Robert Keywood was married and had two daughters, lived in Kent, and worked for an international company as director of human resources.
A few weeks before his death, he had travelled to Poland and America on business and was having trouble sleeping. He went to see his GP, and was prescribed sleeping tablets and antidepressants.
One Friday last November, Mr Keywood drove to the Pentagon shopping centre in Chatham, where he took his own life by jumping from the top of the multi-storey car park (right). A note left on the passenger seat of his car read: “You’re better off without me, love Bob.”
Ann, his wife of almost 30 years, told the inquest her husband had acted “agitated” and “out of character” on a number of occasions before he died.
Deputy assistant coroner Allison Summers (left) said, “One gleans some insight into a particular person’s life and it’s clear to me this was very out of character,” before recording a verdict of suicide.
To give a verdict of suicide, a coroner needs to be certain that the person intended to kill himself or herself. Often, the existence of a written note is regarded as evidence of intent. In this case, Mr Keywood had written just seven words on a piece of paper left in his car.
In a case where medication could well be the cause, however, it is surely relevant to ask the question: “On the balance of probabilities, would the person have killed him/herself if he/she had not been taking medication?” In this case, like so many before it, Mr Keywood had no recorded history of depression, and only began to act agitated and out of character after having been prescribed medication. From the newspaper report, it would appear probable that an adverse reaction to antidepressants was responsible for Mr Keyword’s death. Therefore, unless there are circumstances that have gone unreported, suicide may not be the most accurate verdict in this case.
Like Mr Keywood, Trina Clinton, a 54-year-old housewife from Redditch, took her life by falling from a multi-storey car park in March 2005. Worcestershire Coroner Victor Round originally recorded a verdict of suicide but told the court that a blood test revealed the prescribed antidepressant Citalopram in Mrs Clinton’s blood.
After Mrs Clinton’s sister-in-law said that the antidepressant “must have been a contributory factor”, Mr Round changed the verdict to “suicide while under medication”. He then modified his verdict again to record an open verdict.
In the same month, Carwyn Lewis, a 38-year-old air steward from Carmarthen, was found dead in a bath full of water with a travel case full of books on top of him. He had been suffering from depression for some time.
But the coroner said he could not record a verdict of suicide because of the possible side-effects of the antidepressant drugs that Mr Lewis had been taking. He recorded an open verdict.
Ian Fox, a 65-year-old retired postal worker from Edgware, died in July 2008 after throwing himself in front of a train at Finchley Road Tube station.
He had been prescribed the antidepressant Citalopram for just one month before taking his life and he had expressed a wish to come off it, complaining of confusion and anxiety.
At his inquest, Mr Fox’s wife blamed her husband’s sudden death on the medication, saying that her husband’s action was completely out of character.
Coroner Dr Andrew Reid (right) recorded a narrative verdict in which he accepted that Mr Fox had jumped in front of the train, but added: “I’m satisfied he did so while the balance of his mind was disturbed while suffering the adverse effects of Citalopram.”
In September 2011, self-employed electrician Brian Palmer (left), 63, from Littlehampton, visited his GP as a consequence of financial worries. He was prescribed Fluoxetine (Prozac) and Zopiclone. A few days later, Mr Palmer shot himself.
At the inquest, Mr Palmer’s widow Jennifer told the inquest that days after Mr Palmer began taking the drugs, his mental health deteriorated. She said: “I noticed a change in him almost straight after taking the pills. I asked to see the box in the days before but he said he couldn’t find it. I found it a few days after his death and it listed all the changes I had seen in him. My heart just stopped. I didn’t go down there with him, when he picked up the prescription – I wish I had. We have had to learn the hard way. I can’t bear to think of any other families going through this kind of trauma.”
In each of the four cases above, the deaths have been linked by the coroner to the victims’ reactions to antidepressant medication. Yet two of the inquests resulted in open verdicts, while, in the other two, narrative verdicts were recorded.
My database also contains cases where coroners have turned a deaf ear to evidence pertaining to reaction to antidepressants. This was particularly noticeable in inquests into the Bridgend hangings.
At the inquest of Christopher Ward, for example, a police officer provided the information that 29 year-old Mr Ward “had been prescribed Citalopram for depression.” Even so, Coroner Peter Maddox (left) declared that: “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. 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, a drug known to induce suicidal ideation, may have “altered his judgement.”
And in the case of 20 year-old Bridgend mother Lana Williams (right), her fiancé said she had seemed “in good spirits” when he had left the house for work on the morning of her death. 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.
It has been proposed that there should be a separate verdict for those who have taken their lives while under the influence of prescribed medication. This would be a verdict of “Iatrogenic Suicide”, the word iatrogenesis being defined as an inadvertent adverse effect or complication resulting from medical treatment or advice. This would be supported by those who are concerned that suicide figures are underestimated due to the number of self-inflicted deaths registered as open or narrative verdicts.
On the other hand, Dr David Healy (left) writes that: “If someone jumps to their death from a 10th floor balcony under the influence of LSD, unless there is clear evidence beforehand that this was what was planned, an open verdict would be more appropriate than a suicide verdict.”
SSRIs are capable of causing similarly tragic outcomes, and bereaved families who recognise that their loved one’s death was caused by a reaction to medication should not have to accept a verdict of suicide in such cases.