Citalopram in the Courts

Pills on trial

Pills on Trial.

Last week reports surfaced of a woman, Marlene Torlay 61, who killed her friend after she called to her home for ‘a cup of tea and a chat’.

After the violent killing, her son returned home and found his mother watching television, completely unaware that her friend’s body was lying in another room. Defense Council Ian Mr Duguid said that Mrs Torlay “is perhaps, on any view, the most unlikely of violent offenders to appear in these courts for some time.” Oh yeah, did I forget to mention that Citalopram was implicated in this tragedy? It got me thinking of court-cases and how often this drug has caused the particular offence and/or prescribed afterwards, no doubt worsening the offender’s problems.

Here are some cases involving Citalopram in the Courts (Courtesy of LexisNexis). The strange thing is that this drug has been prescribed for everything, from difficulty with sleeping to irritable bowel syndrome, and then there’s the case where it was prescribed to a woman for her partner’s stress. Nope, I didn’t make that up, that’s what was recorded in the case of Forrester Ketley & Co v Brent & Anor.

There’s also the ‘wee’ problem that Citalopram never seems to work, worsens depression and quite possibly has caused the initial problem. Anyway, here’s a few snippets, courtesy of Lundbeck pharmaceuticals….

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Haworth v Cartmel and another [2011] All ER (D) 23 (Mar)

Applicant seeking rescission or annulment of bankruptcy order on basis of lack of mental capacity. (Woman with heart condition prescribed high dose of Citalopram, which didn’t work but very probably increased her chances of damaging her heart further and increased her risk of sudden death. Recommended maximum dose is now 40mgs due to Citalopram causing heart problems.)

11th March 2008: prescribed Citalopram 20 mg

1st April 2008: Citalopram increased to from 20mg to 40 mg

10th July 2008: Citalopram increased from 40 mg to 60 mg

24th February 2009:  applicant ‘currently at high risk of suicide’

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Forrester Ketley & Co v Brent & Anor [2009] EWHC 3441 (Ch)

(Bankruptcy Order)

Here the applicant testified, among other things, that the woman whom he shared a house with, needed to take Citalopram, not for her stress but for his. (Now that is something I hadn’t seen before): “However and for some time, Ms Palette had been feeling the stress that I was under and she needed to take medication (Citalopram) for this.”

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R v Colgan (Lewis Daryl) (2009)

The appellant and the 17‑year old female complainant were both part‑time employees at a store in Aylesbury. The appellant was diagnosed with autistic spectrum disorder (ASD).

January 2009 he grabbed the buttocks of a woman standing at a bus stop. He claims that he thought that she was looking at him oddly and did this in an attempt to keep her away from him. He received a caution. The incident had a profound effect upon him and his anxiety levels increased to the extent that his father arranged for him to have weekly psychotherapy sessions.

Between January and March 2009 prescribed Citalopram. This relieved his depression, but according to his family appeared to make him more talkative and volatile than he had been before.

March 2009 the appellant made an inappropriate comment of a sexual nature to the complainant who complained to the store’s manager.

2 May 2009 the appellant, together with his father, attended a disciplinary meeting about the comment he had made, at the end of which he was informed that he would be disciplined by receiving a written warning. Later that day he stabbed the complainant with a vegetable knife. The police were called and the appellant was arrested. The complainant attended hospital where she received a stitch to a one centimetre wound in her back.

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R (on the application of Drinkwater) v Solihull Magistrates’ Court [2012] EWHC 765

(Magistrates – Adjournment – Discretion of justices – Claimant’s trial being listed before defendant magistrates’ court – Trial being adjourned on several occasions – Claimant being diagnosed with depression and certified as unfit to attend court)

25 May the Claimant was diagnosed with depression and started on a low dose of Citalopram.

13 June, her solicitor faxed a letter to the court stating that she would be unfit to attend court for the next two months as a result of severe depression.

Did not work and probably caused severe depression?

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Sardokie-Gyan v The Nursing & Midwifery Council  [2009] EWHC 2131

2003 – 2005 Was treated by her general practitioner on a reducing dose of Citalopram for difficulty with sleeping… ??

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R v Bailey [2011] EWCA Crim 1124

Man kills wife.

11 September 2008 the deceased spoke to her mother and informed her that she was annoyed with the appellant because he had not been taking his tablets as he should. Later that morning a neighbour heard loud banging coming from her lounge. She ran into the room and found the appellant standing outside the window covered in blood. He was behaving in a wild and bizarre fashion. She also heard him say, “I’ve killed her.”

Dr Sarkar, while not an expert in pyschopharmacology, embarked upon an investigation of the literature as to the possible effect of taking Ritalin and Citalopram in combination and with unreliable regularity.

Before trial the defence had been advised by a prominent expert in the field, Dr Peter Tavener, that neither of these drugs was likely to have been causative of the appellant’s behaviour. (Despite reports of self harm and harm to others from Lundbeck who invented Citalopram, and the known dangers of SSRI withdrawal?)

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MN (Rwanda) v Secretary of State for the Home Department [2007] EWCA Civ 1064

The claimant, a Rwandan national, arrived in the United Kingdom and was refused asylum by the Secretary of State, the immigration judge had made a rounded assessment of the risk that if the claimant was returned to Rwanda she would be driven to commit suicide, and had reached a tenable conclusion that there was no real risk that the claimant’s fears would cause her to respond to a removal decision by committing suicide in the UK, or en route to, or on arrival in Rwanda. The immigration judge had dealt with the matter with considerable care and the reasons which she had given for her findings as to the risk on return to Rwanda had adequately explained her approach to the evidence before her.

She complained of sleeping poorly despite medication in the form of Citalopram (a common treatment for depression and PTSD, which was prescribed for the appellant by her GP).

A common treatment for Post Traumatic Stress Disorder?

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Shala and another v Birmingham City Council [2007] EWCA Civ 624

The claimants were refugees from Kosovo who had been granted indefinite leave to remain in the United Kingdom. They had undergone serious ill-treatment in Kosovo, and had lost contact with three of their daughters. The wife had been diagnosed as suffering from hypertension, depression and post-traumatic stress disorder.

Further evidence initially obtained on Mrs Shala was a note of a telephone conversation with her new GP, Dr Salmon, on 8 November 2005, confirming the diagnosis of depression and recording a prescribed dosage of 30mg citalopram. (Not sure if this means she was prescibed Citalopram over the phone..)

“The applicant has a history of depression which has necessitated referral for psychiatric assessment; however her condition is currently being treated with citalopram, a standard Prozac equivalent anti-depressant drug alone and likewise there remains nothing to suggest her condition [is] of particular severity, nor that it has been in the past and nor that impairs her ability to function or significantly impedes her daily activities.” (No, her condition mightn’t but Citalopram certainly could.)

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R v Smallshire [2008] EWCA Crim 3217

Sentence – Imprisonment – Length of sentence – Wounding with intent – Six years’ imprisonment – Defendant’s state of mind at time of offence affected by medication for depression – Whether sentence manifestly excessive.

5 December 2005, after Mr Smallshire had stated that he felt “increasingly paranoid”, his general practitioner prescribed an anti-depressant, Citalopram. It was a small dose of ten milligrams, described in one medical report as half the usual starting dose, for what was recorded as “irritable bowel syndrome, with anxiety and depression features”. (So now it cures irritable bowel syndrome, anxiety, and depression?)

16 December 2005 Violently attacks man

Mr Smallshire relies, in support of his challenge to conviction, upon evidence of Dr Andrew Herxheimer, a consultant clinical pharmacologist, experienced in the investigation and evaluation of the adverse effects of drug therapy and who in recent years has studied a large number of reports of effects relating to SSRI (Select Seroxat Inhibitors) antidepressant drugs, of which Citalopram is one.

Dr Herxheimer wrote a report dated 12 February 2008 and a supplementary report dated 14 March 2008. In the former he concluded that:

“. . . citalopram very likely contributed decisively to Mr Smallshire’s actions on 16 December 2005. He had started taking this antidepressant medication 11 days earlier; its concentration in his brain would have been steadily increasing from about seven days. It is highly probable that alcohol augmented the effect of the drug: on its own alcohol would not account for his behaviour.”

In his supplementary report Dr Herxheimer stated that in his opinion that it was “more likely than not” that because of a mixture of medication and alcohol, Mr Smallshire would have been in a state of non insane automatism at the time of the incident.

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KERRY DONNELLY Pursuer against FAS PRODUCTS LIMITED Defenders 2004 Scot (D) 36/3

The pursuer is Kerry Donnelly. She lives in Holytown, by Motherwell. The pursuer was born on 1 May 1979. She sues her former employers for damages in reparation for a severe crushing and burning injury to her left (dominant) hand sustained on 5 June 2000 when she was working as a production assistant in the defenders’ factory. Liability has been admitted.

5 June 2000 Accident.

Post accident 2000. Prescribed Amitriptyline, an anti-depressant, and Loprazolam, a sedative, in order to help her sleep. Later the prescribed dose was increased.

15 February 2002 2 two episodes of self-harm through drug overdose. The pursuer was admitted to the Psychiatric Department of Monklands Hospital.

January 2003 A second anti-depressant, Citalopram, was added in… also been prescribed a further anti-depressant, Seroxat, and a tranquilliser, Thioridazine.

June 2003 Described by doctor as “still depressed”. He considered that her depression was mainly related to the accident. The pursuer was taking anti-depressant medication on a daily basis until a few weeks before the proof. As at the date of proof she was trying to manage without medication.

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McEWAN v HIGSON 2001 S.C.C.R. 579

The appellant was charged with driving while unfit to do so through drink or drugs. Police officers gave evidence that one of them had stepped into the road and raised his hand to try to stop the appellant who was driving at excessive speed. The appellant did not slow down and the constable had to go back on to the pavement to avoid the car. The appellant then braked sharply and stopped some twenty feet beyond the constable. When the appellant left his car he was slow in his movements, his speech was slurred and his pupils were contracted. There was no smell of alcohol. One of the constables had been trained in tests used to assess whether the ability of motorists was impaired by drugs. The constables formed the conclusion that the appellant was under the influence of drugs. He was arrested and admitted that he had taken a betablocker. He was examined by a doctor about an hour and a quarter later. The doctor found that at that time his ability to drive was not impaired, but that it was possible that it could have been impaired an hour earlier. The appellant was convicted and appealed to the High Court.

The appellant agreed to a medical examination which was carried out by Dr Richard Millburn, the police casualty surgeon on duty at the time. The examination commenced at 6.15 p.m. and, as a result of it, Dr Millburn concluded that at the time of the examination the ability of the appellant to drive the motor vehicle properly was not impaired through drink or drugs. Dr Millburn found that the appellant’s heart [rate] and blood pressure were normal. He noted that the appellant’s speech sounded thick. He noted that the appellant told him that he had ingested one 20 mg tablet of Citalopram and half an 80 mg dosage of Inderal the evening prior to 4th July 1999. Dr Millburn found that the appellant’s pupils were of a reduced size but were reactive normally. The appellant was slightly unsteady when standing on the left leg and on the right leg.

Reduced pupils and unsteadiness while standing on one foot may be consistent with drug taking. Citalopram is an anti-depressant. Inderal is a betablocker. When taken with alcohol, Citalopram can affect impairment of ability to drive. The appellant had taken a 20 milligram tablet of Citalopram on the night of 3rd July 1999 and 80 milligrams of Inderal on the afternoon of 4th July 1999.

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DPP v Mulder [2009] IECCA 45

On 14 January 2008 the Applicant pleaded not guilty to the murder by strangulation of his wife at their family home in Dunshaughlin, County Meath on 17 December 2004. Following a trial in the Central Criminal Court, the Applicant was convicted of murder by the jury on 25 January 2008 and received a sentence of life imprisonment.

This was the second occasion upon which the Applicant had been tried for this offence. In a previous trial in May 2006, the Applicant was also convicted of the same offence, but that conviction was set aside by this court because a brother of the deceased had spoken to a member of the jury outside the courtroom. At the time of the second trial, there had been a change in the law by virtue of the enactment of the Criminal Law (Insanity) Act 2006, which introduced into Irish law the concept of diminished responsibility. On arraignment, however, the Applicant simply pleaded “not guilty” to the offence of murder.

Dr Harry Kennedy is a consultant forensic psychiatrist and Clinical Director of the Central Mental Hospital. He was the first witness called by the defence and gave evidence which was effectively confined to a recital of his notes on the case. He interviewed the Applicant on 20 December 2004 in Cloverhill Prison and saw him on a second occasion on 6 April 2005 at the same location. His notes recorded that at the conclusion of the first interview he prescribed 10mg of Olanzapine at night for the Applicant. When he saw the Applicant on the second occasion he was already taking both this medication and 20mg of Citalopram, an anti-depressant drug. Dr Kennedy clarified that the latter medication was an anti-psychotic drug which was taken in low dosage and was commonly used to reduce agitation, anxiety and a range of related symptoms. Dr Kennedy formed the view on the occasion of his second assessment that the Applicant should come off Citalopram and move onto a different anti-depressant, Mirtazapine. Dr Kennedy confirmed in cross-examination that the Applicant was not and never had been a patient in a mental hospital. He accepted that the Applicant had been referred to him by his general practitioner because of the suicide risk which might arise by virtue of the fact that the Applicant had been charged with the death of his wife. He stated that there was a raised risk of self-harm within the first few days of being in custody. Dr Kennedy accepted that the fact that one had been charged with such a serious offence would in its own right put a person into a “depressed mode”. (Is it standard practice for prisioners to be prescribed medication?)

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Parkin [N00529] 2007

Mrs Parkin contends that she is entitled to payment of Permanent Injury Benefit (“PIB”) under the Scheme and claims that information submitted to the Agency shows that she has been unable to work since leaving employment making such a benefit appropriate. She additionally claims that she has suffered distress as a result of the way that her application for PIB has been handled by the Agency.

April 1999 “Presented in a tearful state saying she was unable to cope with her job. She was not sleeping. She said, she did not want anti‑depressants. I gave her …. and some mild sleeping tablets.”

June 1999 “because she was still showing marked panic reaction when I eventually talked of work and was still having great difficulty in sleeping I started her on Dothiepin 25 mgs … However, because of side effects, on the 5 July 1999 this was changed to an SRRI, Citalopram, the dose of which was increased”

January 2001“She continues to suffer from depression which I would now categorise as a depressive episode of mild to moderate severity…”

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Stanway [Q00530] 2007

Mr Stanway submits that the Trustees of the Novar Pension Scheme failed properly to consider his request for a Category 2, Ill Health pension, by not taking into account his medical condition at the time he originally applied for a pension.

It was during this time that he cancelled his operation for his knee, mainly because he was completely obsessed with regards to his bowel and perianal discomfort….

June 1999 the decision was taken that he should try an anti-depressant Citalopram. This caused nausea. A trial of Efexor faired little better and I tried him with Diazapam.

February 2000 and he described increasing stress and pressure at work, saying that the last 2 years had been very difficult, he had felt increasingly low and had pictures of self harm, he was not sleeping at night. On examination he was of low mood, although not actively suicidal. I gave him Fluoxetine and advised him against resigning from work…

February 2000 On review he was increasingly agitated on Fluoxetine so we swapped to Paroxetine.

March 2000 he noted he had a poor consultation with yourself and he was also finding he was more short tempered. Over the next few weeks he described himself as continuing to be angry, directing frustrations and bitterness from work towards his wife. We increased his Paroxetine which gave him some benefit along with Zopiclone at night.

Current diagnosis of Mr Stanway’s condition is one of depression and some agitation. (Not surprising!)

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Kinsella v Rafferty [2012] IEHC 529

The plaintiff in this case sues the defendant for negligence and breach of duty in the carrying out by the defendant of a Total Abdominal Hysterectomy on the plaintiff on 7th April, 2008. The defendant is a consultant Obstetrician and Gynaecologist in Mount Carmel Hospital in Dublin.

Some controversy surrounded the initial treatment undertaken by the plaintiff late in 2008, when she was prescribed a drug called Cipramil (Citalopram).

November 2008. Started Citalopram.

February 2009, Reported some improvement on this drug…

March 2009 Discontinued due to adverse-effects. Judgment of Justice O’Neill: “However, her evidence and, in particular, the evidence of her husband, was that she found it extremely difficult to tolerate this drug. Her description, and more particularly, that of her husband, was that whilst she was on it, she was a “zombie” or was constantly “out of it”. Her husband described a variety of minor domestic mishaps resulting from her absent mindedness or forgetfulness or lack of concentration while she was on this drug. Eventually, she could tolerate it no longer and gave it up about March 2009.”

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http://davidhealy.org/the-dram-of-eale/

https://leoniefennell.wordpress.com/2012/03/23/citalopram-aggression-violence-suicide-lundbeck-homicide/

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