Mr Ian Smith (Coroner for South and East Cumbria)
It is accepted that, for those who are prescribed antidepressants, the most dangerous times are at the outset, or when the dosage is changed or stopped. Ian Smith not only recognised this, but made the Health Authorities aware of his findings.
In July 2004, Mr Smith, at the inquest of a 42-year-old local writer Dickon Abbott who had hanged himself “out of the blue”, noticed a possible side-effect of changing medication:
Dr Anthony Page … told the inquest that his patient was in the course of switching medication from Effexor (Venlafaxine) to Seroxat (Paroxetine). To make the transition, he had gradually stopped taking Effexor and had been taking Seroxat for 11 days when he died.
Dr Page confirmed that the switch in drugs could cause increased anxiety, and that there had been press reports about Seroxat increasing suicidal tendencies. However, he pointed out that the drug had successfully treated Mr Abbott in the past.
Summing up, Mr Smith said he had dealt with two other suicides which happened when the person was changing medication and pressed for more research.
In March 2008, at the inquest of retired bank manager Nigel Woodburn (left), Mr Smith spoke of a link between antidepressants and suicide:
One of Cumbria’s coroners is to contact drug authorities because he fears people are killing themselves after taking antidepressants.
Ian Smith is to write to the Committee on the Safety of Medicines – an independent advisory body …
… Mr Smith told the inquest he knew of several other suspected suicides involving the same group of antidepressants, known as selective serotonin re-uptake inhibitors (SSRIs).
He said: “I have to say this is probably the fifth, if not sixth inquest I’ve heard within a period of three years when somebody either just going on to Citalopram or Seroxat, or coming off it, have killed themselves one way or another, totally out of the blue, totally without expectation, without a history of suicidal thoughts in the past.”
The following month, Mr Smith conducted the inquest into the death by hanging of 56-year-old farmer Philip Morton.
He … criticised the use of antidepressants and expressed concerns over a pattern of people taking their own lives days after being prescribed the drugs …
… Mr. Morton went to his doctor and was prescribed antidepressant drugs which he was taking at the time of his death days later.
The report concluded with this extraordinary sentence:
Mr. Smith went on to say that he had dealt with six to eight cases in a short period where people had taken their lives days after starting antidepressant drugs and he had reported these concerns to the health authorities despite coming under criticism for speaking out.
Who was it who criticised Mr Smith for speaking out on an important issue?
Who has the authority to interfere with the free speech of a coroner in his/her own court?
Was Mr Smith the only coroner to be admonished, or were other coroners warned in case they should make similar observations?
Wherever the criticism came from, it seems to have been heeded.
In March 2011, Mr Smith presided over the inquest of 10-year-old Harry Hucknall (right), who hanged himself after having been prescribed a lethal combination of Fluoxetine and Ritalin.
Mr Smith acknowledged that the drugs were dangerous, saying: “I do believe it reflects upon society how we expect children to behave. We expect them to be little adults. We as a society quite rightly try to stop children dabbling in street drugs. And yet a child with this label of ADHD is prescribed, under supervision, mind-altering drugs of a very powerful nature.”
At the inquest, Harry’s father challenged child psychiatrist Sumitra Srivastava, about why he had put Harry on drugs. He spoke about this in an interview after the inquest: “This doctor said at the inquest my son had a chemical imbalance in his brain. I asked him: ‘How do you know? Did you take chemicals from his brain?’
“He told me it was a theory. So based on a theory — and seeing my son five times at the most — he decided to put him on this drug, Ritalin, which is as powerful as cocaine. Harry ended up taking two drugs that work against each other — the Prozac that fights depression and the Ritalin that can cause it. How can that be right?”
Even though the psychiatrist was in complete contravention of NICE Guidelines, Mr Smith somehow arrived at the conclusion that Mr Srivastava “had acted appropriately.”
In May 2011, after the hanging of 62-year-old Janis Colvin, Mr Smith appears to ignore the possibility that the same side-effect that he had mentioned 7 years before was linked to this lady’s death:
Mr Colvin said despite his wife being troubled with depression and anxiety throughout the time he had known her, she had never spoken of harming herself.
Dr Andrew Wilson, Mrs Colvin’s GP, said Mrs Colvin had responded positively to changes in medication and did not show any side effects …
… South and East Cumbria coroner, Ian Smith, recorded a narrative verdict.
He said: “I am not going to record a verdict of suicide.
“She died as a consequence of her own actions whilst suffering from severe mental illness.
“Mental illness is still misunderstood by most people. I wish it could be got across to the public that having mental health problems is just the same as having a dodgy heart.
“Suicide involves two things; an action to lead to your own death and being in control of mental faculties. In this instance Mrs Colvin was taken over by this depression.
“Depression decided what she was going to do.”
Robert Francis QC said in his recent report on the Mid Staffordshire Trust that there is a need for “openness, transparency and candour throughout the system“.
It is evident that this should also apply to the Coronial System.
Footnote: Ian Smith retired in October 2014