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- April 05, 2004
- Vol. 61
- No. 13
Why Did Julie Take Her Life?
Julie Woodward Killed Herself a Week After Starting on Antidepressants. Was It the Pills? Growing Fears Prompt An FDA Warning and An Inquiry
Instead, at 16, Julie's life took a dark turn. In the fall of 2002 she began having trouble at a new school and, in defiance of her parents' wishes, began dating a college boy. Julie became quiet and withdrawn, so much so that in July Tom and Kathy took her to a psychiatrist, who prescribed two antidepressants. She lasted on the medication just one week: On July 23, after discovering that their daughter wasn't home—and hadn't spent the night with her grandparents, as they had thought—her parents became alarmed. Tom walked out to the garage behind the house, opened the door and found Julie, 17, dead. "She had hanged herself," he says, his voice breaking. "I grabbed her, and I knew she was gone. I felt her, and she was cold."
Today, eight months after the tragedy, the Woodwards still sound as if they are trying to convince themselves that all of this really happened. "Julie was the most self-protective, self-preserving kid in the world," says her mother, Kathy, 47. Adds Tom, 46, who, like his wife, is a financial consultant: "I never in a million years thought this could happen to us."
But it did, and the Woodwards aren't the only parents to suffer such a loss. On March 22 the FDA issued a recommendation for manufacturers to begin printing warning labels for antidepressants, in response to growing concern that the very drugs meant to lift kids out of depression sometimes do just the opposite. "The labeling we are proposing won't say you can't use these drugs," says Dr. Thomas Laughren of the FDA psychiatric drugs division. "[But] the one thing that was clear from our hearings is that many patients were not being well monitored." The labels will caution patients to watch for signs of hostility and agitation, especially during the first days of use and whenever dosage is adjusted.
Exact figures on the number of children on antidepressants who have killed themselves are impossible to come by. In February, 31 families—including the Woodwards—traveled to Washington, D.C., to testify before an FDA panel. There, anguished parents told of sons and daughters who became agitated, aggressive and, in the most extreme cases, suicidal, sometimes within days of the drugs' being prescribed. In addition to warning labels, the agency has ordered further scrutiny of the drugs, many of them SSRIs (for selective serotonin reuptake inhibitors), which, in rare circumstances, have also been suspected as a factor in adult suicide. "We want to make sure if there is the slightest indication these drugs cause suicide that children not be exposed to that," says U.S. Rep. Jim Greenwood (R-Pa.), who has called on drug companies to release unpublished research on the subject. "Right now we are trying to fit the pieces together and sort this thing out."
It may come as a surprise to parents just how little testing has been done on kids and antidepressants to date. About 1 million children are now taking the drugs, sold under names like Prozac, Celexa and Paxil, and the majority report side effects no more serious than dry mouth and sleeplessness. The benefits, meanwhile, when used in conjunction with other therapy, can be huge. Paradise Valley, Ariz., mother Sherri Walton, 45, describes antidepressants as a lifeline for her 15-year-old daughter Jordan, who has battled Tourette's syndrome, depression and obsessive-compulsive disorder. "Now I have a happy, healthy teenage child who's successful in school and can't wait to get her learner's permit," says Walton. "Her medication helped every step of the way."
Yet some doctors complain that information is scarce when it comes to kids and antidepressants. In all, just 4,000 children have taken part in clinical trials for antidepressants. Only one of the drugs, Prozac, carries official FDA approval for treating kids with depression. (Because of the complex way medicines are introduced to the market, other antidepressants that have proven safe and effective in adults may be legally prescribed "off-label.") "[At this point], we're not sure how children and adults react differently," says Dr. Philip Walson, director of clinical trials and pharmacology at Cincinnati Children's Hospital Medical Center. "We need to test these drugs and monitor them and realize that children aren't just little adults." For its part, Pfizer, the company that manufactures Zoloft, declines to comment specifically on the Woodward case, although a vice president, Dr. Catherine Clary, says that it will work closely with the FDA to devise label changes for the drug.
Caution comes too late for the Woodwards, whose three-story stone house in the Philadelphia suburbs is the kind built for a large family. "You live for your children," says Tom, who coaches track while Kathy teaches Sunday school. Julie, an older sister to Caroline, 16, and brothers Tom, 12, and Brian, 8, was always precocious and introspective. "She was more the observer," says Kathy. As a toddler, "she wanted to go to the park and just see the other kids. She didn't want to be part of the crowd."
But Julie was no loner. At Gwynedd Mercy Academy, her private high school, she played sports and sang in the choir. "Her friends here would say she was a very creative person, a good writer and a good friend," says the school's principal, Sister Kathleen Boyce. But for her junior year, Woodward decided to transfer to a much larger public school. "She wanted the real high school experience," says Kathy. The transition was tough. Julie's grades suffered, and she abandoned old friends and activities. She also began secretly dating the 19-year-old brother of one of her friends. The relationship ended, but not before Julie had stayed out all night and been involved in a minor car accident the next day. "Julie was very depressed," says Lindsay Harris, 17, who had known her since fourth grade. "If you talked about school, she didn't want to talk about it. If you talked about the future, she didn't want to talk about it."
Kathy Woodward was the first to bring up the idea of counseling for her daughter. "I drove her to the doctor, but she wouldn't get out of the car," says Kathy. The Woodwards eventually had Julie examined by two doctors before a third diagnosed her with depression. Julie enrolled in a group-therapy program at the Horsham Clinic in Ambler, Pa., where the admitting doctor prescribed Zoloft and trazodone, the generic name for another antidepressant often used on patients who are having trouble sleeping. Kathy says she was initially opposed to medicating Julie but, told it was an important part of her therapy, deferred to mental health professionals.
Julie took her first Zoloft last July 16 and, six days later, after complaining of insomnia, began taking trazodone. Her moods were mixed: Some days she seemed sweet and contented. On another she argued with Kathy and shoved her to the floor. "I got up and hugged her and said, 'What's that?'" recalls Kathy. "She just kind of looked surprised. It took a few seconds, but she hugged me back."
In the days that followed, Julie celebrated her younger brother's birthday with the family and helped pack for vacation. On the night she died, Kathy left the house to take her three younger kids to softball and a swim meet. Tom was already driving home from work at the time. Out of the blue, Julie called him from home and said that Kathy wanted him to come directly to the swim meet. "I told her I loved her," says Tom, barely able to collect himself. "She told me she loved me too."
The Woodwards weren't terribly concerned that Julie wasn't at home when they returned that night, since she routinely spent nights at her grandparents' house nearby. But the next day, a counselor from the Horsham clinic called to say Julie had missed a therapy session. Now worried, Kathy said she wasn't sure exactly where her daughter was, to which the therapist replied, "You have to find her. Julie had a terrible session on Monday," recalls Kathy. It was later that day that Tom found Julie's body in the garage.
In the wake of her death, police confiscated the teen's computer and journals, and found no mention of suicide. But the family did discover what Tom describes as a "goodbye note" in a backpack that Julie had left at her grandparents' house days earlier. "The whole thing was shocking," says her friend Jacqueline Cellucci, 17. After a period of depression, Julie "seemed much happier. I thought she was fine."
In retrospect, the Woodwards say there may have been signs that Julie was having an adverse reaction to the drug. Her sister Caroline, who shared a room with Julie, now says that Julie, lying in bed, said she was experiencing the feeling of being lifted up toward the ceiling. Other family members recall seeing Julie pacing back and forth in her bedroom several days before the suicide, and rocking back and forth—both possible signs of a condition called akathisia, which can include agitation. (Akathisia has been reported as one of Zoloft's adverse reactions.) An autopsy determined that Julie had a higher-than-expected level of the antidepressant in her blood, which may indicate she was not absorbing the drug as quickly as other patients.
As in other cases of adolescent suicide, impulsivity may have also been a factor. According to Dr. Norman Fost, a University of Wisconsin pediatrician and bioethicist, antidepressants can create what's called an "activation syndrome" in depressed children—giving them the energy to act on suicidal thoughts. "I don't think these drugs should be prohibited," says Fost, "but anyone prescribing them to adolescents needs to tell parents about the risks."
That is now the Woodwards' fervent hope. Since Julie's death, they've torn down the old wooden garage where she ended her life. But there are other things they cannot bring themselves to do—closing out her checking account or choosing a headstone for her grave, which they often visit. Grappling with questions that may always remain unanswered, they insist there's at least one thing they're certain of. "If it hadn't been for that drug," says her father, "Julie would still be here with us."
Susan Schindehette. Bob Calandra in Pennsylvania, Jane Sims Podesta in Washington, D.C., and Kelly Williams in Chicago
- Bob Calandra,
- Jane Sims Podesta,
- Kelly Williams,
- Susan Horsburgh.
April 18, 2015
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