A coroner’s inquest into the death of Sara Carlin, 18, has now completed with the jury releasing 16 recommendations calling for greater precautions taken by doctors place patients on Selective serotonin reuptake inhibitors (SSRIs) like Paxil. The recommendations are at least one relief for the Carlin family who had sought changes to help save young lives in the future.
Sara, an Oakville resident, had been placed on Paxil, hanged herself in her parents’ basement on Sunday, May 6, 2007. At the time of her death she had been taking the drug for over a year. The anti-depressant has warnings by Health Canada to increase the chances of suicides when given to children and adolescents under 18.
During the inquest, lawyers for the Carlin family argued the drug had caused the death while lawyers for Paxilmanufacturer GlaxoSmithKline and three doctors associated treating Sara argued her suicide was a result of depression and drug and alcohol abuse.
The jury did not list Paxil as causing Sara’s death in their verdict. The family believes the jury attributed Sara’s death to the drug. The drug company disagrees with the family conclusions, however, since the jury did not attribute the death directly to Paxil.
One recommendation calls for guidelines to be put into place so that prior to prescribing an SSRI like Paxil, physicians must give a patient a physical exam, request laboratory work, inform the patient of the benefits and risks including rare and serious side effects, inform the patient of reasonable alternative treatments, inform them of an SSRI treatment plan and discuss the impact of drugs or alcohol on illnesses such as depression.
Sara’s doctor admitted during the inquest that the suicidal thoughts and behaviour side affects were not discussed with her since it would be difficult to get a patient to take medication with such admissions. In fact, her appointment only lasted 30 minutes.
Other recommendations made by the jury included:
- Monitoring patients weekly for the first month after introducing SSRIs, bi-weekly visits for the second month and one visit in the third month.
- Allowing family members, guardians or trusted friends to be brought into the treatment process so they could monitor potential side effects.
- Establishing an independent drug safety board.
- Creating an educational program regarding mental health and substance abuse for adolescents and youth in Ontario schools.
- Creating a provincial and national suicide prevention strategy.
- Creating a Drug Information System to track and monitor all drugs dispensed in Ontario.
In this case, Sara’s family had not been told she was being given this drug after Sara had specifically told the doctor she did not want her family knowing. Under doctor patient confidentiality the doctor could not disclose information to the family.
Sara’s friends and family testified she went through drastic behavioral changes after taking Paxil in February 2006. They testified she went from being an academically driven individual to an apathetic person with alcohol and drug abuse problems.
Arguments for Paxil being responsible include some of the side affects noted for Paxil include increased alcohol consumption, drug dependence, depression and depersonalization. These statements were denied by the lawyers representing the drug company stating that these were not side affects but rather things people taking Paxil have reported but not conclusively tied to Paxil as the cause.
Three expert doctor witnesses concluded that Paxil was not a cause because the symptoms show up early in treatment not 1 year later as in Sara’s case. Their testimony was challenged, however, when it was argued they had limited information to which they were basing their findings. One doctor noted he only had one and a half pages of information.
There is no guarantee that the recommendations made will be followed because past inquiries have made similar recommendations and none were implemented. The family and public, however are hopeful that this time something will be done to protect the public.
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