What if a common antidepressant could help stop some angry, impulsive men from committing domestic violence? This question has been at the heart of a groundbreaking clinical trial by researchers from UNSW and the University of Newcastle. For over a decade, they have been investigating whether a potential solution to domestic violence might be found behind pharmacy counters across the country.
Their findings, published in the Lancet journal eClinicalMedicine, are likely to ignite interest among domestic violence experts and government officials. The ReINVEST trial demonstrated a significant reduction in domestic violence offenses at 24 months, with a 21 percent relative risk reduction for participants taking the antidepressant sertraline compared to those on a placebo.
Significant Findings and Initial Criticism
The trial revealed a 30 percent reduction in domestic violence reoffending among men who adhered to their medication regimen more frequently, and a 52 percent risk reduction in those experiencing high psychological distress. These results are particularly noteworthy given the initial criticism the study faced from women’s advocates and politicians, who questioned its safety and the allocation of government funding—$6.9 million from the former Coalition NSW government—while victim support services were underfunded.
Experts now suggest that the results should prompt further government investment and a reevaluation of how domestic violence is addressed in Australia. Some argue for treating it as a health issue, with interventions tailored to perpetrators’ individual needs, rather than relying solely on behavior change programs or primary prevention campaigns focused on gender inequality.
“This is top-notch-quality research,” said Troy McEwan, professor of clinical and forensic psychology at Swinburne University. “This is so much more rigorous than the vast majority of work that’s been done to look at intimate partner violence outcomes following interventions.”
Understanding the Link Between Impulsivity and Violence
The ReINVEST trial is based on the connection between poor impulse control and aggression, which is associated with criminal behavior, including violence. Given the link between impulsivity and reduced serotonin levels, the research team hypothesized that sertraline, a selective serotonin reuptake inhibitor (SSRI), could help mitigate impulsivity and aggression, ultimately reducing violence.
Of the 1,738 men in NSW screened for eligibility between 2013 and 2021, 630 were randomized into the trial, with roughly half receiving sertraline and the other half a placebo. The study found sertraline to be safe and well-tolerated, with fewer adverse events in the treatment group (6.9 percent) compared to the placebo group (9.3 percent).
Despite the challenges, including participant dropout affecting data collection, the trial spanned nearly eight years. “If ever you were designing a difficult trial, you would choose this group, who are suspicious of everybody,” said UNSW Professor Tony Butler, co-principal investigator of ReINVEST.
Domestic Violence vs. General Violence
After 24 months, no difference in general violent offending was observed between the treatment and placebo groups, as assessed using records from the NSW Bureau of Crime Statistics and Research (BOCSAR). However, a significant difference in domestic violence offending was noted, with lower rates in the sertraline group (28.2 percent) compared to the placebo group (35.7 percent).
A separate pre-planned analysis showed a 45 percent reduction in domestic violence offending in the sertraline group at 12 months, compared to a group of eligible men who took sertraline during a four-week “run-in” period but did not proceed with the trial.
The Role of Support and Future Implications
All participants received intensive support from a team of experienced mental health nurses and psychologists, likely aiding their trial participation and compliance. However, questions remain about the effectiveness of sertraline without such support.
“I do think it’s important to understand what sertraline alone could do without wraparound support,” said Lee Knight, clinical coordinator of ReINVEST. “Just giving them a pill and saying ‘See you later’ — their compliance with taking the medication would probably be questionable.”
The researchers suspect that domestic violence offenders are more emotionally reactive than general violent offenders, whose actions may be more premeditated. This difference could explain the reduction in domestic violence but not general violent offending.
Reactions and Future Directions
While some academics and advocates criticize the notion that impulsivity drives domestic violence, arguing that male perpetrators choose to abuse their victims, others see value in addressing individual vulnerabilities such as childhood trauma or mental illness.
“I think the thing to take away from this study is that we should be looking more closely at tailored interventions that reflect the reasons why a person is engaging in violence,” said McEwan.
Michael Salter, professor of criminology at UNSW, noted that SSRIs modulating emotions could play a role in reducing some men’s use of violence in intimate relationships. He emphasized the need for a multi-sectoral response, recognizing health as a critical component in addressing domestic violence.
The ReINVEST team hopes to expand the trial into an ongoing service and conduct further research to understand the nuances of domestic violence and the potential responsiveness of specific offender subgroups to SSRIs. They are optimistic that their findings will prompt governments to take notice.
“I’m very excited and hopeful about taking this forward now that we have identified a plausible mechanism for domestic violence that can be treated,” said Butler. “My favorite quote that emerged from one of the partners was: ‘The house became peaceful quiet instead of terrified quiet’. And that might not sound like much, but after 10 years living in fear, it was everything.”
