Seroxat Sara Carlin - family pleased with inquest jury's recommendations

If these recommendations had been in place at the time Sara was prescribed Paxil she would be alive today. We are truly confident that if these are acted upon there will be young lives saved down the road."- Neil Carlin, Sara's father.

After listening to more than two long weeks of testimony, the Carlin family says they have gotten what they wanted — recommendations that will save lives.



A coroner's inquest into the death of Sara Carlin, 18, concluded Monday with the jury releasing 16 recommendations geared towards preventing similar deaths in the future.



Among the recommendations were calls for greater precautions to be taken when doctors place patients on Selective serotonin reuptake inhibitors (SSRIs) like Paxil, the drug Sara had been taking and which her parents blame for her death.



News of these recommendations were well received by Sara's family.



"We're ecstatic. This jury listened. These recommendations are what we wanted," said Neil Carlin, Sara's father.



"If these recommendations had been in place at the time Sara was prescribed Paxil she would be alive today. We are truly confident that if these are acted upon there will be young lives saved down the road."



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



For more than a year before her death, Sara had been taking Paxil, an anti-depressant, which Health Canada warns can increase the risk of suicidal events in children and adolescents under 18.



During the inquest the Carlin's lawyer Gary Will argued the side effects of Paxil drove Sara to kill herself while lawyers for Paxil manufacturer GlaxoSmithKline and three doctors associated with treating Sara, made the argument Sara's suicide was a result of depression and drug and alcohol abuse.



The Carlin family believes the jury attributed Sara's death to Paxil due to the recommendations they made.



However, Teresa Walsh, lawyer for GlaxoSmithKline did not see it that way.



While many of the recommendations are aimed at bringing forward greater awareness of the potential side effects of Paxil and other SSRIs, Walsh said the jury did not list Paxil as causing Sara's death in their verdict.



Under the cause of death, the jury has listed `hanging by ligature while affected by depression, cocaine and ethanol (alcohol).'



"I think the verdict speaks for itself," said Walsh when asked about the role Paxil played in Sara's death.



One recommendation called for guidelines to be put in place so that, prior to prescribing an SSRI like Paxil, physicians would be required to give a patient a physical exam, request laboratory investigations, inform patients of the benefits and risks of treatment including rare and serious side effects, inform the patient of reasonable alternative treatments, inform the patient of an SSRI treatment plan and discuss with the patient the impact drugs or alcohol could have on an illness like depression.



During the inquest, Sara's family doctor testified that he did not inform Sara about the possible risk of Paxil causing suicidal thoughts and behaviour when he prescribed it because, he said, it is difficult to get a patient to take such a medication after that kind of admission.



According to testimony, the appointment where Sara was put on Paxil only lasted 30 minutes.



Other recommendations called for physicians to monitor patients with weekly visits for the first month after initial introduction to an SSRI, then with bi-weekly visits for the second month and with one visit in the third month.



The jury said this would effectively monitor the period where a serious adverse reaction to a drug like Paxil is most likely to happen.



Still another recommendation called for physicians to try, repeatedly, if necessary, to get a patient prescribed an SSRI to allow for their family members, guardians or trusted friends to be brought into the treatment process, so they can monitor for potential side effects.



One of the Carlin family's greatest concerns, which arose during the inquest, was that they were never told that Sara was placed on Paxil and as such they did not know what to look for in the event she had an adverse reaction.



Sara's doctor testified Sara had told him she did not want her medical records shared with her parents. Under doctor patient confidentiality he had no choice but to respect that request.



Other recommendations called for the creation of an independent drug safety board, the creation of an educational program regarding mental health and substance abuse for the adolescents and youth of Ontario's school system, the creation of a provincial and national suicide prevention strategy and the creation of a Drug Information System that would track and monitor all drugs dispensed in Ontario.



This question of how much of a role Paxil did play in Sara's death was hotly debated during the inquest with several of Sara's friends and family members testifying that she went through drastic behavioural changes after she began taking Paxil in February of 2006.



These witnesses testified Sara suddenly changed from an academically and athletically focused young woman into an apathetic person with alcohol and drug abuse problems.



Will argued some of the side effects listed on the Paxil product monograph were increased alcohol consumption, drug dependence, depression and depersonalization to name a few.



Walsh countered that these are not side effects, but things that people taking Paxil have reported and have not been conclusively tied to Paxil as the cause.



Three expert witnesses testified during the trial with each bringing their views on the impact they felt Paxil had in Sara's death.



Dr. David Juurlink, head of the division of pharmacology and toxicology at Toronto's Sunnybrook Hospital and medical toxicologist at the Ontario Regional Poison Information Centre in Toronto's Hospital for Sick Children, testified that Paxil can cause people to commit suicide, but he did not believe this to have happened in Sara Carlin's case.



He said most suicides and side effects from Paxil occur within the first few weeks and months after a person starts taking it. Sara had been taking the drug for more than a year before her death.



Dr. Paul Links, a professor of psychiatry at the University of Toronto and past president of the Canadian Association for Suicide Prevention, testified Paxil was a plausible explanation for Sara's death, but not one he would favour.



Dr. Nathan Scharf , director of crisis services at the Youthdale Treatment Centre in Toronto, testified Paxil could have been a contributing factor in Sara's death, but not as big a factor as alcohol.



Links did agree that a sudden withdrawal from Paxil could result in dysphoria and disinhibition. In his arguments, Will pointed out Sara had been without her pills for one to four days before her death.



Exactly how much information these experts had on Sara Carlin's case was made an issue during the inquest. Will said Scharf had only had access to a page and a half of information.

While the recommendations have been made, the government bodies they are directed at have no legal obligation to implement them.



Coroner's counsel Michael Blain said, however, that more often than not the recommendations do result in action.



"The Coroner's office does track recommendations and a large percentage of recommendations do in fact result in actions being taken," he said.



"Obviously it's not 100 per cent, but there is a significant percentage of recommendations that do end up bringing about change."



While he is hopeful, Will said some of the recommendations made by this jury were also made by a previous jury during the inquest into the death of Oakville MP Terence Young's daughter, Vanessa, nine years ago.



"There were 56 recommendations made during that inquest and very few were actually implemented," said Will. "Hopefully because many of these recommendations have now been made a second time there will be action."





http://www.insidehalton.com/news/article/840376--this-jury-listened