Experts Discuss Drug Cocktail

The family of John B. Edwards III ’10 filed a wrongful death suit against Harvard and two UHS professionals last week, alleging that Edwards’ doctors negligently prescribed the young man a cocktail of four drugs that contributed to his suicide in November 2007.

Three of those drugs­—the anti-acne drug Accutane and the antidepressants Prozac and Wellbutrin—have been shown to increase the likelihood of suicidal thoughts in patients.

In interviews with The Crimson this week, a majority of Harvard psychiatrists said that the combination of drugs prescribed to Edwards was within normal standards of practice but required close supervision by a physician.

Edwards, who first sought care at University Health Services in June 2007, was prescribed the three drugs in addition to Adderall over the course of the following five months to treat symptoms of anxiety, depression, and difficulty concentrating.

Though three of these drugs increase suicidal thoughts, Dr. Donald B. Condie, a psychiatrist at Massachusetts General Hospital, said that suicidal side effects are generally not known to be additive and that it is fairly common for a patient to be taking more than one anti-depressant.

“Combining the use of Adderall, Wellbutrin, and Prozac for someone who is suffering from symptoms of depression, as well as attentional difficulties, may be reasonable,” added Brigham and Women’s Hospital psychiatrist Dr. Kelly J. Hoagland.

Though this mix of drugs is commonly prescribed for patients who exhibit such symptoms of depression, the combination may increase the risk of suicide, according to Dr. Andrew B. Clark, medical director of the children and the law program at MGH.

“There is no data to indicate that the effects are additive, but it stands to reason that if one contains a risk that the addition of another would raise risks,” Clark said.

The Edwards family’s suit alleges that the deceased’s nurse practitioner, Marianne Cannon, prescribed his medication without proper oversight from her supervising physician.

Brigham and Women’s psychiatrist Dr. Arthur J. Barsky III, who said that the combination of drugs was appropriate, nevertheless expressed concerns regarding a nurse practitioner’s role as the sole healthcare provider.

“In general, if you’re worried about [patients’] suicide potential, you probably would want an MD to do a suicide evaluation,” Barsky said.

The lawsuit also alleges that Edwards told doctors at UHS that he had already resolved suicidal thoughts he had harbored in the past.

Brigham and Women’s psychiatrist Dr. Barry S. Fogel said that depending on the facts and details of the case, the practitioners could have indeed failed in their responsibilities towards their patient.

“If someone has a genuine past history of suicidal thoughts and is started on an anti-depressant and then a second anti-depressant is added, having appointments several weeks apart with no scheduled interim contact and no review apparently by a psychopharmacologist, this sounds like substandard care,” Fogel said.

“If the facts are right, the family will have an extremely easy time convincing a jury that the follow-up wasn’t commensurate with the seriousness of the problem,” he added.

—Staff writer Elias J. Groll can be reached at egroll@fas.harvard.edu.

—Staff writer Danielle J. Kolin can be reached at dkolin@fas.harvard.edu.