The Scientist, the Doctor and the Coroner

MargaretTisdale

Dr Sylvia Margaret Tisdale (top), known to her family as Margaret, was an internationally renowned scientist. As a virologist, she helped to develop treatments for HIV and AIDS during the 1980s and 1990s. She went on to establish a worldwide reputation as an expert in antiviral resistance, working on the implementation of a flu vaccine and setting up an international organisation to monitor resistance in circulating influenza viruses.

After she retired, Margaret became well known as a “pillar of the community” in the village of Wrestlingworth, in Bedfordshire, where she lived. She worked voluntarily as a warden at the local church, and was chair of the governors of the local primary school.

On April 29th this year, Margaret was found unconscious by her partner Brian. He had let himself in and began searching for her when she failed to respond to his greeting.

Citalopram1Brian went upstairs and found on her bedside table a copy of a self-help book on coping with stress, a pair of glasses and her Citalopram tablets. He also noticed a stool placed under the window.

Brian went into the garden where he found Margaret lying unconscious.  He immediately alerted emergency services but, later that day, the 64-year-old was confirmed dead as a result of complications arising from severe head injuries. She had fallen from the bedroom window on to the patio,

Today’s inquest heard how, in the months leading to her death, Margaret shared concerns about her responsibilities and the stress they were causing her. In fact, she had handed in her notice to the school the day before she died.

Margaret’s sister Linda said: “She was so meticulous, she would always do a good job … She knew it was getting too much but there wasn’t anyone else to take it on.”

Brian added: “In her profession, she was always in a position that required a great deal of attention … like many other people I was urging her to pace herself, take more time for herself.

LaurenceDrakeA statement by Margaret’s GP, Dr Laurence Drake (left), was read to the court: “She was a very sensible lady, a pillar of the community who took on voluntary work after she retired. I recall her mentioning that she had a lot on her plate, with being church warden and head of governors.

“She admitted to feeling rather stressed due to the many commitments. She realised she had a lot of responsibilities in terms of fundraising, I had a long talk with her. She was a really decent person, a real asset to the village who will be greatly missed.”

Dr Drake’s statement made no mention of why he thought it appropriate that Margaret should be prescribed an SSRI antidepressant with known links to suicidal ideation.

The GP must surely be familiar with NICE Guideline CG90, which states specifically that SSRIs should be prescribed only for “moderate to severe depression”, not for someone like Margaret who was merely “feeling rather stressed.”

The warning in CG90 is clear enough: “Do not use antidepressants routinely to treat persistent subthreshold depressive symptoms or mild depression because the risk benefit ratio is poor.

At the inquest, it was Linda who raised concerns about the 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.”

TomOsborneThese concerns were crudely rebuffed by the coroner, Tom Osborne (right), who replied: “If you went online and read the side effects of almost any medicine, you would never want to take any medication at all.”

It is true that the side effects of Citalopram are mentioned in a vast number of places online. After all, it is linked to more self-inflicted deaths in the UK than any other antidepressant.  However, the side effects are also mentioned in the Patient Information Leaflet (PIL), to be found in every box of tablets.

Tom Osborne is a very experienced coroner: this will not have been the first time that an SSRI-induced death has been examined in his court. By now, he should be well aware of the links to suicidal ideation attributed to the drug, and of the heightened risk incurred by flouting NICE Guidelines.

Delivering a verdict of suicide, the coroner concluded the inquest by expressing his “condolences and sympathies to the family for this sad death” and his belief that: “The person who took their own life that day was not Margaret – she had been overtaken by stress and distress.”

It would have been more honest to have said that Margaret, like so many others, had been overtaken by an adverse reaction to a mind-altering drug that she should never have been prescribed.

Co-incidentally, Tom Osborne’s area of jurisdiction includes Milton Keynes, where Lundbeck, manufacturers of Citalopram, has its UK headquarters.

Related Articles:

Under the Coroner’s Carpet

Failed in Furness

Jessica, Epilepsy & Antidepressants

 

6 Replies to “The Scientist, the Doctor and the Coroner”

  1. Maybe if more people read the side effects better, fewer people would take these dangerous medications.
    So often we cannot medicate our way out of distress, only deeper in. We need more care and understanding and then actual therapeutic treatment. Iatrogenic damage is done to all except the wallets belonging to shareholders of the pharmaceutical companies.

  2. My dear sister Margaret’s death was a great shock to everyone and enormously distressing, it was very hard to believe that she would ever have taken her own life. We were not aware that it was a drug induced suicide!
    It grieves me to think that she should die as a result of, in my opinion, an inappropriate prescription of Citalopram, was it a cheap way to get patients through the door? Margaret was not depressed but suffering from stress and anxiety.
    I now know that antidepressants are prescribed too frequently and far better results would be achieved through counselling.
    We all miss her but rejoice and rightly feel proud that she was our sister.

    • You have good reason to be proud of your sister, for who she was as well as what she achieved.
      It’s an absolute tragedy that Margaret spent her illustrious career helping to produce medication that saved countless lives, only to lose her own life to mis-prescribed medication.

  3. My son who suffered from epilepsy was prescribed Citalopram in late summer 2015. He had had no seizures for years following a benign brain tumour removal operation and had been driving for the last 5-6 years.
    Late November 2015, when advised to double the dose of Citalopram by his GP, he had a road accident where he almost certainly had a grand mal seizure and ran into a telegraph pole. Three weeks later, he had a further grand mal seizure whilst at work and was out for about 15 minutes. He was taken taken to hospital and later discharged.
    He immediately stopped taking Citalopram but, a further 3 weeks later, he had a further grand mal seizure at work. Colleagues found him wandering in a confused state, having partially undressed himself and having placed his shoes outside an emergency door where he works.
    Despite his historical epilepsy diagnosis, he had NEVER suffered an grand mal seizure nor did he ever behave in such a confused state in the past. He is totally convinced that the episodes previously described have been brought on by the taking of this medication.
    Maybe Dr Tisdale could have been similarly affected by a seizure causing her to be confused, which resulted in her falling from the window.
    Having dealt with a number of London coroners over a period of 30 years, some have been excellent whilst others have displayed what might be described as intellectual arrogance and have totally dismissed compelling evidence that may have been a contributing factor as to the circumstances in which a person met his/her death.
    Since stopping Citalopram, my son has not had any further seizures and, hopefully, if his progress continues, he may be able to drive after a 12 month period has elapsed.

    • Thank you for your contribution, AJ. We know that the prescription of SSRIs like Citalopram is fraught with risks; to combine the drug with another, different type of psychiatric medication appears somewhat reckless.
      I hope that your son continues to recover, and that he is back behind the wheel before too long.

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