Fifteen-year-old Christopher Pittman, peering around a Charleston, S.C., courtroom, is today's poster boy for the "Zoloft defense."
On trial for the 2001 shotgun murders of his grandparents, Jim and Joy Pittman, he is claiming, through his lawyers, that a switch between two antidepressants transformed him into a juvenile Jekyll and Hyde, haunted by and hostage to his nightmares come to life.
On top of growing concerns over the risks of antidepressant use among children, the Pittman trial is testing the public's perception of personal responsibility in the hazy gap between a diagnosed mental affliction and its treatment. Already, antidepressants have been under fire - particularly in their application to children and teens - for increasing the risk of suicidal thoughts and behavior, as some short-term trials have indicated. Now, the Pittman case is offering a lens on an intensifying debate, and a test of how far Americans are willing to go in blaming pills for personal actions.
"I think this is a trial to watch, in part because we're becoming aware that these drugs are not helping all children," says Jack King with the National Association of Criminal Defense Lawyers in Washington. "At the same time, the crime here was particularly horrible, and the defense is really going to have to explain that [Christopher] was not in control of himself."
A similar "Prozac defense" was deployed in some 80 cases in the 1990s. Yet it wasn't until 2000, in Connecticut, that a judge acknowledged an antidepressant's potential role in a crime and acquitted the defendant, Chris DeAngelo, of a robbery three years before.
In the case of Zoloft, which comes from the same family of "selective serotonin reuptake inhibitors" (SSRIs) as Prozac, the defense has gained more legal traction, with two successful cases in the past two years in California and Wyoming. Picking up on the strategy, some defense lawyers are even specializing in Zoloft defenses, leading drug company Pfizer to counter their effort with the "Zoloft Prosecutor's Manual."
The Pittman case, though, is the first criminal trial to test the Zoloft defense, and it touches on an evolving public consciousness of SSRIs' broad use by pediatricians in a country where 1 in 5 children are at some point diagnosed with depression.
The case also comes just a few months after the FDA mandated "black box" warnings for suicide risk - the nation's strongest caution, short of a ban - on Zoloft and 32 other antidepressants, a decision made in light of two Congressional hearings that revealed the FDA has known about problems with the drugs since 1996, but failed to take decisive action. In the last quarter of 2004, the use of such antidepressants dropped 10 percent among children; many attribute the decline to growing awareness of the drugs' potential danger, and to new reluctance in the face of the "black box" label.
To the drugs' critics, Christopher's plight reveals a deeper problem: rampant overprescription of antidepressants for blues that may often be nothing more than the throes of adolescent angst. Taking antidepressants "changes you, and you approach what I call 'learned helplessness,'" a blind faith in the prescribing doctor's advice, says drug-industry critic Jeffrey Wilson, author of "Irrational Medicine."
Beyond the trusting or doubting of physicians, though, the trial has focused attention on personal responsibility, says David Cohen, author of "Medications as Social Phenomena." "Our entire system is: You are responsible for your actions. We know Pittman did it. Now we need to look at the mitigating circumstances."
But others worry that, should the Zoloft defense fail, the high-profile case could leave drug opponents all the more zealous in their campaigns - and prevent people diagnosed with severe depression from taking drugs that can help them, and may prevent suicides as often than they're implicated in them. Despite research pointing to increased risk of suicide in the early stages of children's antidepressant use, a new study shows that some of the drugs do, in fact, prevent teen suicide. To help combat the confusion over seemingly conflicting results, the country's top psychiatrists last week launched a website, www.parentsmedguide.org.
"There's definitely a lot we don't know, but I'm concerned that some of the confusing and contradictory information may frighten parents and make them less likely to seek help for their children," says psychiatrist David Fassler, author of a book on childhood depression.
The Pittman family's defense is that Christopher was in an altered, uncharacteristic state of mind when he killed his grandmother and the grandfather he called "Pop-Pop." He was so attached to his grandfather that the family sometimes called him "Shadow" for sticking to his side.
According to testimony, Christopher was reeling from his parents' divorce and acting up in his grandparents' care. The family doctor first prescribed Paxil, then switched him to Zoloft. That change, some experts say, may have created a an intense reaction that pushed Christopher past his limit when his grandfather threatened to send him back to his father after a school-bus altercation. That night, Christopher has written, a "voice" in his head told him to kill his grandparents.
But prosecutors say Christopher's calculating actions - he set the trailer on fire, took the dog with him, and later lied about being kidnapped - are the trademark not of a victim, but of a willful murderer.
More disturbing for many onlookers, Christopher's story - a child disturbed by his parents' divorce and angry at his caretakers - is a common American tale.
Now, the Charleston jury will puzzle through what some say is essentially a timeless common-law case, one echoed in trials across milleniums.
"The Zoloft defense is not new," says Mr. King, the defense lawyer. "It's a variation on the involuntary intoxication defense - being slipped a Mickey in the bar."
While the ancient Romans held that wine revealed a person's true character, the Greeks believed that intoxication obscured it, changing one's very essence. It's an ancient debate, ultimately about the consequences of chemical states, that has been keenly felt in the courtroom.
"The real philosophical and scientific question is: Can drugs possess people?" says Mr. Cohen. "The Pittman case seems to back up findings that drugs like Zoloft interfere with normal thinking. Knowing all that the boy was wrapped up in, he just didn't think about all that right."