'I will never be able to move on' - Mum's agony at death of son (14) who was taking Prozac
Stephanie McGill-Lynch says her life ended on March 19, 2013, when she opened her 14-year-old son Jake's bedroom door and found him lying motionless under a rifle.
Sitting at her kitchen table in a quiet residential area of Clondalkin, Dublin, Stephanie described the haunting image of her son that she said will live with her and her husband John forever.
"We were sitting in the living room and Jake was in his bedroom after returning home from school," she said.
"John got up to get Jake's milk and toast and he went out to the hall to call him but there was no reply. John just looked at me and we both ran up the stairs.
"We opened Jake's bedroom door, and I'll always remember that my son had no socks on his feet. There was a porcelain look to them. And then I saw the rifle that we kept in our home lying on top of him."
In a harrowing interview, Stephanie criticised the lack of support for teenagers who are struggling with their mental health and said her son's death was "preventable from start to finish".
Jake was diagnosed with Asperger's syndrome, which is an autism spectrum disorder, in 2012. He was intermittently seeing a psychologist at the Child and Adolescent Mental Health Services (CAMHS), but Stephanie said that overall Jake was a happy child.
His anxiety increased ahead of his Junior Certificate mock exams, and the psychologist at CAMHS referred Jake to a consultant psychiatrist.
On January 31, 2013, John took Jake to the appointment, where Jake was prescribed the antidepressant Prozac. The psychiatrist had not met Jake before this consultation.
"I have no idea why my child was prescribed medication at that one meeting," Stephanie said.
"Jake had generalised anxiety, like most kids who were about to sit big exams, but he was not depressed and did not need medication.
"There is so much pressure on the mental health services that there isn't enough time or resources to spend properly talking with these kids that are suffering."
According to a Freedom of Information request to the HSE, in the first half of 2016 almost 1,500 young people under the age of 16 were prescribed antidepressants. Of those, 66 teenagers were prescribed Fluoxetine (Prozac) between January and July 2016.
Stephanie said that following the meeting with the psychiatrist, she took the prescription to a pharmacy and picked up the medication.
"At the pharmacy I didn't get the full package - I got a part of the full product. Jake's Prozac was liquid and it was given to me in weekly doses, poured into a small plastic bottle," she said.
"I have no problem with Prozac, I have no issue with antidepressants, I have an issue with informed consent not being mandatory and off-label prescribing.
"The drug is used for under 18s for moderate or severe depression. My Jake was not depressed. He had generalised anxiety from school. He should never have been given Prozac."
Stephanie said a patient information leaflet was not included with the drug.
The patient information leaflet for Prozac, which can be found on the HPRA website, and which was in place at the time Jake took his own life, carries a warning that "patients under 18 have an increased risk of side-effects such as suicide attempt, suicidal thoughts and hostility (predominantly aggression, oppositional behaviour and anger) when they take this class of medicines".
"If I had known what that drug was, I would never have given it to my child," Stephanie said.
The year before, Stephanie had taken Jake to a dermatologist to see if she could treat his mild acne, but refused to put him on the popular drug Roaccutane, as she was aware that it could lead to depression and suicidal ideation.
After four days of being on Prozac, Jake started his mock exams. Two days into his exams, Jake walked out halfway through his Irish exam, which was "unheard of" for the star student.
"That night, he had his first meltdown ever in his life and he cried for about three hours. He said, 'you don't know what it's like in my head mammy'. I said, 'no son, I don't. But I'll tell you what, put that science book away. It's only a bloody exam'. We just presumed it was from the exams."
The next week, Stephanie went back down to the chemist to collect the second week's supply of Prozac for Jake.
She said that Jake had been left on Prozac unmonitored for several weeks before he received an appointment with the psychiatrist in mid-February.
"I told her I didn't really think that the drug was working out for Jake and about his sleep patterns and meltdowns," Stephanie said.
"I was told it would all wear off in four to six weeks. So we left, and that was the last time he was ever seen in CAMHS."
Over the next month, Jake got through his exams but struggled through the days.
"On March 19, Jake went to school as always but when he came home that evening he said he didn't feel well," Stephanie said. "John came home from work and Jake was upstairs in his room. He was agitated and I thought maybe he had fallen out with his female friend in Iowa, who he often spoke to online.
"John went up to him after work and had a chat with him and he seemed OK again."
That night, John and Stephanie found 14-year-old Jake lying on his bedroom floor with self-inflicted gun wounds.
"I will never, ever be able to move on from that day," Stephanie said.
Jake had joined a gun club with his mother a few months previously. He didn't enjoy other sports, which is not uncommon for people with Asperger's, however he showed an immediate enthusiasm and aptitude for shooting.
"Jake and I were both members of a gun club. We had a rifle in the house and it was kept in the gun safe. I was in charge of the gun and Jake was in charge of the toolbox with the ammunition and the two were never kept together. So if the gun was taken out of the safe, the toolbox would be removed.
"The gun would be taken down every now and again, because you had to do poses with it. We allowed him to take the gun down that night and I forgot to take the toolbox out of his bedroom. I have to live with that guilt for the rest of my life."
John, who is a paramedic, started working on his son and he was rushed to Tallaght Hospital.
"They couldn't save Jake and we made the decision to turn the life support machine off. It was just awful," he said. "The first thing I did when I came home was throw the bottle of Prozac against the wall. That was the only thing that had changed in my son's life. I didn't have a depressed, suicidal child.
"He doesn't deserve to be dead at 14 for his Junior Cert or because he had Asperger's."
In an email written 24 hours before his death, Jake said he was feeling "drugged" and described how he had "panicked to the point of tears before some pretty big exams".
"It'll be six years on the 20 March this year and nothing has changed. The black box warning is still not on Prozac," Stephanie said.
The US has adopted "black box" warnings to indicate that antidepressants may increase the risk of suicidal thinking and behaviour in some adolescents.
"The support in this country for families whose loved one has died by suicide or a self-inflicted injury is disgusting," Stephanie said. "We were brought into the coroner's court 13 times over a 15-month period. We were left with a bill of more than €50,000, which our insurance wouldn't cover because they don't cover 'that kind of death'."
In October 2015, Jake's inquest heard the US black label was based on a meta-analysis carried out in 2003 but subsequent studies have found no increase in suicidal ideation in young people with anxiety taking Prozac.
The Irish Medicines Board contacted doctors in 2003 to say that having studied the class of medications affected, they recommended Prozac as being the safest in children under 18.
The coroner, Dr Brian Farrell, returned an open verdict.
Stephanie welcomed this as she said the ruling 'death by suicide' didn't reflect her son's death, as she believes it was drug-induced. She has since been campaigning for the introduction of a new verdict at inquests which could record suicides as having been caused by prescribed medication.
However, in May 2018, Justice Minister Charlie Flanagan ruled out the proposed bill after it was defeated in the Seanad.
"It was absolutely devastating. My son's death wasn't a suicide. I felt like my child didn't matter as a citizen of this country. Jake was 14, he had a right to life," Stephanie said.
"We are not looking for anyone's head on a plate. But we are looking for some kind of accountability."
Martin Rogan, chief executive officer of Mental Health Ireland, said Prozac, like all medication, has "its benefits and its side effects".
"Before any medication goes on the market, it goes through significant testing. But every medication will have side effects and won't always suit every individual," he said.
In a statement to the Herald, the HSE said it cannot comment on individual cases, but said medication "may be prescribed in line with best practice and clinical evidence".
"Treatment with medication is always considered as only being one part of a care plan," the HSE added.
- If you have been affected by any of the issues raised in this article please contact Samaritans helpline 116 123 or Aware helpline 1800 80 48 48 or Pieta House on 1800 247 247.