Healthy Skepticism Library item: 14463

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Publication type: news

Lea D.
Grieving mom and dad want inquest
Oakville Beaver (Oakville, Ontario, Canada) 2008 Oct 18
http://www.oakvillebeaver.com/news/article/213791

Full text:

They want to change the future to save others

They can’t change the past to save their daughter, so two Oakville parents want to change the future to save other children from the dangers of antidepressant drugs.
Rhonda and Neil Carlin are demanding the Ontario coroner call an inquest into the death of their 18-year-old daughter Sara Allison Carlin.

Sara, a graduate of St. Ignatius of Loyola Catholic Secondary School and an Ontario Scholar, was described by her parents as a beautiful and intelligent young woman with limitless potential.

She was an accomplished athlete in many sports and was looking forward to finishing university in order to pursue a career as a dermatologist.

Instead, on Sunday, May 6, 2007, Sara, suffering from the apparent side effects of a powerful antidepressant drug, grabbed a piece of electrical wiring, fashioned a crude noose and hanged herself in the basement of her parents’ house.

In the months leading up to her death, Sara was taking the antidepressant Paxil (paxoxetine), which had been prescribed to help alleviate some anxiety she was feeling about leaving home for the first time to attend university.

Known as a selective serotonin reuptake inhibitor (SSRI), the drug works by altering the level of chemicals in the brain that control mood.

Sara’s parents are convinced it was this drug, and the way in which the province allows it to be distributed, that killed their daughter.

“Certainly we suffer from terrible grief, but at the same time we’re not anti-psychiatry, we’re not anti-prescription drugs, we’re not anti-SSRI anti-depressants,” said Neil.

“What this is about is ensuring the appropriate use of these drugs and seeing that the public and patients are properly informed of their dangers.”

Oakville MPP Kevin Flynn is now aiding the Carlins in their efforts to get an inquest into the events surrounding Sara’s death.

“When they told me their story, it certainly increased my appetite to find out more because it was such a tragic story,” said Flynn.

Flynn sent a letter to the Minister of Community Safety and Correctional Services, Rick Bartolucci, requesting support for a public inquest, but the minister soon wrote back noting that he would be leaving the decision in the hands of the chief coroner.

On June 12, 2008 the Regional Supervising Coroner, Dr. David Evans, contacted the Carlins and denied their request for a public inquest.

In a letter to the Carlins, the coroner noted an inquest must serve the public interest and stated that such an inquest into Sara’s death would not do that. He said a jury would not make useful recommendations that could prevent similar deaths in the future. “I want to stress that an inquest is not intended to be the vehicle by which someone is held responsible or accountable for a death,” wrote Evans.

The response was a severe blow to the Carlins.

“I think that eventually the issue of these SSRI related deaths will explode – and that the OCCO (Office of the Chief Coroner of Ontario) will be seen as having done nothing – in the interest of public safety – especially to protect our young ones,” said Neil.

Flynn also disagreed with the coroner’s ruling and noted that he is continuing to push minister Bartolucci for a public inquest.

He has also informed the premier’s office of his efforts.

“If you don’t have a child that needs SSRIs you probably don’t even know what they are. It’s just not an issue that’s been picked up by the general public,” said Flynn.

“I think in the case here where you have a tragedy like this and other tragedies that appear to be similar in nature, I can see that there would be some public good in this.”

Flynn is not the only politician trying to help the Carlins. Newly-elected Oakville MP Terence Young is also trying to bring about an inquest.

Young’s daughter Vanessa died after taking a prescription drug in 2000 and he was successful in getting an inquest into her death that resulted in a coroner’s jury making 59 recommendations on how to prevent similar deaths in the future.

Young wants the same for the Carlins, but notes that it will be difficult.

“I think it (Vanessa’s inquest) only happened because I’d been an MPP and there were cabinet ministers at Vanessa’s funeral,” said Young.

Neil and Rhonda said they first began to suspect the drug was not right for their daughter when they noticed changes in her behaviour just after she started taking it.

They said Sara shifted from being someone who was quite disciplined to someone who did not care.

This level apathy got to the point where Sara quit her hockey team and lost her job as the assistant to a local optometrist – two things that were important to her.

Suspicion about the drug turned to anger following Sara’s death when Neil read two Health Canada advisories stating that Paxil should not be given to children or adolescents under the age of 18 due to a possible increased risk of suicidal events.

Sara was 17 when she was first prescribed Paxil.

The 2003 advisory further noted that in pediatric clinical trials into major depressive disorder, patients treated with Paxil showed an increased rate of suicidal thinking, suicide attempts and self-harm when compared to those taking placebos.

Health Canada spokesperson, Alastair Sinclair, noted that Health Canada uses a variety of methods with which to get its advisories out to health care professionals.

These include the mailing or faxing of advisories directly to doctors, sending advisories to relevant professional associations to encourage the posting of the information on websites and in journals and newsletters.

The advisories are also posted on the MedEffect Canada website.

Given what happened to Sara, Neil believes it is necessary to go one step further and create a law that would require drug companies to hand doctors the latest warnings on the drugs they deliver.

In response to queries from The Oakville Beaver, Peter Schram, of Corporate Communications, GlaxoSmithKline, the manufacturer of Paxil, issued this statement: “Any suicide is tragic and the greatest risk for suicide is untreated depression. Paroxetine has been used by tens of millions of patients and has been proven to be a safe and effective treatment since its launch more than 15 years ago. The label contains instructions regarding the use of paroxetine and important safety information about the product.” If patients have questions regarding the use of paroxetine, or the management of their depression, they should contact their health care professional.

“Also, it is very important that patients do not stop taking paroxetine without first consulting with their doctor.”

The Carlins also hope an inquest will change how a teen can be prescribed such a potentially dangerous drug without first involving the parents.

Currently, medical treatment in Ontario does not require parental consent unless the patient is found to be incapable of making his or her own informed decision. The Health Care Consent Act does not list any particular age the person has to be as a prerequisite for consenting to medical treatment.

Therefore, if a doctor believes a teen has the ability to understand the consequences of a decision for medical treatment no parental consent is required.

After taking Paxil, Sara also had trouble sleeping and when she did sleep she suffered terrible nightmares.

Her torment only increased in late 2006 when she visited a doctor to get some relief from her insomnia, at which point Neil said she was prescribed sleeping pills and her dosage of Paxil was increased.

Neil pointed out that the Health Canada advisories caution against sudden shifts in the amount of Paxil being taken and believes this event sent Sara into a downward spiral from which she would never recover.

More irregularities in Sara’s taking of Paxil took place shortly before her death when her pill bottle was believed stolen.

Her parents think Sara may have made up for the missed doses by taking more of the drug at one time, something the literature on Paxil strongly advises against.

Rhonda wants an inquest to look into the way those taking Paxil are currently monitored noting that her daughter was given enough repeat prescriptions for Paxil to last her two years without having to visit a doctor.

The path the Carlins have taken towards getting some answers to their questions has not been easy.

Neil noted that it wasn’t until 10 months after Sara’s death that he was able to get a report from the coroner that even confirmed how his daughter died.

As they wait with cautious optimism to see if their request for an inquest will be reconsidered, the Carlins are calling on the public for help and are asking that anyone who is inclined contact Flynn so he can show the minister that the public is interested in an inquest on this issue.

Rhonda hopes that through these actions, lives will be saved, thereby bringing some kind of meaning to her daughter’s death.

“I’m one of those people who believe that things happen for a reason,” she said.

“Some good has to come from this tragedy. It can’t end like this.”

• * *

Drug company response

In response to queries from The Oakville Beaver, Peter Schram, of Corporate Communications, GlaxoSmithKline, the manufacturer of Paxil, issued this statement: “Any suicide is tragic and the greatest risk for suicide is untreated depression.” Paroxetine has been used by tens of millions of patients and has been proven to be a safe and effective treatment since its launch more than 15 years ago. The label contains instructions regarding the use of paroxetine and important safety information about the product. If patients have questions regarding the use of paroxetine, or the management of their depression, they should contact their health care professional.

“Also, it is very important that patients do not stop taking paroxetine without first consulting with their doctor.”