Bridgend: the antidepressant factor

In May 2012, an article in People magazine reported that between January 2007 and February 2012, 79 people in the Bridgend area of South Wales had taken their own lives by hanging. Most of the victims were young adults, but many of them were teenagers. Coroner Philip Walters (left) speculated that an Internet-based suicide cult was to blame, although police found no evidence to link the cases together.

In February 2008, the parents of one of the young victims accused the media of “glamorising ways of taking one’s life to young people“, while Madeleine Moon (right), MP for Bridgend, said that the media were “now part of the problem.” Later, the Police asked the media to stop covering the deaths in an attempt to prevent what they referred to as “copycat suicides”.

From my database of inquests, I found 10 hangings in the Bridgend area between 2007 and 2011 where antidepressants were involved. These are mentioned by Professor David Healy (left) in his excellent article: Left Hanging: Suicide in Bridgend. It was only when I studied these inquests more closely that I discovered something extraordinary.

Leigh Jenkins (22) (right) was one of 5 suicide victims whose inquests were heard in one day by coroner Philip Walters, during which Mr Walters appealed for a national suicide strategy. Leigh’s mother told the inquest that he had been “prescribed medication for depression.” Mr Walters was more interested in the alcohol and amphetamines in Leigh’s system, and “recorded the short narrative verdict after saying the drugs Mr Jenkins had taken would have highly affected his judgment.”

The mother of 20 year-old Liam Clarke (left) “told the inquest that her son had been prescribed medication for depression and would become aggressive whenever he forgot to take his tablets.” Coroner Philip Walters made no mention of his medication when he recorded a narrative verdict that “Mr Clarke killed himself while under the influence of drink.” (Medical experts will tell you that antidepressants can induce a craving for alcohol, and can exacerbate the effects of alcohol).

In the inquest of 19-year-old Sean Rees (right), the pathologist named the tricyclic anti-depressant Lofepramine as one of the drugs in his system when he hanged himself. Coroner Peter Maddox said that “I would say the alcohol was the main component on his mood or judgement” before delivering an open verdict.

Craig Evans was 25 when he was found hanged in his house. The report does not tell us who provided the information that “he was given antidepressants”. The report concludes: “Toxicology results showed his prescribed drugs and a substantial amount of alcohol in his system. The cause of death was noted as asphyxia as a consequence of hanging, and assistant deputy coroner Wayne Griffiths for Bridgend and the Valleys recorded a narrative verdict.”

In March 2010, an inquest heard that 18 year-old Angeline “Angie” Fuller (left) hanged herself after a row with her boyfriend. Angie had a history of depression and had made two previous suicide attempts. She had received “treatment” in a clinic, presumably with antidepressants. Mr Maddox recorded a narrative verdict that Angeline hanged herself, but said her intention could not be determined.

In September 2010, at the inquest of 40 year-old carpenter Paul Harris, it was the Police report that mentioned that he was on antidepressants. A postmortem report “concluded that the cause of Paul’s death was hanging, and stated that no alcohol or drugs were found in his system.” (In an inquest, it is common for ‘drugs’ to mean illicit or recreational drugs).

Mr Maddox (right) delivered a verdict of suicide, ignoring the presence of antidepressants when he told the court: “There was nothing in Paul’s system which may have affected his judgement. The circumstances in which he was found obviously leads me to a verdict of him taking his own life.”

The following month, in October 2010, Mr Maddox presided over the inquest of accountant Gareth Williams. Mrs Williams told the inquest that her husband had been prescribed antidepressants for work-based anxiety. In her statement she said: “This was so out of character. We were financially comfortable and our relationship was good.”

The report concludes: “Coroner Peter Maddox said a postmortem revealed a small amount of alcohol and prescribed medication in Mr Williams’ system, but neither amounts were sufficient to affect judgement.”(A therapeutic amount of an antidepressant is easily enough to induce suicidal thoughts).

Just 5 days later, the inquest of 17 year-old Robert Scott Jones was held. Robert was resident in a children’s home, and it was a police officer who told the inquest that he “was on medication for depression”. No further mention of this is made in the newspaper report, which ends with the sentence that “Coroner Peter Maddox said Robert had no signs of alcohol in his system and only a small amount of cannabis, not recent. He recorded a narrative verdict that Robert hanged himself.”

Another 2 days later, at the inquest of Christopher Ward, a police officer provided the information that 29 year-old Mr Ward “had been prescribed Citalopram for depression.” Even so, Coroner Peter Maddox declared that “blood and urine samples showed no drugs or alcohol in Mr Ward’s system.”

“There was a lack of anything in the system that would have altered his judgement, you would expect him to understand what he was doing and the consequences,” said Mr Maddox. “I can’t ignore the circumstances in which he was found, the toxicology results which suggests he was in control of his faculties.”

Mr Maddox recorded a verdict of suicide, thus completely ignoring the possibility that Citalopram may have “altered his judgement”.

The final inquest report I found was that of 20 year-old mother Lana Williams (left). Her fiancé said she had seemed “in good spirits” when he had left the house for work that morning. A police officer reported that “although Miss Williams had suffered post-natal depression, for which she was still taking medication, there was no other history of mental health problems.” After hearing the evidence, “Coroner Peter Maddox said he thought an appropriate verdict was that Lana Williams took her own life.”

Re-visiting these inquests has left me extremely perplexed.

There are 3 people in an inquest who would know for sure whether antidepressants are involved in a suicide: the family doctor, who would, presumably, submit a report on the victim’s medical history, the pathologist, who performs the postmortem, and the coroner, who reads these documents.

It is, therefore, rather concerning that in these ten inquests, the pathologist reveals the existence of an antidepressant just once, as part of a “cocktail” of drugs taken. In another inquest, the source of the information is not reported and, in a third, the prescription of antidepressants is euphemistically referred to as “treatment”. In the remaining 7 inquests, the Police provide the information in 4 of the inquests, family members in the other 3.

It is also difficult to understand why the coroner refuses repeatedly to acknowledge that antidepressants can have played a part in affecting the victim’s state of mind prior to taking their life. By 2010, the link between antidepressants and suicide had been well-established, and it is reasonable to expect that all but the most negligent of coroners would be aware of this.

I looked at other inquests in the Bridgend area around this time, including those of 17-year-old Natasha Randall (right), Zachary Barnes (17), Dale Crole (18), Lisa Dalton (24), Rhys Davies (23), Gareth Morgan (27), Andrew O’Neill (20), Allyn Price (24), Nathaniel Pritchard (15), Kelly Stephenson (20), Jason Williams (21), Anthony Martin (19)  and Sarah Williams (28). In these and others, I found that toxicology results were not fully reported. Significantly, I found no inquest reports where it was stated that psychiatric medication was not involved.

No valid reason was found at the time for the spate of suicides in the Bridgend area. From my research, I would suggest that one possible reason may have been over-prescription of antidepressants. Maybe some of the victims were encouraged to take antidepressants to keep them safe from the “epidemic”. If so, this would suggest that the coronial system may have been used to suppress the evidence. Some of Mr Maddox’s ill-informed statements would lend credence to this theory.

In summary, 13% of those who took their lives by hanging had been taking antidepressants, 0% were not on antidepressants, and the remaining 87% remain unknown. Perhaps it is time for a thorough inquiry while medical records are still accessible.

Related articles:

South Wales Suicides

Wales: The Missing Link

When is a Suicide not a Suicide?