Editorial Note: This RxISK story written by Jeannie’s mother records a growing epidemic of sudden unexplained cardiac deaths. These are linked to the effects of a range of drugs on the cardiac QTc interval. There is considerable evidence that pharmaceutical companies have known about these risks for years and sometimes before drugs like citalopram are marketed. The risks can arise when the drug dose is pushed up and up, as here, or when someone is on several different drugs, all of which raise the QTc interval slightly but in combination do so dangerously. In this case individual manufacturers can wash their hands.
Jeannie’s story
Jeannie Elizabeth Campbell Wile was born Dec 20, 1976, the only child her mother Marian was to have. Unfortunately, Jeannie’s parents separated when she was six, and later divorced. Being a sensitive child and close to both her parents, this was a source of stress and unhappiness for her.
When she was 18, Jeannie was diagnosed by a cardiologist with an irregular heart beat and a mitral valve prolapse. She was also found to have hypomagnesemia, which is associated with low electrolytes. These conditions are not uncommon, and are not considered life-threatening. However, they are factors to be monitored and taken into consideration in prescribing medications.
In 1995, Jeannie left Toronto, where her mother lived, to pursue a degree in film at the University of Southern California (USC). Her father was living out west and moving to California allowed Jeannie to see him frequently. She completed her first year as a Dean’s list student. However, at the end of that year, she decided to move back to Toronto, where she lived until 2004.
Citalopram started — dose upped & upped
In the spring of 2004, Jeannie was seen by a psychiatrist, Dr. O, in Toronto. On the first day she met Jeannie, Dr. O. prescribed 20 mg/day of Celexa (citalopram). At her next appointment, Dr. O. upped the dose to 40 mg/day. She noted in Jeannie’s record that she felt there had been an improvement during the week. On the third visit, Dr. O. increased the dose to 60 mg/day, noting that Jeannie was not sleeping well.
“This was the fifth dose increase in just over a year.”
In the fall of 2004, Jeannie returned to USC to complete her degree. While at USC, she was referred to Dr. P, a psychiatrist.
Dr. P. carried on prescribing 60 mg of Celexa for a few months, then raised the dose to 80 mg/day, then to 100 mg/day, and finally in late 2005, to 120 mg/day. This was the fifth dose increase in just over a year. Her general practitioner (G.P.) in L.A. knew that she was taking citalopram, in spite of her unstable electrolytes and heart condition.
“She wrote that she felt increasingly tired for no reason.”
By 2006, things seemed to be going well for Jeannie. She enjoyed university, had an apartment, new girlfriends, and started dating a young man she liked a lot. Still, she was increasingly fatigued, as she confessed in diary entries that summer. In August she visited her G.P. complaining of exhaustion, and was tested to find out if she was anemic. She was not. She wrote that she felt increasingly tired for no reason. From her diary entry on Friday, Sept 8, we know that Jeannie was feeling congested and unwell. She thought she must have a sinus infection. That night, she went to a late movie with her boyfriend, then went home to sleep. On Saturday morning Jeannie wrote her last diary entry. She noted that she had enjoyed the movie, that her boyfriend was fun, and that she had a lot of course reading to do. She also recorded that she felt “so tired”.
Jeannie found dead
Jeannie’s boyfriend called several times during the day on Saturday and became increasingly uneasy when she did not answer as they were supposed to attend a birthday party. Normally she would stay in touch when they had plans. By Sunday morning, when he still had not heard from her, he decided to confirm that she was alright. He got the superintendent of her building to gain entry to her apartment. They found Jeannie dead in her bed.
Coroner rules cause of death was citalopram intoxication
L.A. coroner Dr. Wang determined that citalopram intoxication was the cause of Jeannie’s death. The autopsy revealed that Jeannie had an enlarged heart, and had developed a bundle branch block and a tricuspid valve prolapse.
The 2006 American Celexa (citalopram) monograph noted under warnings, under the Heading ECG, that:
“…Celexa decreases heart rate. In patients < 60 years old, the mean decrease was approximately 5 bpm”. (Page 25) On Page 27 under the heading Cardiovascular Disorders, it lists the following “rare” side effects: “bundle branch block, cardiac arrest,…ECG abnormal, heart disorder”.
Court finds physician not responsible
When Jeannie’s mother Marian learned this, and the dosage of Celexa that Jeannie had been taking, she filed a lawsuit against Dr. P. During the May 2011 trial, Marian’s lawyer had an expert testify that citalopram is known to exacerbate heart conditions. The expert on the other side argued that the drug is generally safe for heart patients, and that prescribing is a matter of physician judgment. He argued that Dr. P was acting in accordance with professional standards when he assessed that citalopram was safe for Jeannie, even if hindsight proved him wrong in her case. In his testimony at trial, Dr. P. stated that as far as he knew “nobody ever died from taking Celexa” and that he frequently issued prescriptions at that dosage. He appeared unaware that the drug poses a risk to people with heart conditions. In his records there is no indication that he ever considered the heart issue, let alone warned Jeannie about it. The court found that Dr. P. could not be held responsible for Jeannie’s unfortunate reaction to citalopram.
FDA warns of danger of citalopram doses >40 mg per day
In August 2011, the FDA issued a Drug Safety Communication (DSC) stating that Celexa (citalopram) should no longer be used at doses greater than 40 mg per day because it could cause potentially dangerous abnormalities in the electrical activity of the heart. In March, 2012, the FDA updated this warning and noted that because of its effect on QT prolongation, citalopram should be avoided if possible for patients with certain conditions such as electrolyte imbalance.
Death recorded as accidental
Jeannie’s death was recorded by the coroner as ‘Accidental’.
Also see Vanessa’s Story and Sudden Cardiac Death and the Reverse Dodo Verdict.
julie wood says
If patients were able to identify which part of their medical histories were relevant each time a prescription was issued, we would not need doctors. Of interest here, as David Healy has pointed out, is that the prescription system has perversely become a barrier to acknowledging damaging side effects.
Johanna says
Good point Julie! I had a near-miss experience with two drugs that affect the QT interval: lithium and Cipro. The combination caused me to pass out cold twice in 24 hours. Like most people I knew precious little about matters cardiac. But thanks to this site I located the problem, stopped one of the medications and had no more trouble. (And while RxISK is the best, I know of at least two other sites where this information is available to any layperson who can spell Cipro.)
However, no one warned me — not the doc who prescribed the lithium, not the doc who prescribed the Cipro, not the pharmacist. Despite all three being riveted to their computer screens. You’d think in the brave new world of Electronic Health Information, it would be easy as pie to include an app that would flash a Caution whenever two such drugs were prescribed together. (Or whenever one was prescribed for someone with a known cardiac problem.)
This can’t be a technical problem, it’s too damn easy. Must be a lack of the political or economic will to do it. (Both doctors dismissed the possibility when I reported it.) Yet I bet there’s an app that can flash a reminder to write a statin script whenever the doc enters a cholesterol number over some set level!
Noel Hershfield says
Any data on non prescription drugs including herbs?
Mike Schoger says
My mother died of a heart attack on December 10th, 2011, after ingesting a single dose of Cipralex-10mg, which was prescribed the day before. I was successful in convincing Kathy Tomlinson of CBC News’ ‘Go Public’ segment in doing a story on this, that appeared on Oct. 1st, 2012. (see links below – perhaps you have already seen this story?). Since January 2012, I’ve been studying and researching what exactly happened to my mother, and now, just over a year later, I believe I have a good understanding of what transpired (I am not a healthcare professional, so most of this was all new to me).
I’m convinced my mother was also addicted to Ativan (Lorazepam), since almost all the symptoms she was experiencing – confusion, memory loss, loss of balance, ‘unable to function’, episodes of sobbing, sleeplessness, auditory amplification, monophobia – are classic symptoms of benzo. addiction. The product monograph for Ativan states that it should not be taken for any longer than 2-4 weeks, yet the pharmacy records that I obtained show that my mother was on it for almost 5 years – and increasingly so in the weeks leading up to her death. Her GP thought nothing about refilling her prescription, month after month, year after year.
Tragically, my mother REPEATEDLY expressed concerns of possibly being addicted to Ativan to both the outreach nurse and her GP as is evident from the medical records. Her doctor, not knowing what else to do, booked her an appointment with a psychiatrist, who prescribed her Cipralex-10mg, which I believe killed her. It is known to cause QT-Interval prolongation which can lead to Torsades de Pointes. The ER report from the day she died, just 1 page long, clearly states “Torsades de Pointes”.
Both the ER report and the Coroner’s report state “Natural Causes”. The Coroner’s report is a joke, saying that my mom was depressed because my dad was admitted to a nursing home.
IF this is all true, know that benzo. addiction not only wreaked havoc on my mother, but myself and the rest of our extended family and friends as well, for almost 2 years. Ultimately, this addiction led to the prescription of dangerous antidepressants & her death, since her symptoms were interpreted as depression, when it fact it is clear to me it was benzo. addiction. That so-called medical experts did not recognize this, even with my mother having suggested it on multiple occasions is more than astonishing to me.
I too, plan to file a lawsuit not only against the prescribing doctors and the prescribing pharmacy, but also Health Canada and Lundbeck, since they knew of the risks carried by Cipralex at the same time as the regulators and Lundbeck divisions in Europe – yet Lundbeck Canada & Health Canada waited MONTHS before issuing the same advisories in Canada.
I blame ALL OF THEM for my mother’s death – no, murder.
After reading the results of the trial above, I will leave it up to the attorneys as to whether
a case can even be won.
I am absolutely disgusted with our drug regulators, big pharma and the medical profession in general. Even if changes are implemented by the profession and the drug regulator, it will not remove my disdain for them. The damage has been done, and may very well be permanent. I will continue to speak out about them to as many people that I can.
The story below is the first salvo:
Here is one version of the CBC Video news segment:
http://ca.news.yahoo.com/video/drug-warning-delays-090800794.html
or on CBC: http://www.cbc.ca/player/News/Health/ID/2285655374/
Here is the 2nd version of the news segment: http://www.cbc.ca/news/canada/story/2012/09/28/bc-cipralexdeath.html?cmp=rss
or http://www.cbc.ca/player/News/ID/2285868794/
Here is the Printed story (be sure to read the comments after the story – they’re good):
CBC Webpage: http://www.cbc.ca/news/canada/story/2012/09/28/bc-cipralexdeath.html
Yahoo Canada News: http://ca.news.yahoo.com/
And there are many other websites carrying this story, including YOUTUBE, just search for the title “Son Blames…”. On YouTube, just type in “Cipralex” and the video is in the first 3 items on youtube.
Be vigilant, and tell as many people as possible about the dangers of SSRIs and Benzodiazepines!
Sonya says
In 2012 I was very close to die of hearth attack after only 5 days of being on Celexa 10 mg! I live a healthy lifestyle, no medical issues, I don’t smoke, don’t drink, and never take drugs other than some Advil. The psychiatrist has prescribed me Celexa even though I was against any medication. stay away from Celexa!!!
Cara says
Sonya, I was just prescribed the 10mg too and am totally healthy, 29yrs old. I haven’t taken my first dose because I’m concerned about what others are saying. What was your experience in those 5 days? Did you end up in the ER? Thanks in advance for your reply!
Helen Tsamis says
If I were you I would not take any antidepressent, there are other ways to deal with anxiety and depression.
Becky says
I am on Celexa..my heart rate went into the 30’s…was in Cardiac Unit for 6 days… requested my primary to swap me to different anti depressant
He won’t…sending me to Psychiatrist
Which I can’t get into for 3 months
with full insurance.
I’m scared to death…which doesn’t help at all
Sergio says
Hi,
I just started browsing about Citaloprsm and found this site.
Last year my mother died of some sudden cause. We are still puzzled (we’re from Brazil, things are bureaucratic). She died on her bed, just like the described case. She had complained of headaches the days before. I know she was taking Citalopram. I have to ask my brother about the dosage. She was 51, healthy although she would stop and restart smoking from time to time, nothing else. I don’t know what to think yet, but I will sure talk about it with my family.
I wish us all clarity to understand what happened.
Peace,
Sergio
Marian Jean Campbell Wile says
Jeannie’s doctors were Dr. M. her GP, Dr. T., her cardiologist, and Dr. P., her therapist/psychiatrist.
These three comprised the “team” of physicians who looked after Jeannie during her entire first year as an International Student at USC in Los Angeles, and they were all very well aware of her heart issues and complete health history. Medical records turned over for trial after Jeannie’s death revealed that her cardiologist, Dr. T., possibly saved her life at one point during this first year, when he quickly alerted her GP in time to have Jeannie stop using a medication which Dr. P. had prescribed that threatened a risk to her heart. When Jeannie later returned to USC to complete her degree, these same 3 doctors were in place to carry on, and Dr. P. once again “led the team”. As before, these doctors were fully aware of Jeannie’s health and history to date, and picked up with her as their patient where they’d left off. The records document how Jeannie was open with her doctors, and that she didn’t hold back, reporting any concerns that came up. It is clear Jeannie completely trusted Dr. P.
But she would never have agreed to take Celexa if she’d been made aware of the risk to her heart.
Helen Tsamis says
I was given lexapro after the birth of my daughter. I started having heart Palps, my heart would flutter, I told the doctor who prescribed these deadly pills to me, she insisted it was my anxiety. I have been off 3 years and I’m off a benzo 7 months after a long taper, I have been suffering 5 ling years because of these drugs, I still get the heart Palps, my new doc thinks the lexapro has caused demaged to my heart. These drugs need to be banned. They destroy lives. I’m sorry to hear about you’r daughter, I’ll be honest I don’t even think the docs know what these drugs do.
Rebeca says
Yeah , it is so true, we trust doctors but they should have our entire health history and should take the time to read it and make sure they’re safe for us, but it doesn’t seem to be that way.I think that we should do our research on any medication we are been prescribe and decide from there if we take it or not.
Anto says
Is there any safe antidepressants? Was prescribed celexa and i have mitro valuve prolapse. I took my first dose today and have been feeling heaviness on the left side of my chest…idk if its psycosamatic, but i will not be taking anymore celexa after reading these comments. I will try some kind of natural herbs. It always death or Increased medical problems with all these new drugs. This is sick and sad that pharmacist company’s are this low down and dirty and the physicians they work hand and hand with….Really sad and my condolences to those who’ve lost loved ones because of it.
Cat says
Taking 20 mg citalopram after bad side effects with vibryd 10 mg. have taken cit before but this time I started feeling a fullness and congested like a head cold or sinus infection. Developed a deep cough as well. Woke up in the middle of the night and my right foot and hand were swollen and tingling. The next day still felt tingly. Heart palpitations began. Mental fog creeped in. Woke up with right eye watering and blurred vision. Dizziness began. I took today off work. No citalopram. I’m hoping these symptoms will start to clear up. Scary and unusual. I’m beginning to believe that anti depressants and 7 years of klonipin use are taking their toll on my overall health. Be weary of starting a psychiatric drug regime for mild depression and anxiety. Work on diet, exercise, adequate rest, building a support system where you help others as well, and spiritual well being. Make friends and find a hobby. See a good therapist.
Brendan says
My sweet mom died from taking lexapro. She died instantly from a heart attack. She was only 68 years old and I knew something was wrong with her because she breathed like she was gasping for air all of the time and she had crazy muscle twitching. Please, if u do take this drug, look out for deadly side effects.
Jen says
I’ve been on 80mg of celexa for 15+ years with no issues. My new doctor is telling me I can’t do this any longer and I’m freaking out bc I take it for severe anxiety and OCD and after trying many different drugs, found this to be the only thing besides xanax to help.
Nancy says
What did you wind up doing about the Celexa? I’m a carbon copy of you but I’m 73.
Kimberly sargent says
Hey Jen text at 814-673-9461
Dina Alexander says
I’m on Celexa dr just upped dose to 40 mg reading all this I’m getting anxiety im57 been taking 20 mg for 10 years I’m worried
James says
Was on citalopram 20 mg for 8 years
. Didnt really help me past the first year or 2 but I continued to take it. I was a walking zombie not really caring about life. I’ve now started to have some health problems. Though I’ve been off the drug for 3 years now and things were actually better. Scared I’ve done damage to my heart and they didn’t even help me I’m only 39 and never really got my life started thanks in part to these drugs. That poor woman in this story. I’m so sad.