Seroxat - Expert and family friend disagree on impact of Paxil @ Carlin inquest

Expert and family friend disagree on impact of Paxil




Expert and family friend disagree on impact of Paxil. Supplied photo Related Stories •Sara Carlin inquest begins

•Doctors describe Sara Carlin as troubled

•Erratic behaviour alarmed friends

•'I'm so low, I'm hurting'

•Should parents have been told daughter was prescribed anti-depressant?

It's possible, but not probable.

This was the dominating message that emerged Thursday, the ninth day of an inquest into the death of 18-year-old Sara Carlin, as lawyers hammered away at an expert witness in the field of suicide over the role Paxil played in her death.

Sara, an Oakville resident and graduate St. Ignatius of Loyola Catholic Secondary School, hanged herself in her parents' basement on Sunday, May 6, 2007.

Doctors had been prescribing her the anti-depressant Paxil for more than a year before her death despite Health Canada advisories stating the drug could increase the risk of suicidal events in children and adolescents under 18.

The inquest into Sara's death has been called by the Ontario Coroner's Office to examine the circumstances surrounding her death and, if possible, make recommendations to prevent similar deaths in the future.

During his testimony, Dr. Paul Links, a professor of psychiatry at the University of Toronto, deputy chief of psychiatry at St. Michael's Hospital, and past president of the Canadian Association for Suicide Prevention, said he did not see Paxil as the most viable explanation for Sara's death.

While Links agreed Paxil could produce suicidal thoughts and behaviour, he said this was unlikely in Sara's case. He said Sara had been taking Paxil for more than a year and the risky period for suicide is in the first months.

To his knowledge, Links said there was no dramatic period of restlessness, agitation or dramatic shifts in her mood that would show the drug was having a negative effect on her.

The inquest did here a contrary opinion to this analysis, on Thursday, from long time Carlin family friend Gillian Kerr, who joined a number of past witnesses in stating Sara's behaviour did radically change after she started taking Paxil in February of 2006.

Kerr said she had known the Carlin family for 26 years even serving as their live-in nanny at one point.

She developed a close relationship with Sara, similar to that of an aunt. Kerr said she supported Sara at a large number of the athletic events, as well as during music recitals and other important events in her life.

"Sara was amazing," said Kerr, choking back tears. "She had a great sense of humour, she was very loving. The whole entire family was very affectionate and that was Sara. She was just wonderful, she had a good heart, she was a very hard worker, not only at school, but around the house."

Kerr said, however, a different Sara emerged in the weeks following her introduction to Paxil.

The family had been getting ready for a family member's birthday party and Kerr had come to the Carlin family home from London around 2 p.m.

She went to check on Sara and found her in bed unwilling to move.

"I said, 'We need to get to your Aunt Christine's house in an hour. You better get up and shower.' and she snapped at me, which was a shock to me," said Kerr.

"She was very moody, didn't want to go to the family event. I asked what was going on with her, but she didn't answer me, just grumbled."

Sara did end up going to the party and here, too, Kerr noticed behaviour that she said was completely out of character for Sara.

Previously, Kerr said, Sara had always played with her aunt's young children and had been the centre of attention at these parties, but this time Sara just sat in a corner.

When the party ended at around 6:30 p.m., Kerr said, Sara returned home and went back to bed.

Kerr recalled another incident in July 2006 when she entered Sara's room and found a huge hole in the wall.

When she asked her about it, Sara said she had punched the hole in the wall one day when she was angry.

When Kerr asked Sara what had made her so angry, she said Sara was not able to provide a reason.

On another occasion, Kerr remembered Sara becoming frustrated while trying to load the dishwasher. Sara ended up throwing a bowl on the counter and slamming the dishwasher door shut when the bowl wouldn't fit.

Sara then left the room amid a flurry of profanities.

All of this was new behaviour for Sara, Kerr said.

Other witnesses have testified alcohol and drug abuse also became a problem for Sara during this period. Her autopsy showed she had consumed a large amount of alcohol (twice the legal limit had she been driving) the night before her death.

Chemicals consistent with cocaine use taking place within 48 hours of her death were also found.

With this information, Links has argued a combination of depression, anxiety and substance abuse were the more likely the cause of Sara's suicide, particularly because alcohol is a disinhibitor and consuming large amounts can make people do things they normally would not do.

Cocaine is also dangerous for someone with depression or anxiety, Links said, as coming down from a cocaine high can cause dysphoria, the sudden onset of additional depression.

The Carlins’ lawyer Gary Will, however, argued the explanation is not that simple.

He drew Links attention to Paxil manufacturer GlaxoSmithKline's product monograph for Paxil. This monograph, Will said, lists a number of side-effects associated with taking Paxil, which include depression, increased alcohol consumption, possible drug dependence, trouble articulating words, paranoid reactions, thinking abnormally, rapidly changing mood and Akathisia, a horrific restlessness and inner torment.

On cross-examination GlaxoSmithKline lawyer Teresa Walsh said these side effects have only been reported in association with taking Paxil. She said there is no evidence Paxil causes them.

Links said he saw no evidence Sara was suffering from any of these side effects, but acknowledged that Akathisia, which can lead to suicide, can be internalized.

Will also noted a sudden stoppage in drug treatment, as Sara experienced for two to three days near the end of her life, could result in dysphoria and suicidality. Links said this was possible.

Links said it was also possible that restarting the medication after a period of absence could lead to disinhibition and possible suicidal thoughts or behaviour.

He added, however, that it was more common for the withdrawal symptoms a person is experiencing to simply be alleviated when a person begins taking Paxil again.

In the end, Links said it was plausible Sara's suicide was the result of the Paxil, but said this he was not in favour of that explanation.

When asked about Paxil treatment, Links said it is important to involve the family in the treatment plan for drugs like Paxil, but

added he would have to respect the request of a youth 16 years of age or older to keep their medical information confidential.

Kerr testified she tried to accompany Sara during a session with Dr. Lynne Benjamin, so she could discuss the effect she felt the Paxil was having on Sara, but was stopped by Benjamin.

It was later pointed out that Sara did not tell Benjamin, in Kerr's presence, that it was okay for Kerr to come inside the doctor's office for the session.

Links said psychotherapy is an important part of treatment. However, he said the patient has to attend therapy voluntarily. Therapy can't be compelled unless it is determined the patient is an immediate threat to themselves or others.

Sara was referred to a psychotherapist and Halton ADAPT (Alcohol Drug and Gambling Assessment Prevention and Treatment Services). However, in both cases she stopped going after only a single session.

Links said there was nothing he had read that indicated Sara was not capable of making her own choices. He said as an adult she could choose not to return.

While Links may have had some doubts about Paxil's role in Sara's death, he had none about suicide being a problem among adolescents in Canada.

Links said there are around 3,600 suicides in Canada every year with Canada currently having a suicide rate of 12 to 13 per 100,000 people with the numbers being higher for youth.

In a 2001 survey it was found that 19 per cent of high school students had thought about suicide, 15 per cent had actually formulated a suicide plan at some point while 9 per cent reported a suicide attempt.

To combat this Links said Canada needs to put together a national suicide prevention strategy to break down the stigma around mental illness, so more people get help when they need it.

The strategy would also work to improve access to mental health services.

http://www.insidehalton.com/news/article/835844--expert-and-family-friend-disagree-on-impact-of-paxil