidelines say they should only be prescribed for four weeks. That is rarely adhered to. Many doctors hand them out for longer – intensifying patients’ dependence.
And yet, trying to stop the medication is difficult, with terrible withdrawal symptoms.
Stephen Paddock was allegedly prescribed 50 10mg pills of diazepam in June.
To put that in context: anything near 40mg of Valium in one day would be a very strong dose, and not recommended unless advised by a doctor.
The drug is available in strengths of 2mg, 5mg and 10mg. Patients are advised to take 4mg in one day and consult their physician if they want or need more.
Physicians across the board – from family doctors to psychiatrists – are in broad agreement that Paddock’s crimes were not the product of a pill.
Even Dr Amen said: ‘It’s never just brain. There are a lot of people who have bad brains that do nothing bad. I think to understand him, we have to understand all the factors.
‘There are biological factors, like his medication and family history; psychological factors, like what he has experienced; social factors, what his day-to-day life what like; and spiritual factors, what is his sense of meaning and purpose?’
However, the drug has become a focal point of the investigation into the many reasons why Paddock came to be murderous and suicidal.
Dr Amen, a double board certified psychiatrist, said he stopped prescribing benzodiazepines in the early 90s when he opened his brain imaging unit to look at how such drugs impacted neurons.
‘I’ve been a psychologist for 35 years,’ he told Daily Mail Online.
‘When I was in my residency, Valium was widely prescribed. Then Xanax came onto the market and it was more widely prescribed. Then in 1991 I started looking at people’s brains and I stopped using these drugs because they’re toxic to brain function.’
According to Dr Amen, his brain scans have shown that the purpose of the drug (to target overactive neurotransmitters in the pre-frontal lobe) is the exact reason it can be dangerous.
‘If you decrease the frontal lobe, what happens? That part of the brain is needed for focus, forethought, judgment, impulse control, empathy. You can actually make someone less empathetic with Valium. So that’s why I’ve not been a fan of them for many years.’
One of the riskiest things about prescribing these drugs is working out an end date.
Weaning patients off diazepam is not easy.
‘When you start someone on them, it’s really hard to get them off,’ Dr Amen explained.
‘These drugs change a person’s brain, and the brain now needs them to function normally.
‘We have to be smart. If you’re taking psychiatric medication and you’re being properly supervised and they help you then just make sure you’re in regular contact with your doctor. But if you notice your behavior is changing, just stopping a medication like that can cause someone to go into a seizure or have rebound anxiety and aggression.’
The vast majority of psychotropic drugs in both the US and the UK are not prescribed by psychiatrists.
In 2009, a study by the U.S. Substance Abuse and Mental Health Services Administration found at least 62 percent of anti-anxiety and antidepressant medications were prescribed by family doctors. The agency estimates that figure has since risen closer to 70-80 percent.
‘They may not have the best training to do that. They are messing with people’s minds,’ Dr Amen said.