Antidepressant shows surprising impact in reducing domestic violence, major trial finds
In April 2024, Australian Prime Minister Anthony Albanese declared domestic and family violence a “national crisis” and called for proactive responses that “focus on perpetrators and focus on prevention”.
The problem hasn’t improved much since then.
But a world-first trial by the University of New South Wales and Newcastle University to test whether medicine can reduce violence and domestic violence may offer a new way forward.
A comprehensive approach to a complex problem
The trial tested whether sertraline, a widely prescribed antidepressant, could reduce violent recidivism in impulsive men.
We screened 1,738 men in NSW between 2013 and 2021, resulting in 630 participants being randomized to receive sertraline or placebo in a “double-blind” trial. This means that researchers, nurses, psychiatrists and participants did not know which men were taking sertraline or placebo.
Most participants were recruited through community corrections officers and courts.
Results regarding the effect of sertraline on overall violence were inconclusive.
However, those taking sertraline showed significant reductions in recidivism of domestic violence crimes:
- At 12 months, the recidivism rate was lower in the sertraline group (19.1%) compared to placebo (24.8%).
- At 24 months, the recidivism rate was lower in the sertraline group (28.2%) compared to the placebo group (35.7%).
The decrease in the rate of recidivism in men who used their medications more regularly reached 30 percent in 24 months.
How does sertraline work?
The antidepressant sertraline works by increasing the function of serotonin in the brain, which plays a crucial role in impulse control and regulation of emotional responses.
For highly impulsive men, this directly addresses one of the key drivers of violence: the inability to pause and regulate emotional responses.
Domestic violence often involves emotionally charged, impulsive reactions in intimate relationships. It is theorized that this type of anger and aggression in reactive contexts is most sensitive to regulating serotonin neurotransmission in the brain.
General violence is much more varied; this includes premeditated actions that are often less responsive.
All participants received sertraline during the first four-week period before randomization and we observed the following:
- 55 percent reduction in depression
- 44 percent experience psychological distress
- 35 percent with anger
- 25 percent irritability
- 20 percent impulsivity.
These changes occurred before most of the psychosocial supports in the trial were fully effective, indicating a direct effect of the drug.
One participant who served a significant prison sentence told us, “I was having a road rage tantrum, and a guy jumped out of his car, attacked me, and any other time I would have run him over. But I just said, ‘Dude, leave before I call the cops.’ I’m fully committed to believing it was because of the drug. I’m proud, it’s been a long time coming, but hey, I finally got myself under control.”
The critical role of comprehensive support
The drug’s effectiveness depended on participants actually taking the drug and staying engaged long enough for it to work. This is where the comprehensive support provided is essential.
Many participants had issues such as homelessness, untreatable mental health disorders, substance use, relationship crises, disengagement from health care, and conflicts with government agencies.
About the authors
Tony Butler is Professor and Program Head of the Justice Health Research Program at UNSW Sydney. Emaediong I. Akpanekpo is a PhD candidate at UNSW Sydney School of Population Health. Lee Knight is Academic Program Director for the Mental Health Practice Program at UNSW Sydney. Peter William Schofield is Joint Professor School of Medicine and Public Health at the University of Newcastle. Rhys Mantell is a PhD candidate at UNSW Sydney School of Population Health. This article is republished from: Speech It is under Creative Commons license. Read original article.
Many men had “fallen through the cracks” because their cases were too complex for mental health services or standard remedial programs. This means they can’t access the support they need.
We realized that prescribing medication without meeting these broader psychosocial needs would fail to fulfill our duty of care.
Therefore, our work has evolved to include a comprehensive support model that combines pharmacotherapy with trauma-informed clinical counseling, proactively follows up with participants, provides 24-hour crisis support, helps refer men to support services, and includes shared safety planning.
This has proven crucial for higher engagement leading to better results.
Perhaps most striking, sertraline reduced the rate of repeat domestic violence offenses (more than one offense in 24 months) by 44 percent compared to placebo.
These findings reveal an important relationship: sertraline improves a number of behavioral measures and reduces impulsivity. Comprehensive psychosocial support, meanwhile, addresses the trauma, social disadvantage, and unmet needs that perpetuate patterns of emotional reactivity and violence.
As one participant stated: “I improved […] I was actually taking a step back and listening to what other people had to say before taking my clothes off.
What about partners and family members?
Our research found that 96 percent of partners reported maintaining or increasing safety, 85 percent (in men) observed positive behavioral changes, and 77 percent reported increased personal well-being.
One partner noted: “I used to sleep with a hammer under my bed. Since he started this medication, I can sleep better and I don’t need to sleep with a hammer anymore.”
Reframing domestic violence
We have shown that when we help men address the psychological, relational and social factors that lead to domestic violence, we can prevent harm before it occurs.
The men in our trial had extensive histories of trauma; many had experienced childhood abuse, marginalization, and conflict with state institutions.
This perspective in no way diminishes the devastating harms and impacts of domestic violence or the need for basic support for victims. Nor does it diminish the importance of addressing structural determinants of domestic violence, such as gender inequality or outdated cultural norms.
But the current crisis requires evidence-based interventions that can reduce domestic violence, while complementary efforts continue to support victims.
A way forward
Our trial showed this approach to be cost-effective: around A$7,000 per participant per year, compared to $150,000 for incarceration.
The model’s independence from mainstream services proved vital to engagement. Working through a university research program rather than through government systems helped build trust in men who had had extensive negative experiences with institutions.
We do not claim that our approach is a silver bullet, but it deserves serious consideration as a proven intervention in the domestic violence prevention ecosystem and can be implemented now.
The national domestic violence helpline offers support to women on 0808 2000 247 or visit: Asylum website. There is a special section men’s advice line on 0808 8010 327. US residents can call the domestic violence hotline at 1-800-799-SAFE (7233). You can reach other international helplines at: www.befrienders.org
