Kuykendall, J. R.

English

Case Western Reserve University School of Law

Health Matrix: The Journal of Law-MedicineVolume 15 | Issue 12005LETTER TO THE EDITORS OF HEALTHMATRIX -- Is Antidepressant DrugDiscontinuation Warranted Prior to PolygraphAdministration ?J. R. KuykendallFollow this and additional works at: https://scholarlycommons.law.case.edu/healthmatrixPart of the Health Law and Policy CommonsThis Note is brought to you for free and open access by the Student Journals at Case Western Reserve University School of Law Scholarly Commons. Ithas been accepted for inclusion in Health Matrix: The Journal of Law-Medicine by an authorized administrator of Case Western Reserve UniversitySchool of Law Scholarly Commons.Recommended CitationJ. R. Kuykendall, LETTER TO THE EDITORS OF HEALTH MATRIX -- Is Antidepressant Drug Discontinuation Warranted Prior toPolygraph Administration ?, 15 Health Matrix 235 (2005)Available at: https://scholarlycommons.law.case.edu/healthmatrix/vol15/iss1/12LETTER TO THE EDITORS OF HEALTHMATRIXIS ANTIDEPRESSANT DRUGDISCONTINUATION WARRANTEDPRIOR TO POLYGRAPHADMINISTRATION?J R. KuykendalltAlthough the use of polygraph evidence is allowed in many legalsituations, knowledge of the influence of legitimate drug use on thosetests is limited. One of the most common indications for drug therapyis depression, and several drug classes are used to treat the many as-pects of this psychological disorder. Currently, there are no publishedguidelines or precautions for drug cessation prior to polygraph testing.This communication is meant to address this deficiency and is in-tended for the non-medical professional as well as the lay public.The involuntary or "autonomic" nervous system controls basicfunctions-which do not require conscious effort-such as breathing,blood pressure, heart rate, perspiration, and body temperature. Con-trol of these autonomic nervous functions is achieved by two opposingsystems (a sort of checks and balances effect), which are termed thesympathetic and parasympathetic nervous systems. The sympatheticnervous system is also termed "adrenergic" because the neurotrans-mitters involved in these processes are the hormone epinephrine(adrenalin) and the neurotransmitter norepinephrine. The sympatheticnervous system is generally activated in the "flight or fight" re-sponses, which are elicited by fear, hunger, and sexual aggression toname a few. The chemical signals of the sympathetic nervous system(epinephrine and norepinephrine) cause increases in blood pressure,heart rate and breathing rate. In opposition to the sympathetic (orexcitatory) nervous system is the parasympathetic nervous system.The parasympathetic nervous system is also termed "cholinergic"t PhD. BioChemistry, University of Tennessee 1988; Pharm D., Idaho StateUniveristy 1994; currently Assistant Professor of Medicinal Chemistry, Raabe Col-lege of Pharmacy, Ohio Northern University.because the primary neurotransmitter is acetylcholine. This system isable to cause slowing of heart rate and breathing rate. A well-characterized exception to this scheme is the perspiration response,which is caused by sympathetic activation, but acetylcholine is thechemical signal that mediates this response.The autonomic control of basal body functions such as breathing,blood pressure, heart rate, and perspiration can be monitored usingelectric and/or pneumatic devices. This is the basis of polygraph test-ing, which employs three basic features, 1) a blood pressure cuff todetect changes in blood pressure, 2) pneumatically operated recordersto detect changes in respiration, and 3) electrodes fastened to the fin-gers and connecting to an electrical device for recording of the "gal-vanic skin reflex," which is a result of changes in the activity of sweatpores in a person's hands.' The responses to questions are monitoredthrough changes in respiration, blood pressure, and perspiration,which are not readily controlled by alterations in conscious thought(such as motor control of voluntary movement). Rather, these altera-tions in involuntary functions are thought to more likely representemotional responses to the thoughts evoked by the investigator'squestions.The central nervous system's role in voluntary responses and con-scious thought, among many other functions, is far more complex thanthat of the involuntary peripheral nervous systems (sympathetic andparasympathetic). However, both the central and peripheral nervoussystems use epinephrine and acetylcholine as neurotransmitters. Also,a third major neurotransmitter, serotonin, is a primary factor involvedin the central nervous system activity. Drugs affecting behavior canoften cause changes in the norepinephrine, acetylcholine, and sero-tonin activities in the brain. Antidepressant drugs can cause an in-crease in either norephinephrine or serotonin (or both). Some of theearlier antidepressants, 2 primarily affect the adrenergic (norepineph-rine) and cholinergic (acetylcholine) systems, and some simultane-ously affect serotonergic (serotonin) systems, as well. This couldexplain the high incidence of side effects, such as changes in bloodpressure, respiration, heart rate and perspiration.A newer class of antidepressants, known as serotonin selective re-uptake inhibitors (SSRIs) work primarily through increases in sero-tonin activity in the brain. These compounds, which include Prozac(fluoxetine), are known to have minimal or no effects on adrenergic1 The polygraph (lie-detector) technique, in SCIENTIFIC EVIDENCE INCRIMINAL CASES 699-723 (3rd ed. 1986).2 Central Nervous System Agents, in DRUG FACTS AND COMPARISONS 890-929 (Philip 0. Anderson et al. eds., 2004).236 HEAL THAMTRIX [Vol. 15:235LETTER TO THE EDITORSand cholinergic systems. This results in a very different side effectprofile compared to the earlier antidepressants. As a result, the SSRIsdo not interfere with the autonomic nervous system, which controlsthe involuntary nervous functions such as respiration, heart rate, bloodpressure, and perspiration.To reiterate, drugs which affect epinephrine, norepinephrine oracetylcholine levels could be expected to interfere with tests whichmonitor the involuntary nervous system (such as those used for poly-graph testing). However, SSRIs such as Prozac do not have thismechanism of action; rather they work more specifically by increasingserotonergic activity in the brain. In fact, there are no published re-ports in the scientific medical literature (MEDLINE) to indicate thatProzac, or any other SSRI, is able to affect polygraph results, eitherpositively or negatively.Should someone request that a medication be discontinued so thata polygraph test could be administered, the timing of the period whenthe drug is withheld is important. For example, Prozac (fluoxetine)has the longest half-life (three to four days with multiple daily dosing)of any of the currently marketed SSRIs, 3 meaning that it will be pre-sent in the blood stream for weeks after drug administration hasstopped. In addition, metabolites with pharmacologic activity may bepresent for even longer periods of time. For instance, fluoxetine ismetabolized by the liver to norfluoxetine, which retains some offluoxetine's activity, yet norfluoxetine has an even longer half-lifethan fluoxetine of seven to fifteen days.4 Standard procedure is toallow seven half-lives to pass after drug discontinuation in order theclear the drug (less than 0.01% of original drug levels remaining inthe bloodstream). This would translate to a period between 21-28days to clear fluoxetine, and at least 49-105 days to clear its metabo-lite. This is termed a "wash out period" and would be required inorder to eliminate any possibility that the drug may be adversely af-fecting polygraph results by direct mechanisms. This scenario couldbe applied to any medication which has pharmacological effects onthe peripheral nervous system. These may include most of the antide-pressants, anti-anxiety, and anti-psychotic medications, as well as painmedications, stimulants, over-the-counter cough and cold medicationsand many of the commonly prescribed blood pressure and heart medi-cations.To further complicate the matter, many antidepressants affect thelevels of neurotransmitter receptors or the sensitivity of the receptors3 HANDBOOK OF CLINICAL DRUG DATA 358-59 (Philip 0. Anderson et al.eds., 1997).4 id.20051238 HEALTH MA TRIX [Vol. 15:235to neurotransimitter levels. This is a well-known phenomenon whichappears to be based, in part, on modulation of the receptor numbers innerve cells. This being the case, drug withdrawal can cause "reboundeffects" which lead to exacerbation of the very condition (such asdepression and anxiety) that antidepressants were originally intendedto treat. In many cases, discontinuation of the above medicationswould not be prudent, and may even be hazardous. Conversely,forced discontinuation of medications which do not affect polygraphresults would be unnecessary and unethical.

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