Stephanie McGill-Lynch says her life ended the day 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 in 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. 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 with Independent.ie, 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 his son Jake to the appointment with the psychiatrist where Jake was prescribed the anti-depressant Prozac. The psychiatrist had not met Jake before this consultation.
"I have no idea why my child was prescribed medication at that one meeting. 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 (FOI) request into the HSE, in the first half of 2016 almost 1,500 young people under the age of 16 were prescribed anti-depressants.
Of those, 66 teenagers were prescribed Fluoxetine (Prozac) between January and July in 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 with no Patient Information Leaflet. They don't write Prozac on the prescription, they write Fluoxetine which is Prozac's generic name, and I have a massive issue with that.
"I have no problem with Prozac, I have no issue with anti-depressants, 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. 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 CAHMS."
Stephanie said that 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.
"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 tool-box 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 tool-box 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. 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 Aspergers."
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.
She added that there is very little support for grieving family members in Ireland and described Jake's inquest as a "circus".
"The support in this country for families whose loved one has died by suicide or a self-inflicted injury is disgusting. 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 that 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 concluding the lengthy inquest proceedings.
Stephanie welcomed the open verdict 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, Minster for Justice 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. The whole point of an inquest is to find cause of death, it is not to find somebody guilty.
“The verdict would have said ‘without apportioning blame’. We are not looking for anyone’s head on a plate. But we are looking for some kind of accountability.”
Stephanie insists that her family is not out for “material gain”, nor are they anti-medication.
“We’re not trying to frighten people. We believe that medication should be the last resort, not the first one.
“If your child is stressed about exams or breaking up from a relationship... that’s not depression. That’s life.
"We can talk about mental health and we can raise awareness, but we need to have supports in place too. We are aware, now what are we doing about it? There is no point in having boards of people sitting around a table or celebrities discussing teenage mental health, when they're not backing it up with actual supports.
"Every school should have a psychologist. I don't want any other child to suffer like Jake did or how our family is suffering now. Life stopped for our family that night and I'll never be able to move past it.
"Jake's death was very preventable from start to finish. My son is never coming back to me and all I can do now is try and raise awareness about the lack of mental health services in this country so that parents can make informed decisions that are in the best interests of their child."
Martin Rogan, Chief Executive Officer of Mental Health Ireland, said that 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 and that's why prescribing is done by specialist teams. Like any medication, it will only go so far, but it will be much more effective if it is in combination with other therapy approaches."
Mr Rogan said that it is common for psychiatrists to prescribe anti-depressants after one meeting.
"It's up to the prescriber to suggest the best possible treatment for the young person and if they think an anti-depressant is the best thing, it would be remiss of them not to prescribe it. Usually with teenagers, family members would be involved in the decision-making too.
"There are other supports and therapies that can be tried first but most anti-depressants take from two to three weeks to benefit so you're losing time if the young person is depressed or stressed. If its indicated that the young person would benefit from anti-depressants there's not much point in saying come back in a few weeks and we'll see how you are then."
Mr Rogan added that despite a huge improvement in mental health services in Ireland over the past decade, challenges do remain.
"The biggest challenge for mental health services in Ireland is ensuring that there are sufficient skilled staff available for all of the teams. There's huge difficulty in recruiting child psychiatrists. The services also must be appealing to young people and more importantly effective. It's important that young people know where to find help and that the help is available to them."
In a statement to Independent.ie the HSE said that they cannot comment on individual cases, but said that 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, in combination with other non-pharmacological therapies," the HSE said in a statement.
"Commencing treatment with medication requires careful consideration of the grounds for commencement, discussion of the rationale for such treatment and possible side effects. Once commenced regular reviews will take place to monitor for the occurrence of side effects and response to treatment."
The HSE said that drug Fluoxetine (Prozac) is prescribed for under-18s "for a number of clinical conditions when indicated, taking into account the severity of the presenting problem and response to other psychological interventions".
"When a family believes that the treatment provided did not meet their expectations their feedback is most valuable in assisting the service in learning as to the ways it can improve the experience for young people and their parents. Ensuring that a positive relationship is established with the service is a fundamental to ensuring the best possible outcomes for young people."
The Health Products Regulatory Authority (HPRA) said that Prozac is authorised in Ireland for people over the age of 8.
"Prozac is a selective serotonin reuptake inhibitor (SSRI) antidepressant medicine authorised for the treatment of children and adolescents aged 8 years and above for the following indication: ‘moderate to severe major depressive episode, if depression is unresponsive to psychological therapy after 4-6 sessions. Antidepressant medication should be offered to a child or young person with moderate to severe depression only in combination with a concurrent psychological therapy.’
"The decision to grant this indication to Fluoxetine followed an EU-wide review of the safety and efficacy of the medicine in this patient population.
"Once a medicine is approved and placed on the market, European and Irish legislation provides for on-going monitoring of its benefits and risks. This monitoring includes review and evaluation of suspected adverse reaction reports at National and EU level."
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