Antidepressant Drugs

[NaciravBanks]

Dear forum members, before I get into detail I would just like to put a few questions to you if I may;

Re: My Brother

 

1) What is the correct guideline for GP’s to follow once a patient has expressed his suicidal thoughts?

 

2) Assume the said patient has never had any psychological complaints on record before and then one day turns up at the GP “revealing” that he has been taking his wife’s antidepressant pills (10mg) for a short period of time and is feeling suicidal. What should be the doctors correct response to this?

 

3) Is it correct for a GP, when faced with such a patient, to go on to spontaneously prescribe him 40mg a day of the antidepressant drug Fluoxetine?

 

The said patient, my late brother (late thirties) died 6 days after his last visit to the GP. He has left 5 lovely children; the eldest is 16 where the youngest is only 1. The police are treating his death as suicide but I am certain that he would not have done this to himself/familly. It is either third party involvement or adverse foreign chemicals in his brain.

 

I would really appreciate any answers to the questions above

Thanking you in advance

Regards

 

Nacira

[Guest wino]

Oh Nacira, This is a terrible story. I am truly saddened by your loss.

 

Depression is a terrible thing to have. There are many causes and we all handle things differently.

 

I don't know what 'Guide lines are out there for GPs to follow hopefully someone will be along soon to help you.

 

I do think that this will be a tricky one to answer.

[MilkTrayMan]

Hi Nacirav Banks!

 

Why don't U try Browsing/Posting in the following Forums...

 

Consumer Health Forums

 

...U may find the answers which U are looking for...

 

 

...

[Monty2007]

Dear forum members, before I get into detail I would just like to put a few questions to you if I may;

 

Re: My Brother

 

1) What is the correct guideline for GP’s to follow once a patient has expressed his suicidal thoughts?

 

2) Assume the said patient has never had any psychological complaints on record before and then one day turns up at the GP “revealing” that he has been taking his wife’s antidepressant pills (10mg) for a short period of time and is feeling suicidal. What should be the doctors correct response to this?

 

3) Is it correct for a GP, when faced with such a patient, to go on to spontaneously prescribe him 40mg a day of the antidepressant drug Fluoxetine?

 

The said patient, my late brother (late thirties) died 6 days after his last visit to the GP. He has left 5 lovely children; the eldest is 16 where the youngest is only 1. The police are treating his death as suicide but I am certain that he would not have done this to himself/familly. It is either third party involvement or adverse foreign chemicals in his brain.

 

I would really appreciate any answers to the questions above

 

Thanking you in advance

 

Regards

 

Nacira

 

Dear Nacira

 

Firstly, please accept my sincere condolences, I have been through depression myself and can understand what he must have gone through.

 

Upon telling his GP about suicidal thoughts the GP should have undertaken an assessment of his psychological state through direct questioning and also completing a questionnaire which is done certainly here in Scotland. Secondly, I find it strange that your brother was prescribed 40 mg of Fluoxetine (Prozac) which is the most popular and mildest of the SSRI's class of anti-depressants (there is a site dedicated to this). It is usual to start with a 20 mg dose and monitor the patient every 1-2 weeks, especially if there is a possibility of suicide.

 

I think you need to see a specialist solicitor in medical negligence and explore your options in terms of trying to get some answers and possibly compensation for his family.

 

If there is anything else I can help with then please ask/PM me.

 

Good luck and kind regards

 

Monty

[Rooster-UK]

Very sorry to hear about your loss.

Unfortunately, we are not really equipped or experienced to handle this sort of situation.

 

MilkTrayMan has given you the best advice.

The Consumer Health Forums have sections which may be able to help you....... Click on the link....

 

Consumer Health Forums

 

I hope that this helps.

 

Regards, Rooster.

[NaciravBanks]

Hi all & thank you for your replys. MilkTrayMan, i tried to copy paste my thread onto the Consumer Health Forums forum this morning but kept getting an error msg upon accepting the T&C. I have just tried again and had the same problem; databast error or somthing like that... I'll try again on another PC later. Any tips would be great.

 

Monty, I'm sure things were not done correctly with my brother. His medical records which i obtained through my sister-in-law, his widow, were a complete and utter shambles. i dont know where to start. well for starters, there is an entry on his medical records 6 days before he dies that states; "comment: incrse to 30mg od r 3w" also "Medication: Fluocetine Hydrochloride capsules 20 mg 60 capsule 2 OM".

 

two things with this, 1) why has the doc noted that he has "incrse" the dosage to 30mg when in fact my brother had 20mg pills to take 2 a day. 2) Using the word incrse (increase-i asume) implies that the patiant was already on x dosage and that the doc sees it fit to incrse the dosage. clearly this is a mistake as my brother was not on any mind drug before this. Indeed he had only visited the GP on four occations since 2005.

 

Im still in shock at the whole situation, and feel quite sick realy....

 

Kind Regards

 

Nacira

[Monty2007]

Hi all & thank you for your replys. MilkTrayMan, i tried to copy paste my thread onto the Consumer Health Forums forum this morning but kept getting an error msg upon accepting the T&C. I have just tried again and had the same problem; databast error or somthing like that... I'll try again on another PC later. Any tips would be great.

 

Monty, I'm sure things were not done correctly with my brother. His medical records which i obtained through my sister-in-law, his widow, were a complete and utter shambles. i dont know where to start. well for starters, there is an entry on his medical records 6 days before he dies that states; "comment: incrse to 30mg od r 3w" also "Medication: Fluocetine Hydrochloride capsules 20 mg 60 capsule 2 OM".

 

two things with this, 1) why has the doc noted that he has "incrse" the dosage to 30mg when in fact my brother had 20mg pills to take 2 a day. 2) Using the word incrse (increase-i asume) implies that the patiant was already on x dosage and that the doc sees it fit to incrse the dosage. clearly this is a mistake as my brother was not on any mind drug before this. Indeed he had only visited the GP on four occations since 2005.

 

Im still in shock at the whole situation, and feel quite sick realy....

 

Kind Regards

 

Nacira

 

Dear Nacira

 

When did he (i) first see his GP and disclose his suicidal tendencies (ii) get prescribed the first 20 mg x 1/day Fluoxetine HCl and (iii) when was the dose increased to 20 mg x 2/day ? Are there any notes as to why the dose was increased.

 

This does not seem right to me and you need to get some professional medical negligence advice.

[WebMaster]

Hi Nacira,

 

You should able to sign up on the health forums now - we've corrected the signup problems.

 

One of the suggestions to explain the apparent increase in suicides amongst those taking antidepressants has been that a severely depressed person may not have the motivation or energy to act on any suicidal thoughts, but that once they are taking the ADs and starting to improve, that energy and motivation returns.

 

The GP's actions would have depended largely on how real he judged these suicidal tendencies to be. A depressed person could be having suicidal thoughts, but still be a long way from ever acting these out (simply because they're only thoughts). On the other hand, the person could seriously be at risk of carrying them out. In the latter case, I think the patient would probably be sectioned.

 

The fact that the GP put your brother straight onto 40mg does suggest that he thought the depression was serious enough to need swift action. In more moderate depression, it would be more usual to start at 10 or 20mg and slowly increase if necessary. Part of the reason for that is that there can be rather unpleasant side effects when starting it. Naturally these would be heightened when starting off on 40mg.

 

One of the saddest things about this story is that with ADs taking a week or so to have an effect, your brother might have almost been over the worst of it, and the initial side effects should have started to subside

[NaciravBanks]

Hi all

Monty, I am Reading through my dear brothers medical records again, and I must say that I am not at all please with what I received from the GP as it was just simply a brown envelope with 116 lose A4 sheets of paper init, and they were not in any date order at all, plus there were multiple copies of particular sheets, just a mess really.

 

So to answer your questions:

 

(i) According to the med record, my brother first visited his GP & disclosed his suicidal tendencies on the 19th march 08, Just 6 days before he died.

 

(ii) It was on that visit that he was first prescribed Fluoxetine 20mg x 2/day (I have the packet in my hand). He had never been prescribed any antidepressant drug before this and this why I find it so strange that the doc said that he had “increased” the dose as there was NO dose to increase it from!? Unless of course he was considering my brothers claim that he had indeed been taking his wife’s 10mg pills for a short period but even then, a doc should not take this info as gospel should they? prehaps the suicidal thoughts were a result of him taking the 10mg pills prescribed to his wife??

 

(iii) The notes on his medical records for 19th March 08 (his last visit to the GP) state that: “Comments: Incrse to 30mg od r 3w” & “Medication: Fluoxetine Hydrochloride Capsules 20mg 60 Capsule 2 OM” Also it states “Examination: lo affect gen quite well calm insight feels will be ok”

 

Apologies if I am not making sence here but I am just finding it so difficult getting my head around what’s happened and its affecting my vocab.

 

Webmaster, Thanks for your post.

You say that: “the fact that the GP put your brother straight onto 40mg does suggest that he thought the depression was serious enough to need swift action”, but on the day my brother was prescribed 40mg Fluoxetine the doc commented: “lo affect gen quite well calm insight feels will be ok”. ALso on the notes (iii) above, can you see where it says he should be taking 40mg a day??

 

Thanks for your time folks

 

K Regards

 

Nacira

[Monty2007]

Hi all

Monty, I am Reading through my dear brothers medical records again, and I must say that I am not at all please with what I received from the GP as it was just simply a brown envelope with 116 lose A4 sheets of paper init, and they were not in any date order at all, plus there were multiple copies of particular sheets, just a mess really.

 

So to answer your questions:

 

(i) According to the med record, my brother first visited his GP & disclosed his suicidal tendencies on the 19th march 08, Just 6 days before he died.

 

(ii) It was on that visit that he was first prescribed Fluoxetine 20mg x 2/day (I have the packet in my hand). He had never been prescribed any antidepressant drug before this and this why I find it so strange that the doc said that he had “increased” the dose as there was NO dose to increase it from!? Unless of course he was considering my brothers claim that he had indeed been taking his wife’s 10mg pills for a short period but even then, a doc should not take this info as gospel should they? prehaps the suicidal thoughts were a result of him taking the 10mg pills prescribed to his wife??

 

(iii) The notes on his medical records for 19th March 08 (his last visit to the GP) state that: “Comments: Incrse to 30mg od r 3w” & “Medication: Fluoxetine Hydrochloride Capsules 20mg 60 Capsule 2 OM” Also it states “Examination: lo affect gen quite well calm insight feels will be ok”

 

Apologies if I am not making sence here but I am just finding it so difficult getting my head around what’s happened and its affecting my vocab.

 

Webmaster, Thanks for your post.

You say that: “the fact that the GP put your brother straight onto 40mg does suggest that he thought the depression was serious enough to need swift action”, but on the day my brother was prescribed 40mg Fluoxetine the doc commented: “lo affect gen quite well calm insight feels will be ok”. ALso on the notes (iii) above, can you see where it says he should be taking 40mg a day??

 

Thanks for your time folks

 

K Regards

 

Nacira

 

Dear Nacira

 

I think you are correct to be very suspicious. Did he complete a self-questionnaire? There must have been a medical justification for increasing the dose from 20 mg, this must be in his records. I was not aware of a 10 mg dose but have found that this is available via a web search, I am not aware of the basis on which a dose/patient decision is made. I work in the pharmaceutical industry and have a doctorate in chemistry but cannot really add much more, the only advice I can give is to seek specialist legal advice from a legal firm that has a proven record in medical negligence. The problem in many of these cases is getting access to all the information so you may have to undertake legal process to get to the full disclosure stage.

 

I wish you well and again offer my condolences.

[demon_x_slash]

Firstly, my sympathies for your loss.

 

Something occurred to me when reading your thread. I, too, am on antidepressant medication, and have been for a while. The general practice is for the patient to be started off on a small dosage and have that dosage slowly increased (if needed) over a period of months. The effects are also cumulative - i.e., you need to take them for a while to show the beneficial effects. The estimate for my particular brand and dosage to 'settle down' is roughly two weeks - so although the doctor prescribed a different brand and increased the dosage, due to the time period involved it is not definite that the drug would have been the root cause of your brother's suicide. It is very possible that the preliminary effects of the medication made your brother feel awful on top of the depressive feelings he was experiencing, and the doc doesn't seem to have followed the usual diagnostic procedures (something you and your brother's widow have every right to comaplin about), but I wouldn't blame the entire cause of his suicide on the medication itself. Do you have any idea for how long he had been taking your sister-in-law's medication?

[MilkTrayMan]

Depression Support Group

 

Anti depressant drug firm slammed

 

Britain 'is true Prozac Nation' ---- BBC Web News

 

Medicines and Alternative medicines

 

Access to Health Records

 

Bereavement Support Group

 

 

...

[crash3903]

I too am sorry to hear about your loss

 

If you believe that your brother was done wrong by, then can I suggest you seek proper legal advice regarding medical negligence, if that is what you believe has gone on

 

This nor any other forum of this nature is the right place to get advice

 

Medical negligence is a complex area that only a specialist solicitor or counsel can advise you on properly, once they have looked at all the documents you present to them

 

After all we are not talking about some over charging are we!!!!

 

Good luck

[Guest deep]

Hi

 

So sorry to hear of your loss.

 

I agree with all above posts that this is in need of specialist advice.

 

Are you sure he was taking his correct dosage,as just a quick mention, as that a year ago a friend of mine was perscribed 10mg 4 X a day, total 40mg a day. On repeat perscription.

 

Quite often as is common with most perscribed drugs the packaging of repeat perscriptions could be quite different.

 

After my friend had been taking them for some months with deteriating and sucidal thought observations, when her partner checked the dosage on the front of the box, it stated 2 tablets of 25mg to be taken at night, which was 50mg in total.

 

My friend had been taking 4 X 25mg a day total of 100mg instead of 4 X 10 mg total 40mg a day as had been originally perscriped.

 

She had been getting repeat perscription from her GP's surgery without seeing the Doctor after original perscription. Although her repeat perscriptions came in different packaging she was still taking original dose. When her partner confronted her GP's surgery, he was informed it is up to the patient to read dosage carefully on all repeat perscriptions.

 

Whilst, I agree ultimately it is up to the patient. I can fully understand why my friend, in her vulnerable condition, carried on with her original dosage.

 

My sincere and genuine sympathy to all your extended family, and I do hope you can find the help, guidance and closure you all so deserve.

 

Kindest regards

 

Dee

[NaciravBanks]

Good morning all & thank you all for your posts.

demon_x_slash, I am afraid I will only be speculating if I was to say how long my brother had been taking his wife’s medication for. She didn’t notice much missing and believes that it could only have been a matter of weeks. Is it a coincidence that he had, for the first time in his life, expressed suicidal tendencies at this time? I don’t think so.

MilkTrayMan, Thanks for the links, I appreciate that.

Crash3903, I couldn’t agree with you more when you say: “This nor any other forum of this nature is the right place to get advice. Medical negligence is a complex area that only a specialist solicitor or counsel can advise you on properly, once they have looked at all the documents you present to them”. Indeed I am only here to politely obtain a brainstorm of views from kind hearted people. And this thread will in no way dictate any solo, formal move by be. I do intend on speaking to a specialist solicitor but at the moment I am just about coping with the bereavement process and talking is helping.

Also no, we are not talking about charges.

Deep, that is a good point about being sure whether he was taking the correct dosage. I am not. As on the packaged drug he got mid march it says: 20mg 2 a day but an entry on his medical records for the SAME day says: “Comments: Incrse to 30mg od r 3w”???? Does that make sense?

K Regards

Nacira

[poppynurse]

I'm sorry for your loss and can understand how angry you feel, looking for answers and someone to blame is a common expression of grief, particularly with sudden death.

 

Reading through your posts it seems that the GP was only consulted once about depression? It might be an idea to request a meeting with the GP and practice manager to go through the issues you have raised and clarify them.

[389shell]

I have no advise to give, I just wanted to say I hope you are all coping and I am sorry for your loss too. I hope you can get some answers.

[tomterm8]

I agree, it is horrible, and I feel very sorry you are in this position.

[davethorp]

I'm also on anti depressants and it's worth noting that one of the side effects of some anti depressants (least all the ones I've been on) is that they can actually cause suicidal thoughts especially in the first few weeks of taking them

[tomterm8]

Well, there is some debate on that, some people think they cause suicidal thoughts, others think that the person has more motivation etc and can actually express and carry out already existing suicidal thoughts.

[Monty2007]

Well, there is some debate on that, some people think they cause suicidal thoughts, others think that the person has more motivation etc and can actually express and carry out already existing suicidal thoughts.

 

Tom, you are partially correct. The facts are that there is a massive variation in the genetic responsiveness to the SSRI's (Selective Serrotonin Re-uptake Inhibitors) such as Prozac, plus a variable dose effect within the population. In addition there is a delay in the onset of action that means it can take a month to work, in patients that are responsive of course. The side effects are also substantial and this class of medication should always be a last resort. Unfortunately, the average GP does not really have much of a clue as to how to prescribe such medication or calculate the dose given the average patient time/doctor is

 

This case is strange, I am not qualified to make or suggest judgement only that if I were the OP then I would seek independent expert medical advise on the possibility of error.

[please return my money]

Due to my disabilities and the depression that came with them it took a while for my GP to prescribe the right treatment.

 

I had one set of tablets I took that made me feel quite suicidal quite quickly am so sorry I dont remember their name.

 

But that dosage is very high to what i was put on too.

 

We had 7 deaths last year, dont really know how we got through it, but we are all still here.

 

If you need to chat just post xxxxx I know its possibly not the most appropriate chat, but I feel as if i am now a professional on deaths and suicides due to such a terrible year last year. If you need help getting through it I am here for you xxxx