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Inquest jury rejects suicide verdict due to Shane Clancy's SSRI levels

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 David Healy

Professor David Healy after the inquest into Shane Clancy's death

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".

Prof 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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Family to question SSRI
use at Clancy inquest

September 6, 2009 — by Ali Bracken

 

The family of a young man who carried out a murder-suicide in Bray three weeks ago are understood to be concerned about his use of antidepressants and intend to raise the issue at the inquest into his death.

The Sunday Tribune has learned that members of Shane Clancy's family, from Dalkey in south Dublin, want to explore whether antidepressants could have in any way influenced his behaviour on the night he murdered Sebastian Creane (22), at his home in Bray in Co Wicklow, before turning the knife on himself.

The Trinity College Dublin student also stabbed his former girlfriend Jennifer Hannigan and Creane's older brother Dylan in the attack. Both have recovered from their injuries.

A source close to the family said some members of the family plan to research antidepressants and speak to the appropriate experts about the medication as they are anxious to explore whether the pills could have influenced his behaviour. Family members believe the best place to raise these concerns will be at an inquest into the 22-year-old's death, which will be held at Wicklow Coroner's Court in several months' time.

The two men's inquests will be dealt with at the same hearing by Wicklow east coroner Cathal Louth. If permitted by the coroner, expert witnesses could be called to give evidence about the impact antidepressants can have on a patient's behaviour.

Clancy started taking antidepressant medication a week before the murder-suicide and had told friends that he did not like the way the drugs made him feel.

Last week, a psychiatrist claimed that the murder-suicide in Bray would not have happened if Clancy had not been taking antidepressants.

Dr Michael Corry, who is an outspoken critic of antidepressants, said: "If he was not on medication, he would not have done what he did. I would stake my career on that.
"His behaviour was out of character. He went from homicidal to suicidal. It's a Jekyll and Hyde situation." Corry was not involved in the medical treatment of the 22-year-old.

Other psychiatrists and GPs have since disagreed with Dr Corry's assessment.

 

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How antidepressants led a
young man to killing spree

On the night of August 15/16 2009, Shane Clancy stabbed his friend, Sebastian Creane, to death in Bray, Co Wicklow, seriously injured his ex-girlfriend and almost killed his victim's brother. He then stabbed himself to death.

He had been taking SSRI antidepressants. At the time, police said he may have been 'overdosing'. However, later this was shown not to be true. In any case, he had been prescribed the drugs by a GP rather than a psychiatrist, after presenting with the symptoms of sadness and a broken heart after breaking up with his girlfriend.

These drugs are dangerous, and they don't work. Their use has become widespread, and prescribing is uncontrolled and unmonitored, as Ali Bracken demonstrated by going undercover as a 'depressed patient' in the weeks that followed.

In the Sunday Tribune of 4 October, Ali Bracken reported that Shane Clancy was given a three-week supply of antidepressant medication by a pharmacy on the day before the tragic events, despite his doctor instructing he should only be supplied one week's dosage at a time because of a previous overdose. Since Bracken's exposure, controversy has raged. Dr Michael Corry of The Wellbeing Foundation told the Sunday Tribune: 'If he was not on medication, he would not have done what he did. I would stake my career on that. His behaviour was out of character. He went from homicidal to suicidal. It's a Jekyll and Hyde situation.'

Clancy (22) started taking medication a week before he murdered Sebastian Creane and stabbed his former girlfriend Jennifer Hannigan before killing himself. Clancy had told friends that he did not like the way the drugs made him feel and gardaí believe that he may have been misusing the medication by taking more than the recommended dosage.

Dr Corry said that the side affects of antidepressants can be severe when people initially take them.

"In the first three to seven days [on antidepressants], people can feel totally out of character and worse than before. Side effects can be patients wanting to self-harm, commit suicide and harm others," he added. "Antidepressants inhibit oxytocin, which is basically the self-love hormone. It results in an emotional numbing. People can be feeling no pain but not feeling alive either."

This would not be the first case of homicide under the influence of SSRIs or SSRNIs, the modern classes of antidepressants which cost the Irish taxpayer €54 million in 2008. The shooters in the infamous Columbine High School massacre in the USA were taking SSRIs, and there are many other documented examples of of 'out of character' violence and murder, often of close family or loved ones, sometimes of work colleagues, often followed by the suicide of the perpetrator.

Nonetheless, following Dr Corry's statement and Ali Bracken's exposure of how easy it is to persuade doctors to prescribe SSRIs, the usual crew of defenders of these drugs took to the airwaves and print media to decry the notion that they are implicated in this tragedy.

 

Read our full coverage of this important and tragic sequence of events here arrowback


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Tribune coverage lays bare
the role of dangerous drugs

The Sunday Tribune has done a great service by taking this tragedy so seriously and investigating the role of antidepressants in the double deaths of murder victim Sebastian Creane and his killer, Shane Clancy.

Crime reporter Ali Bracken went undercover, detailing symptoms of mild depression to five doctors. Four prescribed her SSRIs, though she was a new patient and clinical guidelines state that these drugs should not be prescribed as a first resort for mild depression, where counselling is the appropriate first step.

And on the front page of the Sunday Tribune on 4 October, Bracken reported that Shane Clancy was given a three-week supply of antidepressant medication by a pharmacy on the day before the tragic events, despite his doctor instructing he should only be supplied one week's dosage at a time because of a previous overdose.
She conducted an extensive interview with Shane's father, Patrick, who expressed his horror at what had happened and his unease at the role of doctors and pharmacists in prescribing and distributing antidepressants:

"I think every parent should ask their GP where they stand on antidepressants and in what circumstances they would prescribe them to their children. We all need to look at the relationship between doctors and pharmaceutical companies. Shane put a high dosage of chemicals into his body and I've no doubt he reacted to that. Some people take antidepressants and they don't agree with them. The consequences of that can be horrific."
Read the Tribune's full coverage here arrow
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The papers that expose the ignorance of Ireland's eight top professors

On Monday 19 October 2009 the Irish Times published a letter from eight psychiatrists, professors of psychiatry who lead the teaching departments in this subject at UCD, UCC, TCD, UCG, University of Limerick and at St James's and St Patrick's Hospitals, Dublin. The eight professors denied that antidepressant use is connected to homicidal acts, though they were careful to use the word 'cause' rather than 'link' when all eight accused Dr Michael Corry of stating 'definitively' that "antidepressants cause homicide".

Ignorance of the scientific literature on the dangers of antidepressants, up to and including provoking acts of murder, and of the warnings by regulators, is deplorable in any health professional.

Ignorance at the highest levels of the teaching of psychiatry in Ireland, ignorance among the eight professors who control the teaching of psychiatry in this country, is not just deplorable, it is inexcusable, it is appalling, it is dangerous.

To demonstrate just how dangerous SSRIs are, and to educate the ignorant, as a public service we publish here just two from a very extensive selection of the scientific literature on this matter, a literature the eight leading psychiatrists should immediately familiarise themselves with.
1: 'Antidepressants and Violence: Problems at the Interface of Medicine and Law'. By Professsor David Healy et al. PLoS Medicine, here or download here.
2. 'Suicidality, Violence and Mania Caused by SSRIs: A Review and Analysis'. By Dr Peter R Breggin. International Journal of Risk & Safety in Medicine, here.

Incidentally, one of the eight is the gentleman who laid a complaint with the Medical Council against Dr Michael Corry, UCC Professor Timothy 'Ted' Dinan.

Even GlaxoSmithKline, maker of Seroxat, states in its own Product Monograph of 12 September 2008, page 6, that:

There are clinical trial and post-marketing reports with SSRIs and other newer anti-depressants, in both paediatrics and adults, of severe agitation-type adverse events coupled with self-harm or harm to others. The agitation-type events include: akathisia, agitation, disinhibition, emotional lability, hostility, aggression, depersonalization. In some cases, the events occurred within several weeks of starting treatment.

And the Food and Drug Administration, the US regulator, includes in its prescribed patient information leaflet for all SSRIs this statement, which is placed below the Black Box warning on suicidal thoughts and acts: 'The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and paediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric.'

The patient leaflet continues: 'Families and caregivers of paediatric patients being treated with antidepressants for major depressive disorder or other indications, both psychiatric and nonpsychiatric, should be alerted about the need to monitor patients for the emergence of agitation, irritability, unusual changes in behaviour, and the other symptoms described above, as well as the emergence of suicidality, and to report such symptoms immediately to health care providers. Such monitoring should include daily observation by families and caregivers. Prescriptions for [Insert drug name] should be written for the smallest quantity of tablets consistent with good patient management, in order to reduce the risk of overdose.

'Families and caregivers of adults being treated for depression should be similarly advised.'

Is it not astonishing and disturbing that Ireland's eight leading professors of psychiatry are ignorant of this?
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Leading sociologist corrects the
eight ignorant professors

Dr Orla O'Donovan, a sociologist who specialises in the politics and sociology of health and medicine, with a focus on 'the cultural and economic power of the globalised pharmaceutical industry', has a letter in the Irish Times castigating both the eight professors and Times writer Kate Holmquist for misrepresenting the known facts about the dangers of antidepressants.

O'Donovan is a lecturer in the Department of Applied Social Studies at University College Cork. Among her works is the study Power, Politics and Pharmaceuticals, co-edited with Kathy Glavanis-Grantham, which was published by Cork University Press last year.

Dr Michael Corry has written to the Irish Times to defend himself against the eight and challenge their misrepresentation of the facts. You can read the text of his letter here.
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