Originally Posted - November 21, 2005

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There is much difficulty putting Terri Schiavo to rest with the barrage of news reports detailing other peoples' circumstances in the United States in similar situations; put to death daily, either by state sanctioned euthanasia, hospital sanctioned euthanasia, or family sanctioned euthanasia.

Add the constant reports of Michael Schiavo speaking tours, awards, and endorsing political candidates, along with judicial activism awards, and we cannot forget. We are constantly reminded of Terri Schiavo's brutal death. Maybe we are not supposed to forget, but instead, dig deeper into what actually happened with Terri, in order to prevent the same thing from happening to disabled, elderly, and brain injured people in this country, before it becomes the norm.

If you read the news and follow laws rapidly changing in other countries of the world, we know euthanasia is advancing in this country. We even have a form of euthanasia, Physician Assisted Suicide (PAS), in Oregon. The constant reports of personal stories in the news and circulating through cyberspace, multiply daily.

One thing the media did not report, and which many were unaware, was that Michael Schiavo was on several antidepressants. This information is contained in court documents and depositions, and available to the public. Many people take antidepressants, and even more have a form of depression or other mental illness which goes untreated. Michael Schiavo's mental health and history wouldn't be an issue, except for a couple things.

There was outright nonchalance about Michael's mental health and history of antidepressant use, some completely ignored the issue, and neither the media, nor the courts, nor law enforcement provided answers. Further, they refused to acknowledge the facts existed, and totally ignored those trying to keep Terri alive.

How long Michael was on antidepressants, whether he is still on them, and whether he took any of the drugs simultaneously, is unknown. Read the 1993 deposition and you will understand why. Michael could not answer the same question phrased differently with a consistent answer. Poor recall, confusion, or not remembering specifics is not an acceptable defense. Yet he got away with it. Nary a soul challenged him.

Out of all the controversy in this case, absence of a police investigation, and the refusal of any law enforcement official to involve themselves or make any coherent statement about the lack of an investigation, the fact that Michael had a depressive disorder to the extent he was taking prescribed psychotropic agents, should have prompted the police to check his background and history for domestic violence and rule it out, at the very least.

Medications Michael took are alluded to in the 1990 police report, but not mentioned in that report. There is no mention of follow up from law enforcement with the "unusual situation" comment contained in that report, no background check of Michael Schiavo to rule out domestic violence, or in tying those circumstances, the possibility of domestic violence, with a history of antidepressant use, together.

Since Michael Schiavo was on antidepressants, we know he had mental illness in the form of depression, at the very least. According to his own sworn testimony in a 1993 testimony, he also had suicidal ideation at times.

Depressive states have been classified as endogenous psychotic depressions and reactive depressions.

Endogenous psychotic depressions are characterized by an absence of external causes for the depression, such as death of a loved one, loss of employment, or debilitating disease, and the grief and depression are of psychopathologic origin.

Reactive depressions are abnormal depressive responses to environmental factors, and are associated with emotional tension and instability.

Most antidepressants work by slowing the removal of certain chemicals from the brain. These chemicals are called neurotransmitters (such as serotonin and norepinephrine). These neurotransmitters are needed for normal brain function, and are involved in the control of mood, and other responses and functions, such as eating, sleeping, thinking, and pain.

Valrelease (Valproic Acid) is a mood stabilizer. Valrelease has also been classified as an anticonvulsant. Other brand names are Depakene and Valproate. These drugs are used in the treatment of bipolar disorder. Valrelease is also prescribed for anxiety, nervousness, and tension associated with anxiety disorders.

Besides anxiety, Valrelease may also be used to treat symptoms of acute alcohol withdrawal, to help control epilepsy, or to relieve muscle spasms. Anxiety or tension associated with the stress of everyday life usually does not require treatment with this drug.

In acute alcohol withdrawal, it is used to relieve acute agitation, tremor, delirium tremens and hallucinosis. It is also used to relieve skeletal muscle spasm such as inflammation of the muscles or joints, or secondary to trauma); spasticity caused by diseases such as cerebral palsy and paraplegia); athetosis; stiff-man syndrome, and tetanus.

Maybe Michael did and does have a back ailment, a seizure disorder, or other, which required Valrelease use. However, since he was on several other antidepressants, and some of those are major antidepressants, we can conclude he has a history of depression as well. These are undisputable facts and again, should have been a point of investigation to rule out, by law enforcement, predicated on the "unusual situation" comment contained in the police report.

Valrelease is habit forming with physical and psychological dependence on the medication. It can increase the sedative effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, (Seldane is an example, and Michael took this drug by his own admission), sedatives (used to treat insomnia), pain relievers, anxiety medicines, seizure medicines, and muscle relaxants.

If combined with other psychotropic agents, careful consideration should be given to the pharmacology of the agents to be employed which may potentiate or enhance the effect of the action of this drug, such as phenothiazines, narcotics, barbiturates, MAO inhibitors and other antidepressants. Since Michael was on antidepressants and Valrelease, there clearly was a valid reason the law should have done an investigation. We know they did no investigation.

Psychotropic drugs comprise tranquilizers and antidepressants. Psychotropic drugs exert an effect upon the mind. The use of these drugs alleviates symptoms and allows the mentally ill to participate in other forms of treatment. The drugs modify behavior, while psychotherapy shapes behavior and produces a change. A thorough evaluation of causative factors is warranted to treat depression. The Schindlers may, or may not know, whether Michael was ever in treatment and for how long. They were in a position to assess Michael's mood changes, any symptoms present, and attitude.

While antidepressant drugs help people feel better, they cannot solve problems in people's lives. Some mental health professionals worry that people who could benefit from psychotherapy rely instead on antidepressant drugs for a "quick fix." Others point out that the drugs work gradually and do not produce instant happiness. The best approach is often a combination of counseling and medicine, but the correct treatment for a specific patient depends on many factors. The decision of how to treat depression or other conditions that may respond to antidepressant drugs should be made carefully and will be different for different people.

Side effects most commonly reported with Valrelease are drowsiness and fatigue. Infrequently encountered are confusion, constipation, depression, headache, hypotension, incontinence, jaundice, and changes in libido, nausea, changes in salivation, skin rash, slurred speech, tremor, urinary retention, vertigo and blurred vision. Paradoxical reactions such as acute hyper excited states, anxiety, hallucinations, increased muscle spasticity, insomnia, rage; sleep disturbances and stimulation have been reported.

Michael Schiavo stated in court documents that he stopped taking these antidepressants due to a sick stomach and clouded thoughts. What is his definition of a sick stomach? That was never questioned. While nausea is a side effect, it is not an adverse reaction. He could have taken an antiemetic to alleviate the nausea, and not quit his psychotropic medications or keep changing them.

Of all the side effects listed above, nausea was Michael's chief complaint. Did his sick stomach include vomiting? Not rage or slurred speech or skin rash, but nausea, prompted him to quit taking his medication.

Tricyclic antidepressants are another class of psychotropic drugs listed in court documents. These drugs have been used to treat depression for a long time. They act on serotonin and another neurotransmitter, norepinephrine, and may also interact with other chemicals throughout the body. They include Elavil (amitriptyline), Norpramin (desipramine), Tofranil (imipramine), Aventyl, and Pamelor (nortriptyline). Common side effects caused by these medicines include dry mouth, blurred vision, constipation, difficulty urinating, worsening of glaucoma, impaired thinking and tiredness. These antidepressants can also affect a person's blood pressure and heart rate.

Elavil (Amitriptyline HCl) is a tricyclic antidepressant, and is used in depressive illness of psychotic or endogenous nature and in some with neurotic depression. Elavil has a sedative action, and is also of value in alleviating the anxiety component of depression.

As with other tricyclic antidepressants, amitriptyline may precipitate hypo-manic episodes in patients with bipolar depression. These drugs are not indicated in mild depressive states and depressive reactions.

Elavil should not be given concomitantly with a MAO Inhibiting compound. Hyper-pyretic crises, severe convulsions, and deaths have occurred in patients receiving tricyclic antidepressants and MAO inhibiting drugs simultaneously. As far as we know, Michael was never on MAO Inhibitors.

When amitriptyline is used to treat the depressive component of schizophrenia, activation or aggravation of existing psychotic manifestation may occur. Likewise, in treating manic depression, hypo-manic or manic episodes and hyperactivity or agitation may become over stimulated. Paranoid delusions, with or without associated hostility, may be exaggerated.

Amitriptyline may enhance the response to alcohol and the effects of barbiturates and other CNS depressants. Therefore, alcohol consumption is a precaution. We have never heard the media discuss if Michael drank or how much.

Reported side effects include dry mouth, blurred vision, urinary retention, constipation, palpitations, tachycardia, weight loss or gain, drowsiness, nervousness, insomnia, Hypotension, dizziness, rash sweating, confusion, mania, psychosis, heart block, arrhythmias, extrapyramidal symptoms, gastric upset, changes in libido, and impotence.

Pamelor (Nortriptyline hydrochloride) is also a tricyclic anti depressant, and is used to treat depression. Side effects are the same or similar as Elavil above. Nausea is not listed as a side effect; however, Michael could have experienced nausea from the tricyclic drugs.

This medication is not to be taken along with any other antidepressant drugs. If taking Prozac, wait at least five weeks before beginning therapy with Pamelor, as a major drug interaction could result. An overdose of this type of antidepressant can be fatal.

Prozac (fluoxetine) is an antidepressant, anti obsessive, and anti bulimic agent or drug with actions that have been shown to significantly reduce the symptoms of obsessive-compulsive disorder in double-blind, placebo-controlled clinical trials. The obsessions or compulsions must be experienced as intrusive, markedly distressing, time consuming, or interfering significantly with the person's social or occupational functioning.

Prozac is an SSRI or Selective Serotonin Reuptake Inhibitor; is an Antidepressant, and is also used in the treatment of anxiety.

According to the FDA, patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of depression and/or the emergence of suicidal ideation and behavior or unusual changes in behavior, whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. There has been a long standing concern that antidepressants may have a role in worsening depression and the emergence of suicide in certain patients. Antidepressants increased the risk of suicidal thinking and behavior in short term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders.

Selective Serotonin Reuptake Inhibitors (SSRIs) act only on the neurotransmitter serotonin, while tricyclic antidepressants and MAO Inhibitors act on serotonin and another neurotransmitter, norepinephrine, and may also interact with other chemicals throughout the body. Selective Serotonin Reuptake Inhibitors have fewer side effects than tricyclic antidepressants and MAO Inhibitors, because Selective Serotonin Reuptake Inhibitors act only on one body chemical, serotonin.

The FDA states further that adults with MDD or co-morbid depression in the setting of other psychiatric illness being treated with antidepressants should be observed similarly for clinical worsening and suicide, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases.

The half-life of prozac after a single dose is 2 days with a range of 1 to 4 days, and after multiple dosing 4 days with a range of 2 to 7 days. Because of the long elimination half-life of prozac, changes in dose will not be fully reflected in plasma for several weeks. So, even when the drug is stopped, the active drug substance will persist in the body for weeks due to the long elimination half-lives of fluoxetine and norfluoxetine.

Wellbutrin (bupropion) relieves certain types of major depression and can also be used for ADHD. Wellbutrin can cause agitation, insomnia, headache and nausea. Major depression involves a severely depressed mood (for 2 weeks or more) and loss of interest or pleasure in usual activities accompanied by sleep and appetite disturbances, agitation or lack of energy, feelings of guilt or worthlessness, decreased sex drive, inability to concentrate, and thoughts of suicide. Unlike tricyclic antidepressants, such as Elavil, Pamelor, Tofranil, and others, Wellbutrin tends to have a stimulating effect.

Wellbutrin should not be taken if, within the past 14 days, you have taken a Monoamine Oxidase Inhibitor (MAO Inhibitor) drug, such as the antidepressants Marplan, Nardil or Parnate. This particular drug combination could cause you to experience a sudden, dangerous rise in blood pressure.

An MAO Inhibitor affects the same neurotransmitters (serotonin and norepinephrine) that the tricyclics do, but they also affect dopamine. MAO Inhibitors are usually the antidepressant of last resort. Michael was not on MAOI's, according to court documents studied.
Factors to consider when taking any drugs are the interactions between the drugs ingested. The more drugs one ingests, the more interactions and adverse reactions may be present, not only between the drugs, but with food as well. Antidepressants can have an effect on many other medications causing serious problems.

Another risk of antidepressants is serotonin syndrome, a drug reaction resulting from the over-stimulation of serotonin receptors. This can occur when an antidepressant is taken either with another antidepressant, with certain recreational and other drugs (see below), or more rarely, even when one antidepressant is taken alone. Symptoms include hyperactivity, mental confusion, agitation, sweating, shivers, fever, seizure, diarrhea, and lack of coordination. To minimize the risk of serotonin syndrome, there must be a 'washout' period of at least two weeks when switching from one antidepressant drug to another.

Drugs that may induce serotonin syndrome when taken with antidepressants:

© 2005 North Country Gazette