Houston Chronicle

June 22, 2001

Yates had taken anti-psychotic drug

Husband says his wife used Haldolforatime

Houston Chronicle Medical Writer

The woman who confessed to killing her five children Wednesday previously had taken an anti-psychotic drug often used to treat such symptoms as hearing voices.

Although neither Andrea Pia Yates nor her husband, Russell, have suggested it was voices that prompted her to drown her children, an expert said the fact that at one point she was on Haldol in addition to an anti-depressant was very significant.

"Haldol is prescribed for psychotic patients hearing voices or thinking delusionally," said Dr. Lucy Puryear, a psychiatry professor in Baylor College of Medicine's mood disorders research program. "The patient usually functions normally as a result of the medication, but is also subject to reoccurrences when he or she goes off it, so it's important to be sure they're not at risk of hurting themselves or someone else."

Haldol was one of four drugs Russell Yates said his wife took. He said she was taking Effexor and Remeron, both anti-depressants, at the time of the killings and was taking Wellbutrin, an anti-depressant, and Haldol before that.

He said that previously she had been in therapy but was not at the time. He said they had recently talked about her going into therapy again but she had not got around to it yet.

John Vincent, chairman of the University of Houston department of psychology, called that "most unfortunate." He said studies have shown that patients do best who receive both medication and psychotherapy and that relying on medication alone can be risky.

Even as they acknowledged that it is too early to say, experts were still debating the role of postpartum depression in the killings. Vincent said the incident sounded like postpartum psychosis, an extremely rare (1 to 4 in 1,000) condition in which the mother loses touch with reality and often experiences hallucinations or delusions. But another expert said what really matters is whether Yates was suffering from depression.

"Whether it's postpartum depression is not the issue," said Dr. Lauren Marangell, head of the Baylor mood disorders program. "We don't know enough to say at this point. Depression is a brain-based disorder that is usually treatable and that doesn't typically lead to homicide. Stressful life events can worsen depression or psychotic disorders, and treatment is essential."

Marangell said events such as the death of a parent -- Andrea Pia Yates' father died in March -- or the birth of a child are classic examples of stressful life events. She said severe depression can include psychosis, and the presence of psychosis makes the possibility of violence more likely.

Haldol treats symptoms such as delusional or hallucinogenic thinking by blocking the flow of dopamine to the part of the brain that can hear voices. Puryear said Haldol has long been one of the first-line drugs for psychosis, though in recent years there are new ones she would prescribe first.

Both Puryear and Marangell said there was no real significance to three anti-depressants Yates was either taking or had taken. None belong to a class of drugs known as selective serotonin reuptake inhibitors -- such as Prozac, Paxil and Zoloft -- that are usually first-line treatment.

They agreed that the use of more than one drug at once usually means the condition is severe and didn't respond well to single drug treatment.

Puryear and Marangell also said there was absolutely no truth to the suggestion that the anti-depressants could have had side-effects that played a role in the killings. Puryear said such allegations tend to come from loved ones of patients disappointed that drugs such as Prozac did not prevent a family member from committing a violent act, usually suicide. She said doctors that agree with that point of view are usually out of the mainstream.

"It's just a horrible tragedy," said Puryear. "I wish it could have been prevented and feel badly, obviously, for the children but also the mother."

Copyright 2001 Houston Chronicle