Doctors Fail to Recognize Life-Threatening Serotonin Syndrome 3

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Doctors Fail to Recognize Life-Threatening Serotonin Syndrome - 2 - 3 - 4

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The social worker said that during one visit, Carolyn told her that urine on the floor was from when Rebecca had taken a nap on the floor, according to an affidavit from investigators, and the social worker said she had to tell Carolyn to clean the floor.

When checking out the social worker's complaint, the DSS Commissioner said all the doctors and a psychiatric hospital caring for one of the children in July 2006 said the medications were appropriate and there was no one else to consult, so the department did not substantiate the complaint.

The medical examiner's office determined that Rebecca died from "intoxication due to the combined effects" of the drugs clonidine, Depakote, dextromethorphan, and chlorpheniramine, the district attorney's office said in a statement.

The official autopsy report states that Rebecca died of the "combined effects" of the drugs and that her lungs and heart were damaged by "prolonged abuse of these prescription drugs, rather than one incident."

Those findings have some experts wondering whether the medical examiner may be a member of the 85% of doctors identified by the New England Journal of Medicine study who are unaware of the serotonin syndrome as a clinical diagnosis.

The statement released by the DA states, "This occurred as a result of the intentional overdose of Rebecca with clonidine," and the manner of death "was determined to be homicide."

Rebecca's parents have both been charged with murdering their daughter.

However, psychiatrist Dr Grace Jackson, a leading authority on psychotropic drugs, takes issue with the claim of the manner of death being homicide.

"I'd put my money on serotonin syndrome as the cause of death," she says, "a potentially lethal condition of serotonin excess, leading to signs and symptoms which include autonomic instability, heart dysrhythmias (sudden death), hyperthermia (high fever), changes in mental status (including possible coma), hyperreflexia, and myoclonus."

"In this case," Dr Jackson says, "the primary culprits were dextromethorphan and chlorpheniramine, an antihistamine which also boosts serotonin levels."

"It is probably quite likely," she explains, "that the family had not been warned by any doctor or pharmacist that this combination of medications could cause death – particularly, in a toddler."

"It is also possible," she adds, "that the psychiatrist did not realize that the family was administering dextromethorphan to the child --- it might have been given from an over-the-counter cough remedy by unsuspecting parents."

Dr Jackson also notes that Depakote has been shown to increase levels of serotonin in many brain regions, "hence," she says, "it was factor #3 in the serotonin syndrome which presumably killed this child."

"This toddler," she explains, "may have been receiving tiny doses of the medications prescribed, but that did not protect her from serotonin syndrome."

Reports by investigators, based on interviews of relatives in the home who observed Rebecca in the days before she died, describe symptoms typical of serotonin syndrome. They said she became restless, disorientated, incoherent, would not respond to her name and that she appeared dazed and "out of it."

She was lethargic at school and at home, and a neighbor described her as zombie-like, according to interviews in an affidavit filed in Plymouth District Court.

The day before she died, Rebecca developed a fever and was coughing uncontrollably, so her parents went to Wal-Mart to buy cold and flu medicine. While at Wal-Mart, Rebecca began to vomit, so Carolyn Riley purchased Pedialyte and a plastic bowl for Rebecca to vomit in during the ride home, and she reportedly vomited about 5 times over the course of that day.

Rebecca's grandmother told reporters that the doctor never told the parents not to give her the over-the-counter cold medications now listed as contributing to her death because of the prescription drugs she was on.

Dr Jackson suspects that Rebecca – like so many patients – was the unwitting victim of "Evidence Based Psychiatry," which means drug, drug, and more drug, because "somebody, somewhere, published a study that showed a three year old responded to five or six or seven drugs in combination," she states.

Dr Jackson is the author of, "Rethinking Psychiatric Drugs: A Guide for Informed Consent," a book that provides a critical appraisal of 3 classes of psychiatric drugs that an estimated 20% of Americans consume on a regular basis, including antidepressants, antipsychotics and stimulants.

According to Harvard Instructor Dr John Abramson, author of, "Overdosed America," this "gruesome story" seems to have two separate and distinct components. "First," he says, "is the question of whether or not the child was being given medication as it was prescribed."

"And the second," he notes, "is the question of why such medicines were prescribed for such a young child."

Doctors Fail to Recognize Life-Threatening Serotonin Syndrome - 3

1 - 2 - 3 - 4


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