Two recent inquests again raise concerns on the widespread practice of prescribing ‘safe’ [sic] SSRI antidepressants. Both inquests involve Citalopram.
On the face of it, Dr Sylvia Margaret Tisdale (64) and Andre Mickley (36) have very little in common. Dr Tisdale, a clinical virologist, had a long and distinguished scientific career with GlaxoSmithKline, while Andre Mickley was a former chef who was his partner’s carer at the time of his death. Mr Mickley had taken heroin and cocaine and was described in one newspaper as ‘a long term drug addict’ – but it should also be noted that he was described as a ‘gentle giant’ by his partner and was actively undergoing addiction treatment at the time of his death.
On April 29th 2015, Dr Tisdale left her ‘coping with stress’ book, her glasses and her
antidepressant Citalopram on her bedside table and jumped from her bedroom window; she died a short time later. While the coroner focused on the stress Dr Tisdale was under, her sister Linda raised concerns ‘about the controversial side effects of citalopram’. She said “I felt that she wasn’t depressed but was instead very anxious and stressed. I was concerned about the citalopram she was prescribed, when I looked up the side effects- I don’t think she knew how serious the side effects could be.”
The coroner Tom Osborne returned a suicide verdict, dismissing Linda’s concerns. He said “If you went online and read the side effects of almost any medicine, you would never want to take any medication at all.” Wait!! What about the doubling of suicide risk? Mr Osborne is obviously not an advocate for ‘informed consent’? Incidentally, the psychiatrist testifying at Jake McGill Lynch’s inquest last week said something similar – “The Patient Information Leaflets (PILs) are too over prescriptive and it might put people off“. It might, and then there might be less use for psychiatrists or doctors to be testifying at inquests?
Andre Mickley’s Inquest and a different Coroner:
Andre Mickley was described as a ‘long term drug abuser’ who had reportedly used heroin and cocaine on the morning of 17th Feb 2015. He collapsed later that day, having suffered a subarachnoid hemorrhage (uncommon form of stroke) and died a few days later. What he had in common with Dr Tisdale was a prescription for Citalopram; he had been prescribed it just a few days before his death. There is emerging evidence that Citalopram can cause major adverse events such as heart attack and stroke, leading to death. A 2012 study published in the journal Neurology, found Patients who take Citalopram and other SSRIs have an increased risk of bleeding in the brain and stroke.
At Mr Mickley’s inquest, the coroner Professor Robert Forrest returned a ‘Narrative’ verdict. Unlike the coroner who dismissed Citalopram concerns in Dr Tisdale’s inquest, Prof Forrest sent a Regulation 28 report (with the aim of preventing further deaths) to the MHRA Director of Pharmacovigilence. In the report he stressed that Mr Mickley had used many drugs for several years “without major ill effects” but he had concerns regarding the drug Citalopram. He said there are “clear potentially adverse pharmacokinetic interactions between cocaine and the SSRI group of drugs, besides case reports” and this is not addressed in the PILs. He asked for action to be taken to prevent further deaths.
Tragically, the coroner presiding over the Dr Tisdale’s Inquest did not feel the need to initiate an investigation, but maybe, just maybe, Andre Mickley’s death might curtail the number of further Citalopram deaths and even provide some answers to Linda’s questions. Who knows – it’s a strange and sometimes wonderful world.
Thanks Mr AntiDepAware for providing me with the coroner’s Report. RIP Margaret and Andre.