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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."
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
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