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.
Leonie Fennell and her partner, Tony Donnelly, after the inquest
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.
Prof David Healy, who testified at the inquest into Shane Clancy's death
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."
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.
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.
Irish Times censors Corry
With regard to the controversy around SSRIs and similar antidepressants, the Irish Times has censored the views of people writing to point out the well-recorded dangers of SSRI antidepressants, including dropping a letter from Dr Michael Corry.
The 'newspaper of record' published a completely one-sided and unprofessional article by Kate Holmquist on 10 October 2009, in which she parroted the views of the pro-SSRI lobby among psychiatrists and attacked Dr Corry's statements setting out the dangers of SSRIs and their possible implication in the death of Sebastian Creane, stabbed by Shane Clancy who then knifed himself to death.
Holmquist also praised the Irish Medicines Board, a regulator funded by the drug companies, as a source of unbiased information. She did so despite the fact that the Oireachtas Committee on the Adverse Side-Effects of Pharmaceuticals recommended the break-up of the IMB in 2007 — a recommendation which the Government has chosen to ignore — because of its cosy links with the drug makers.
Holmquist's far-from-impartial piece was followed by the letter from the eight professors published on 19 October, gushing their congratulations on her support.
Since then one letter taking issue with these views has been printed, that of Dr Orla O'Donovan on 22 October.
Dr Corry wrote to the Times the same day to rebut the false accusations made against him by the eight professors and to set out his views and some of the evidence implicating SSRIs in aggression, violence and homicide more clearly .
The Irish Times did not publish his letter. Instead the newspaper has left false accusations against him to stand uncorrected.
Basil Miller of the Wellbeing Foundation wrote to the paper on 24 October, expressing astonishment and disquiet that the eight bosses of teaching departments of psychiatry in Ireland publicly profess to be ignorant of the dangers of the drugs they recommend, despite extensive evidence. His letter questioned the effect of such ignorance on the thousands of students who pass through their departments and qualify as psychiatrists and stated his belief that this poses a continuing danger to health service users.
The Irish Times did not publish his letter either.
The Irish Times has not published any other letter challenging the eight professors or Kate Holmquist's article — and we are aware that several were sent to the Letters Editor.
Minister for Mental Health must end light touch drug regulation — now
On Wednesday 15 April 2010, a jury in Wicklow returned a historic verdict in the Shane Clancy inquest.
The jury accepted medical evidence which implicated antidepressant prescription drugs in the death of Shane Clancy and, by implication, the death of Sebastian Creane at Clancy's hands.
The coroner's court heard of defects in the warnings on suicide and aggressive behaviour in both package leaflets and doctors' prescribing information for antidepressants, and of lack of monitoring by doctors of patients prescribed SSRIs.
As Wellbeing Foundation founder Dr Michael Corry commented following the double tragedy in August 2009: "If [Shane] 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."
A coroners' jury has now accepted this is the case. The drug did it, nothing else.
Minister of State John Moloney, in charge of mental health, must act immediately to protect the public, and other families, from the dangers of SSRIs provoking more horrendous events such as this double killing.
The regulatory regime is like of the banks before the crash: "light touch". Which means, in practice, no touch.
It's time to end light touch drug regulation before more young people die — or there is a mass killing like the Columbine massacre in the US, also SSRI-driven.
Read our full editorial here
How antidepressants led
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
Tribune coverage lays
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 2009, 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.
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."
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.
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
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:
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?
Leading sociologist corrects the
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.