Wicklow, 15 April 2010 — The jury in the Shane Clancy inquest returned an 'open verdict' following evidence given at Wicklow Coroner's Court today and after the coroner, Cathal Louth, told them that their choice of verdict had to be either suicide or an open verdict.
    Earlier, expert witness Dr David Healy, Professor of Psychiatry at Cardiff University in Wales, told the court that behaviour such as suicidal or violent thinking or actions, seen in some patients prescribed Selective Serotonin Reuptake Inhibitors such as Seroxat, or in this case Cipramil, arose not from the patient's condition but from the drugs.
    Professor Healy stated clearly that in a small but significant minority of patients using SSRIs can give rise to violent behaviour including self-harm, suicide and violence to others, even up to killing them. He said that this was independent of any condition the patient might have, as the same symptoms had been seen in healthy volunteers.
    Professor Healy criticised the existing warnings for patients, as they give the impression that such feelings and behaviours are part of the patient's complaint, and because they are not strong enough.
    "The risk arises entirely from the treatment," he said.
    The jury was strongly influenced by his evidence and that of assistant state pathologist Dr Declan Gilsenan, who testified to "toxic" levels of citalopram in Clancy's blood, the active ingredient in the antidepressant Cipramil which he had been taking in the period leading up to the night of horrific violence in Bray in which he and Seb Creane died and Seb Creane's brother, Dylan, and the latter's girlfriend were lucky to escape with their lives.
    Both doctors also stressed that the high levels of the drug were not necessarily due to an overdose, but could have resulted from a build-up of citalopram resulting from it being slower to metabolise in Clancy's body.

   
Prof Healy told the court that in Shane Clancy's case he had attempted suicide soon after first being prescribed Cipramil. Despite being told this, his doctor had prescribed a further course of the same drug. In Prof Healy's view, Clancy's doctor did not have sufficient warning that this behaviour arose from taking the medication, rather than from his depression and sadness over breaking up with his girlfriend.
    Prof Healy stated categorically that "it is the drug that causes the problem", at least in susceptible patients who can form a small but significant minority. He added that the higher the dose taken, the greater the likelihood of serious adverse effects and behaviours. In Clancy's case, the post mortem had shown levels levels of citalopram which lay between 'toxic' and 'lethal'.
    "My view is that there should be compulsory monitoring of patients in the initial period after starting to take the drug," he said. He explained that the danger period is generally within the first two weeks and usually within the first days of taking the drug. "As many as 50% of patients prescribed citalopram [the active ingredient in Cipramil and other brands] could find it is the wrong drug for them," he said. "If they react to it, if there is any kind of oddity, they should go back to their doctor and ... have the drug changed."
    As in other jurisdictions, the patient should be monitored over a period of two weeks to ensure things did not go wrong. Ideally, an appointment should be made on prescription for a routine screening. As the patient could develop problematic behaviours but not link them to taking the drug, it should be a matter of calling them back to the clinic rather than leaving it up to the patient.
    He felt that public awareness of these dangers is generally low and that information about the risks involved should be widely and continuously available.
    Prof Healy pointed out how individuals had killed themselves after taking drugs such as PCP. It was generally accepted, he said, that such persons did not intend to kill themselves and while influenced by the drug were not in the state of mind which would allow them to form such an intention.
    "Can citalopram have this effect?" he asked. Shane Clancy was suffering from involuntary intoxication on the prescribed drug at the time, his doctor had told him to continue taking it. In Prof Healy's view, he did not intend to kill himself and he felt it would therefore be legally appropriate to return "either an open verdict or a verdict of death by misadventure".
    Dr Healy criticised the existing warnings for patients, as they give the impression that adverse effects, feelings and behaviours are part of the patient's complaint, and because they are not strong enough.
    Prof Healy recommended that the warnings in respect of this class of drugs be strengthened to emphasise that the drug can cause the problem, and that feelings such as suicidal ideation, agitation, restlessness, hostility and others are caused by the drug rather than by the patient's diagnosed condition.
    After hearing a moving deposition, which she delivered to the court herself, from Shane Clancy's mother Leonie Fennell, the jury retired to consider. Ms Fennell said she firmly believed his actions were the result of taking prescribed anti-depressants. She said she could not do much now to undo what had been done, but she could highlight the issue.
    She said she believed an investigation was required. Ms Fennell described Shane as a kind, caring, charming and charitable young man. She apologised to the Creane family and to Jennifer Hannigan for her son's actions and said she could not justify them.
    But it was not in his make-up to do what he did. She described how he had become depressed after splitting up with Jennifer Hannigan, and how that depression had worsened over the course of months.
    She said he was prescribed a course of the antidepressant Cipramil and within days became very agitated and tried to take his own life by overdosing on them. He then went back to another doctor and explained what he had done and how he was feeling.
    She said she had been surprised that he came out with a further course of the same antidepressant at a lower dosage.
    A little over a week later he stabbed Seb Creane to death, seriously wounded Dylan Creane and Jennifer Hannigan, and then stabbed himself to death in the Creane's garden.
    The jury returned within 35 minutes and announced an open verdict, and that Shane Clancy had died of self-inflicted injuries.
    Afterwards, the family said, through their solicitor, that the verdict showed the double killing was not intended and was out of character. They called for patients prescribed SSRIs to be screened during the early stages of medication.
    Both young men were aged 22 at the time of the horrific events.

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The Bill to outlaw the forced administration of Electro-shock 'therapy', introduced into the Senate in June 2008, was debated again on Wednesday 2 December.
    Unfortunately, Mental Health Minister John Moloney did not accept the Bill put forward by senators Deirdre de Burca, Dan Boyle and David Norris, but he did make some promises and set down a timetable for further discussion with action to follow.
    De Burca and Boyle proposed to limit the thrust of their original Bill to a provision which would have removed Section 59 (b) of the Mental Health Act 2001, which permits forced administration of ECT once two consultant psychiatrists have approved the forced administration. Section 59 would thus read only:
    Senators, notably Dan Boyle himself, made some interesting contributions to the debate, which  you can read in full here or download here. Boyle cautioned in particular against the false standard of legislating for the extreme case — in this instance, the extremely rare risk of an individual risking death if not given ECT — so that a large number of persons at no such risk are then wrongly given the 'extreme' treatment.
    Minister Moloney asked the proposers to postpone debate on their Bill to allow further consultation, and he gave a commitment to conclude that consultation by March 2010. He proposes to have advocates of forced ECT and opponents come to give evidence to a session of the Joint Oireachtas Committee on Health and Children setting out their points of view, sometime in the first quarter of 2010.
    While there are obvious dangers in this approach, there are also opportunities. The Wellbeing Foundation urges our supporters who have evidence to give before the Oireachtas committee to write immediately both to the Minister and to the Chairman of the Joint Committee asking to give evidence to the Committee.
    As all the pro-ECT lobbyists will be present in force, it is important that service users and anti-ECT campaigners be equally strongly represented.
    For the committee, write directly to the Chairman, Seán Ó Fearghaíl TD, Houses of the Oireachtas, Leinster House, Kildare Street, Dublin 2 or email the clerk to the committee, Ms Sinead McCann, at sinead.mccann@oireachtas.ie.
    To reach the Minister, write to John Moloney TD, Minister of State at Health and Children, Hawkins House, Dublin 2 or email minister_moloney@health.gov.ie.
    Dr Michael Corry had a letter on the subject published in the Irish Times on Thursday 10 December, which you can read here. In it he appeals to service users and campaigners to take up the Minister's invitation.

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The senior psychiatrist Professor Ted Dinan of University College, Cork, who has laid a complaint against Dr Michael Corry at the Medical Council, has been paid or had his work financed by at least five different drug companies.
    In a letter to the Council's Fitness to Practice Committee, Dinan said Dr Corry had made comments about a tragedy "without regard for the distress" caused to the families; had "made allegations regarding the competence" of a colleague"; "made statements regarding a diagnosis without ever seeing the patient"; and made "statements regarding the pharmacology of antidepressants".
    Dinan is an enthusiastic advocate of SSRIs and SNRIs and has declared his close relations with several drug companies as follows: "Dr Dinan has received honoraria [cash payments] from and is a member of the speakers board and advisory board for Lilly, Pfizer, Lundbeck, and Organon." His Cork Neuroscience Group is funded by, among others, GlaxoSmithKline, maker of Seroxat, and the Wellcome Trust (an offspring of GSK's parent companies which funds biomedical research). 
See here
More here

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A family has been awarded $2.5m (€1.7m) in damages after a jury in Philadelphia decided that the British-made antidepressant Seroxat was responsible for their three-year-old son's heart defects.
Full story here

Irish Times article says 'barbaric age' must end