The documents, which were sent to the BMJ by an anonymous source, appear to suggest a link between the drug fluoxetine (Prozac), made by Eli Lilly, and suicide attempts and violence. They also suggest that Eli Lilly officials were aware in the 1980s that fluoxetine had troubling side effects and sought to minimise their likely negative effect on prescribing.

The documents reportedly went missing during the case of Joseph Wesbecker in 1994, who killed eight people at his workplace in 1989, while taking fluoxetine. He then shot and killed himself.

In 1994, some of the relatives of the victims brought a civil suit against Eli Lilly, alleging that the company had known about the side effects of fluoxetine for years (including the fact that it might increase violence). The company won the case, but was later forced to admit that it had made a secret settlement with the plaintiffs during the trial, which meant that the verdict was invalid.

One of the documents, dated November 1988, reports that in clinical trials fluoxetine can cause behavioural disturbances. The FDA recently issued a warning that antidepressants can cause stimulatory side effects such as agitation, panic attacks, insomnia, and aggressiveness.

These documents provide "the missing link" between the recent FDA advice and what Lilly scientists knew 16 years ago, says Harvard psychiatrist Dr Joseph Glenmullen.

Dr Richard Kalpit, the FDA clinical reviewer who approved fluoxetine, said he was not given the Lilly data. "These data are very important. If this report was done by Lilly or for Lilly, it was their responsibility to report it to us and to publish it."

Congressman Maurice Hinchey (Democrat, New York), who is currently reviewing the documents to determine whether Lilly withheld data
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Contact: Emma Dickinson
edickinson@bmj.com
44-207-383-6529
BMJ-British Medical Journal
30-Dec-2004