In early December 2020, Ian and Tania Morgan had to attend the inquest of their son Samuel in Swansea, South Wales. Sam died in January 2020, a week after he had been put on citalopram by his family doctor, Dr Adams.
Sam was pretty close to a healthy volunteer. A 25 year old, sporty, successful at College, with a girlfriend – there was very little wrong with him. He likely went through a week of excruciating torture before hanging himself in the stairwell of his parents house where his mother found him.
Ian Morgan approached me and I offered to write a report for them. The Morgans were initially surprised that Sam might even think about an antidepressant for a degree of exam related anxiety. After his death, they found that NICE Guidance recommends review after a week. They met with Dr Adams and became aware Sam had not be scheduled for a follow-up visit at a week. They were inclined to blame Dr Adams.
My view was that from the medical notes I’d seen, Dr Adams appeared to be a good doctor and they would do better getting him onside. If both he and they blamed the drug someone might have to do something. I emailed Dr Adams inviting him, given the clarity of this case, to bring some good out of a grim situation.
I wrote a report stating that it seemed very clear that his antidepressant had killed Samuel Morgan. Morgan Inquest Report. The report also noted that many healthy volunteer trials of SSRIs in the 1980s had taken place a few miles away from where the inquest was happening, that young men in those became suicidal and that the Welsh Health Secretary Vaughan Gething had been told about this on more than one occasion – I recognise these constraints.
The Coroner, Colin Phillips, also seemed a decent man. He listened closely to Tania Morgan’s impassioned contribution and didn’t pay too much heed to Dr Adams’ lawyer whose efforts to save his client (and the insurance company money) appear to have consisted primarily in trying to blame Samuel.
Mr Phillips wrote to the family afterwards saying he would submit a Regulation 28 Report to the British drugs regulator, the MHRA. which coroners can submit when a case suggests to them someone somewhere needs to look at what has gone on and do something.
MHRA had a few weeks to respond.
Dr Adams wrote to NICE, who issue Guidelines for antidepressants suggesting that their advice about review in a week needs to be much more clear.
Mr Phillips letters to the family around this time I am sure were designed to console. They failed.
The MHRA Response from June Raine was entirely predictable. Depression is a terrible illness and some people after being put on treatment will be at even higher risk (from their illness is implied).
I wrote to Dr Adam’s and Mr Phillips mentioning that while they were likely well-intentioned, their efforts had made a bad situation worse. Healy to Adams and Phillips.
Until MHRA and NICE who know that drugs can make healthy volunteers suicidal state this clearly, a doctor like Dr Adams faced with someone like Sam coming back after a week, will likely double the dose of his treatment.
A colleague got in touch about another inquest just happening after what may have been a mirtazapine induced suicide where the doctor brought this point home when stating:
It is not uncommon for a patient to notice that their symptoms may get worse before they get better and so we start with a low dose, monitor and get feedback from the patient in order to titrate the dose if tolerated.
The lowest doses of citalopram and most SSRIs are in fact staggeringly high – they block the system pretty completely from the get-go.
What doctors need to be told is they should take a lot of care when adding the suicide inducing effects of a drug into the mix for someone who is depressed or anxious. If they get worse, it is highly likely to be caused by the drug. It is unlikely to be their illness.
I copied my letter to Dr Adams and Mr Phillips into June Raine of MHRA and to Gillian Leng (CEO) and Sharmila Nebhrajani of NICE.
Mr Phillips has said the matter is closed.
Dr Adams has not replied.
June Raine has been impossible to access.
Nice have said the letter has been forwarded to Gillian and Sharmila. Both the former CEO and Chair of NICE have been accessed about this before and done nothing – The NICE Before Xmas. They were men however and one can always hope that women might have more balls than men.
Alexandria Ocasio-Cortez has just ridden into town across on RxISK – Alexandria Ocasio-Cortez: Courageous, Charismatic, Attractive?
The RxISK post was triggered by her calling out the mob who invaded Capitol Hill for their Abusive behaviour at the time and especially afterwards when their behaviour seemed typical of Sexual Abusers more generally.
She and one or two other politicians seem to have the attractive ability to spell out the obvious – an ability most politicians lack – and attract people to them by doing so.
Vaughan Gething, despite having a picture of the very attractive Martin Luther King on the wall behind his desk, seems devoid of this ability.
I’ve been told its bad form to called AOC or any woman Attractive. I added that Yannis Varoufakis, one of the people behind the new European political party DIEM, seems Attractive in this sense.
In the sense of being able to attract people to them on an important issue, Michelle O’Neill and Mary-Lou McDonald of Sinn Fein aren’t coming over as very Attractive on this issue at least – even though they had the incentive of the death of a family member – Stephen O’Neill that featured in these pages earlier this year – The Death of Stephen O’Neill and The Perfect Killing Machine.
If Sinn Fein aren’t going to be just a clone of the other Irish political parties, if DIEM aren’t to just be a clone or other fringe groups on the European political scene or if the Green Parties that Shipwreck appeals to aren’t going to be just the same as the centre right and centre left, someone needs to pick up the gauntlet thrown down in Shipwreck.
Maybe I’m just not Attractive enough – Attractive to Politicians anyway.