Please read Suicides and homicides for background
Maria Bradshaw’s son Toran, who was her only child, was prescribed fluoxetine in January 2007 despite having been assessed as being a healthy adolescent having an expected reaction to a stressful life event, which was a break up with his girlfriend. A month after commencing the drug, Toran experienced a severe cluster of adverse reactions including suicidal behaviour, self harm, aggression, hostility, hallucinations, lack of concentration and impaired functioning. These symptoms were so severe that he dropped out of school. His psychiatrist’s response was to increase his dose, which worsened the adverse reactions. Toran withdrew from the drug and from mental health treatment of his own volition.
The following year, a psychiatric registrar prescribed fluoxetine to him again, against his mother’s wishes. The registrar recorded no diagnosis after having conducted a mental state exam and finding no evidence of depression, anxiety or any other mental disorder. The next day, a multi-disciplinary team reviewed Toran’s file and recorded “diagnosis deferred” noting that there was no evidence of a mental disorder. Toran initially refused the prescription on the basis that fluoxetine should not be taken with alcohol, but the registrar recorded that he had reached an agreement with Toran that he would stop taking the fluoxetine on a Friday, could drink up to six bottles of beer a night over the weekend and restart his fluoxetine on Mondays. Given fluoxetine’s long half-life in the body, 2 to 4 days for the drug and 7 to 15 days for its active metabolite norfluoxetine, this seems to me to be a totally inappropriate recommendation. Toran followed this regime but suffered a repeat of the former adverse reactions and suddenly hanged himself after 15 days on fluoxetine. He was only 17 years old.
After Toran’s death, Maria had genetic testing conducted which confirmed that Toran was an intermediate metaboliser having the CYP2D6: *4 mutation. People with this mutation metabolise drugs slowly and get overdosed because one of the two alleles is inactive. Maria also established CASPER, which is an organisation delivering services for those bereaved by suicide – by those bereaved by suicide (http://www.casper.org.nz/). Maria has told me that the national media have credited CASPER with a 20% drop in youth suicide and that the knowledge that her son continues to do good in the world despite not being here physically means more to her than anything.
Maria also wrote to the 20 District Health Boards in New Zealand asking for the number of patients under their care that died by suicide in the years 2007-2010; the percentage that had been prescribed medication in the 6 months prior to their deaths; the recorded diagnosis; and the age and ethnicity of each patient. Seventeen District Health Boards replied. Overall, 8% of those who died with a recent prescription had no diagnosis of any mental disorder. In the District Health Board responsible for Toran’s care, 75% of those under 18 who died with a recent prescription had no diagnosis.
Maria has informed me that, in New Zealand, psychiatrists and suicidologists have managed to convince the government that publishing information on individual suicides causes copycat suicide. She has reviewed the data on this closely and the case is extremely weak, but it is nonetheless a criminal offense for Maria to tell Toran’s story, punishable by a fine of up to $5,000 each time and a fine for the media of up to $20,000. These threats have not stopped Maria and she has had support from the media. She also encourages the other parents she supports via CASPER to do the same with their children’s stories.
Maria sold her home to pay for Toran’s inquest when the doctors dragged it out over 18 days of hearing thinking she would walk away because of the cost. She now lives in the home of another mother who lost her child to SSRI induced suicide, Leonie Fennell, in Dublin and has everything she owns in two suitcases. The Chief Coroner knows that trying to fine her for telling Toran’s story is a waste of time because she simply doesn’t have the means to pay.
There have been ten government enquiries into Toran’s death but, as in all such cases, the issue it not whether the child received a good standard of care but whether the psychiatrist departed from generally accepted practice. And of course, since the usual practice in psychiatry is terrible and causes harm, most of the investigations found that Toran’s care was not a departure from usual practice and therefore acceptable. However, both the government and Mylan Pharmaceuticals have resolved that it is probable that fluoxetine caused Toran’s suicide.
Maria is still fighting to achieve justice and has persuaded the police to review Toran’s file to see whether manslaughter charges can be laid. She hopes that her efforts will be a deterrent, which could make other doctors consider that their patients may have a stroppy mother like her and be more careful. Maria has spent seven years on meticulously documenting Toran’s case and learning everything she could about psychopharmacology, psychiatry, neurochemistry, genetics, the conduct of randomised trials and anything else that relates to her work in representing her son and all the other children whose parents come to her with stories similar to his.
When I gave a lecture at the Department of Psychology at the Manooth University outside Dublin in October 2014, to which Maria had invited me, another bereaved mother was in the audience, Stephanie Mcgill Lynch, who lost her child to the same drug, fluoxetine, as Maria lost hers, exactly five years to the day. Maria wrote to me:
“I know you agree with me that this has got to stop.”
Jake Mcgill Lynch
Jake’s mother, Stephanie, describes her son as a beautiful, bright 14-year old boy with an IQ of 146. In late 2011, he was diagnosed with Asperger’s syndrome, in an extremely mild form (the diagnosis of Asperger’s was eliminated in 2013 in DSM-5 and replaced by a diagnosis of autism spectrum disorder).
Jake started counselling with a psychologist in 2011 due to some dark thoughts that had appeared in an essay he wrote in school. In January 2013, he had counselling again, for anxiety, and his psychologist decided to refer him to her colleague, a psychiatrist, as she felt his anxiety would be heightened when he was to sit his state exams. Jake’s parents didn’t even know what a psychiatrist was but just thought it was the psychologist’s colleague.
Jake’s dad took him to his appointment because no big deal was made of it, and they met with the psychiatrist for ten minutes whereafter they left with a prescription for fluoxetine. Jake had never been on medication before, but the family was not given any literature or any description from the psychiatrist or the pharmacist, and they didn’t even know what sort of drug Prozac was but simply trusted the psychiatrist.
Six days later, Jake had his first reaction. He walked out of an exam half-way through it and cried for about 2-3 hours that night, saying “you don’t know what it’s like in my head.” His parents thought this was from the stress of the exams. They never imagined that a drug could do this to a person.
About a week later, they got Jake back to the psychiatrist and told her all about what happened, but she said that it would wear off after 3-4 weeks and that Jake would be fine. But Jake was not fine, and on day 46, he was a bit restless after school and looked a bit flush in the face, although he never had a colour in his cheeks. His parents thought he had a row with his little online girlfriend.
The family had a legally held rifle .22 in the house, as Jake and Stephanie were members of a shooting club. They would often take the gun down, and Jake asked if he could take it down that night, which was nothing out of the ordinary, so his request was granted. Stephanie forgot to take the box from his room with bolt and ammunition.
Jake placed the gun in his mouth and pulled the trigger. He had no history of suicide ideation or self harm, and no diagnosis of anything but Asperger’s. However, the national health service in Ireland is now trying to say he had severe anxiety – although this isn’t true – and it fights the parents on every corner with this. It is the same story all the time: put all the blame on the disease, never on the drug. The parents asked David Healy to do a second opinion based on Jake’s medical files, which he did.
Stephanie and her husband have attended their son’s inquest three times so far and are still in the middle of a legal argument about which medical expert the Coroner’s court will allow them to consult. The court has refused their request of using David Healy, as he is considered to be not impartial due to his writings about the relation between SSRIs and suicide.
Stephanie finds the whole thing absolutely disgusting. This is a 14-year old child who had plans for the future. He had no illness, he had a condition that no medication would fix , and he was living quite happily with just counselling for his anxiety. Stephanie and her husband were never told about the dangers of drugs like fluoxetine. Had they known about them, they would never have kept a firearm in the house.