The following was first published on Sharyl ATTKISSON‘s Free Substack

In the wake of yet another mass killing—the tragic event at Annunciation Catholic School in Minneapolis on August 27, 2025, where two children were murdered and 17 others injured—the public discourse often zeroes in on guns, manifestos, and societal failures.

But amid the clamor, a critical question seems to have faded from view: What role might legal and illegal drugs, and toxic exposures play in the volatile mix that drives some individuals to violence?

For years, reporters routinely probed the medical histories of perpetrators, revealing patterns of psychiatric drug use. Today, that line of inquiry has largely vanished, even as evidence mounts that certain medications carry warnings for suicidal thoughts and aggressive behavior, and environmental toxins disrupt brain function. Ignoring these factors not only overlooks potential triggers but also misses opportunities to prevent future tragedies through better data collection and analysis.

Read on for details.

When Medications Were Front and Center

In the late 1990s and early 2000s, mass killings prompted immediate questions about the perpetrators’ mental health treatments, including any prescribed drugs. This was partly because many suspects exhibited clear signs of mental illness, and their medications often came under the microscope.

For instance, in the 1999 Columbine High School shooting, where Eric Harris and Dylan Klebold killed 13 people, Harris had been prescribed the antidepressant Luvox (fluvoxamine), an SSRI known for potential side effects like agitation.

Similarly, in the 2005 Red Lake Senior High School shooting, 16-year-old Jeff Weise, who killed nine others before taking his own life, was on Prozac (fluoxetine), another SSRI.

Kip Kinkel, the 15-year-old behind the 1998 Thurston High School shooting in Oregon that left two dead and 25 injured, had also been prescribed Prozac.

These cases weren’t anomalies.

A compilation by advocacy groups like AbleChild lists over a dozen similar incidents, including the 2007 Virginia Tech massacre, where Seung-Hui Cho, who killed 32 people, had a history of mental health treatment and was prescribed antidepressants, though details on his actual compliance history was spotty.

In the 2012 Aurora theater shooting, James Holmes, who murdered 12 and injured 70, was under psychiatric care and had been prescribed sertraline (Zoloft), an antidepressant linked to manic episodes in some users.

Reporting at the time often highlighted these details, fueling debates about whether the drugs—intended to alleviate depression, anxiety, or bipolar disorder—could instead exacerbate violent impulses in vulnerable individuals.

This scrutiny aligned with emerging FDA warnings. In 2004, the agency mandated black-box labels on antidepressants, alerting users to increased risks of suicidal thoughts and behavior, particularly in young people. Some experts, like psychiatrist Peter Breggin, have long argued that SSRIs can induce violence and mania in a subset of patients, citing akathisia—a state of severe restlessness—as a potential trigger. A 2015 Swedish study of over 850,000 people found that antidepressants were associated with violent crime in 11,225 cases, though causality remains debated.

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The Shift: Silence Amid Pharma’s Rise

Around the early 2000s, something changed. Direct-to-consumer drug advertising exploded in the U.S. after FDA deregulation in 1997, flooding news outlets with pharma dollars. Coincidentally, in-depth reporting on perpetrators’ medications appeared to wane.

While historical databases like those from the Violence Project and Columbia Psychiatry note mental illness in up to 60% of mass shooters, specifics on prescriptions are increasingly absent from media narratives.

This omission avoids alienating advertisers, but leaves a gap in understanding root causes.

No one suggests medications alone are causing violence—and of course perpetrators bear responsibility for their actions. Yet many mass killers suffer from untreated or poorly managed mental illnesses, with studies showing 23% experiencing psychotic symptoms.

Drugs like SSRIs can disrupt brain chemistry, hormones, and the endocrine system, potentially amplifying aggression in those already unstable.

Add environmental factors: Young people face a barrage of toxic exposures, from endocrine-disrupting chemicals in plastics and pesticides to pharmaceuticals in water supplies. Research links these to behavioral changes, including increased aggression and impulsivity. Prenatal exposure to such disruptors has been shown to alter territorial and aggressive behaviors in animal studies, with human correlations to mood disorders. This “toxic stew” could tip troubled individuals over the edge, yet authorities and reporters rarely probe it.

Recent Cases: Unasked Questions

In more recent tragedies, medication status is often unreported or downplayed. Take the 2018 Parkland shooting at Marjory Stoneman Douglas High School, where Nikolas Cruz killed 17.

Cruz had documented mental health issues, including depression and ADHD, and was in treatment, but details on specific medications were scarcely mentioned in major coverage.

Similarly, in the 2022 Uvalde school shooting, where Salvador Ramos murdered 21, reports focused on his bullying and isolation, but omitted any inquiry into prescriptions despite known behavioral health interventions.

The 2023 Nashville Covenant School shooting by Audrey Hale involved mental health struggles, yet media emphasis was on firearms, not potential drug influences.

Even in 2024 and 2025 incidents, like the Midtown Manhattan shooting where the gunman referenced Chronic Traumatic Encephalopathy, a degenerative brain disease caused by repetitive head trauma, in a note, pharmacological details are absent from initial reports.

This pattern persists despite databases like the FBI’s active shooter reports noting concerning behaviors in two-thirds of cases, often tied to mental health conditions.

It’s worth noting the controversy: Some fact-checks dismiss broad claims linking antidepressants to shootings, arguing no causal evidence and that most perpetrators aren’t on meds. Many of the fact checkers are allied with drug industry interests. The fact is, the FDA’s warnings and case studies suggest patterns worth investigating, especially given that untreated mental illness affects a significant portion of shooters.

To address this blind spot, it would seem to be a positive step to create a national database cataloging the mental status, medications, and toxic exposures of mass killers and other violent offenders. By analyzing commonalities—such as specific drug classes or chemical biomarkers—policymakers could identify preventable factors, from better prescribing guidelines to regulating environmental exposures.

This isn’t about excusing violence but about listening to the signals these tragedies send. As mass shootings continue unabated, with over 400 incidents tracked in recent years, ignoring the interplay of biology, drugs, and toxins ensures we’ll keep asking the wrong questions—and missing the answers that could save lives.