What happened to the amazing Dexter Johnson.
The sequence of events.
Dexter Johnson, Dec 2021 – Jan 2022
Background:
It has taken some time to receive and assemble the documents and facts needed to understand what happened to Dexter. It has taken more time for me to decide that Dexter would want his story told, maybe to save others but also to show that if he had a second chance, if he were adequately warned, he would see the harm being done, and it would all unfold differently.
People used to ask about what happened to him, but not much lately. Today, Dec 31, 2022, is the last day of the year in which he was alive. He would want the story told, to protect others. I want it told to show that he had no faults or problems over the years; he was a victim.
Some information may never be obtained, for example my request for basic information from the Kelowna counsellor who Dexter’s friends told me about after his funeral, was rejected in writing.
But we have the important documents, and I am grateful to have received information that I had not known existed. I am especially grateful to have supporting comments from experts like Dr. David Healy and others, who offer the only science-based and sensible views in Dexter’s story.
The sequence of events during December 2021 to January 2022, and some notes on Dexter’s character, make it clear that the outcome was preventable. Again, I feel that Dexter would want this clarified, and he would want to try to prevent it from happening to others. As his friends know, as hardworking and talented as he was, he was always primarily concerned with the welfare of others. This summary might also give his siblings more clarity. The complete failure of the duty to inform and the duty to warn by health care professionals denied us the chance to save his life, and I apologize to my family for not having been able to guess what was being done to us.
Dexter Shige Jorgen Johnson was born in Calgary Feb 2, 2006, and has lived in Lethbridge, Alberta, since birth, where he had all of his school from K to 10. I am his day-to-day care and custody parent, mandated by court order Jan, 2012, and true in every-day fact, then until now. Dexter, his brother, and I lived in Alberta as a happy, successful, and active family of three, since 2011. The boys are famously appreciated and loved by teachers, friends, and our community, as they likely are when they visit Kelowna, BC, during Christmas, and often Easter and New Year, and in July, for over a decade. It has been my pleasure to take them to and from all their schools days pre-school to high school, pay all the costs of their many activities, sports, band, running club, outdoors, awards, science camps, and be the parent attending their events during those years. Everyone loved them.
Dexter had seemed oddly tired in October and November, 2021. When we were at his high school awards night, he said nothing, but picked up his academic achievement award when called. He seemed unusually subdued and quiet, and I was not sure why, but I thought it could be because he might have been hoping to take top math or top science awards as well, as he had in previous years. Now I know that his quiet mood could be related to the increase in dosage of an unknown medication (unknown to me) received at Thanksgiving. We know now that he was telling friends at the time that he would tell his father about it, but it had been going on too long, and was ‘embarrassing’. That embarrassment was not over his realizing some unexpected and private coming of age issues that made him feel lonely; I brought the boys up to respect others and be aware, and when they were younger we attended public diversity rallies in support of Black Lives Matter, Pride events, and other things. He told his friends in messages that the secret medication was not working to cure his sadness, which might have been another cause for his disappointment. The embarrassment and preference for secrecy was regarding what he called the “long story” that began when years before we were turned away at Children’s Hospital in Calgary, because their Alberta Health had been cancelled (falsely). That took a while to correct, and was embarrassing, true enough.
The Christmas concert was December 6, 2021, and I can still clearly make out his trumpet in the recording I made with permission of the band teacher. His high school had asked him to record Last Post, and Rouse, to be played in the school on Remembrance Day, November 11, 2021. Dexter loved music, was dedicated, and good at it. He wore his Band hoodie non-stop during Middle school, and around the world. I never had to remind him to practice, I never wished he did anything differently. One of the really disappointing things in the records of appointments when we finally received them four months after he died was the fiction concluded by someone I had never met or even heard of assumed we must have a bad relationship, so secrecy was apparently justified.
We spent Saturday, December 11, 2021, in my university lab space, just us, learning extraction and purification of DNA, with Dexter recording data for projects. He was pleased to learn methods, and talked about upcoming classes he hoped to take (he was later accepted into a university biochemistry course, “BCHM1850: Genetically Engineered Machines”, and at New Year he texted me the news with pride and excitement). He was forward-looking and always on a mission to learn and do. He told friends in messages (I received later) that he was pleased his dad had saved so much money in his education fund, and he was dreaming of maybe UCLA, and hope to take both music and biomedical science. The irony was that as such a good student, he could have attended on scholarships. He loved our travels, and his room has momentoes from NASA, Morocco, London, Niagara, Yellowstone, Missouri, Rockies, solar eclipses (one 100%in in 2017), archery, and other experiences, as well as his own music, woodworking, science projects, awards, and computer designs. He said he looked forward to us going to Hawaii and Japan, which was still on hold because of the pandemic.
Dexter arranged for us to drive to Calgary on Sunday, December 12, to pick up the soprano saxophone he located on Kijiji as the Christmas gift he chose to receive from me, a bargain at $830. He had multiple talents, and had bought a trumpet upgrade online with money he saved himself plus separate donations from me and his mother. Driving to Calgary, we listened to “The Big Picture”, by Sean Carroll on audiobook, and a little of “Enlightenment Now”, by Steven Pinker. Dexter was a thoughtful boy who was known for volunteering friendly explanations of topics like the Drake Equation, astrophysics, and music theory to his friends. We stopped at Vulcan for a photo together with the Starship Enterprise, and then to IKEA, Calgary, to pick out kitchen cupboards for the renovation he would help me with in January. We shopped for an oven and dishwasher, which we have always wanted (but we kept putting the funds into education savings). He had helped me put down a concrete slab deck in our back yard in the fall, and we had more improvements to do. He built brick garden walls and flower beds for our yard, and other projects. Dexter was talented with tools as well as academic and musical studies, and as a boy even learned woodturning. He made me a perfectly shaped and balanced chisel handle from a tree branch. Dexter was not a troubled teen or outwardly anxious; he was a victim of circumstances and the poor decisions of others.
Dexter was very pleased with his high school and the International Baccalaureate program, which he chose. School (grade 10) was out on Dec 17, 2021. On Dec 18, the three of us drove to Calgary, stopping again at Vulcan to get a three-member selfie with the Starship Enterprise, then visiting their adult brother’s family in Calgary. The next day the boys were on the way to Kelowna with their mother for a Christmas visit as usual, and I was scheduled to pick them up Dec 29. Because during the last decade their mother did not come to Lethbridge for any events, sports, or activities, I chose to give up Christmas when demanded (always) in order to increase the contact between the boys and their mother.
Our 11 years of driving back and forth between Kelowna and their home in Lethbridge were always interesting, summer and winter, but after Christmas the Rocky Mountain drives were sometimes a little too interesting because of snow and cold in the mountains, usually via Highway 1. We traded in our smaller car and bought a 4-wheel-drive for mountain winter safety.
I had started arranging my drive from Lethbridge to Kelowna to pick them up Dec 29, 2021, sent an ETA to his mother, but received a text back that it is cancelled, because Dexter was to have a surprise “checkup” with an unnamed doctor on Dec 29 for unnamed reasons. For what, I asked? Why see a doctor on the day he was to return, and why in BC? Has he had a Covid test? Is his childhood asthma back? Pandemic issues? The cause and the name of the doctor were refused because it was nothing important. It sounded like either asthma was coming back, or minor pandemic depression that is in the news over the past year, and which he might even have had in July (she had said maybe, but not anything important, and supplied the name of our Lethbridge family doctor to the Kelowna mystery doctor). I contacted Dexter by text and asked about the change, and when I should arrive. We agreed on ASAP so we could have New Years together, unlike recent years. A delay of the first week of school was announced for all of Alberta (rescheduled to begin Jan 10, 2022), and weather was bad, so I suggested I would drive to Kelowna after New Year.
After Jan 1, Dexter sent text messages to ask about when I would be there. When I arrived Jan 5, I asked Dexter, what was that about a checkup? He seemed embarrassed and quiet, maybe because we didn’t normally keep secrets, and I said okay, don’t worry, let me know later, don’t worry. We started the 900-km trip home, in snow and cold. Highway 1 was closed due to snow, so we headed south, through Beaverdell and Rock Creek, BC. We were turned back by closures because of avalanches. We had to backtrack to Nelson, BC, making the trip longer, and take the ferry across Kootenay Lake, which actually felt to us like adventure and a fun highlight of the trip. He seemed slightly unwell on the ferry, maybe tired. This is why I later felt he was just tired from the long drive.
We had missed New Years together, but agreed to watch a documentary together the following week, and Dexter suggested some choices.
Jan 7, 2022, Friday. We arrived in Lethbridge in the evening, unloaded, and I told the boys to get some sleep after the long trip. Dexter seemed tired.
Jan 8, 2022. On Saturday morning, Dexter came to the university science lab to learn more about quantifying DNA, and he received training from our biochemist friend in using the BioDrop Micro-volume Spectrophotometer. His brother declined to come along. Dexter worked with me to record morphometrics of the species we are comparing across geographic regions – our joint project, but he seemed tired, writing quietly and concentrating.
Dexter is listed as a posthumous coauthor on our recent scientific team presentation given on Oct 22, 2022. The day before I picked them up in Kelowna, he sent me the letter he received that accepted him into the university course “Genetically Engineered Machines”, as a grade 10 student, and he was excited that it would begin soon. He said he was hoping to join iGEM (The International Genetically Engineered Machine competition) in the fall or as soon as possible. The instructor told me she considered him a top student, from past experience. But this Saturday he was very tired, and his eyes seemed blurry and out of focus. In the lab, he was concentrating just to write down numbers from the spectrophotometer, so I said, let’s go home early, you are still really tired from the long trip. Get some sleep. On the way home he sat silent and pensive, which was unusual. I said let me know if you are not feeling well, or just tired. He was so quiet that I blurted out “nothing matters to me as much as your health and well being”, which seemed dramatic and I had wondered why I said it. He looked like he had something to say, but said nothing. That was when we would have gone to the hospital if I had known anything about 40 mg daily fluoxetine, the name of a drug which at that point I had never even heard of.
Jan 9, 2022. Dexter rested on Sunday and chose not to go along with me walking our dog by the river. Dexter was on his computer, then spent a little time playing the soprano saxophone we bought when he and I drove to Calgary before Christmas. He liked to practice alone with the door closed, and it sounded so good I recorded a few minutes on my phone so he could hear it later, and see how much he had learned. He was already good at it, confirmed by music academics who I have played my impromptu iPhone recording for, after his death. The soprano saxophone was his fourth instrument but he started trying it out right away. With only a week or two of actual practice, he was playing “Chopin, Nocturne Op.9 No.2 for Soprano Saxophone and Piano”. The music sheet is still sitting at his desk.
His band teacher wrote to me: “I've said this more than a few times to colleagues today - Dexter was the finest musician I've ever taught in my career. And I don't say that casually. He really was. You and I have discussed this before. He had so much talent and a yearning to stretch himself like no other student I've seen. All the instruments he's mastered is nothing short of amazing to me. He also worked hard at his craft, not content to just rest on his talent and coast. I will never forget him. He truly was one of a kind.”
Any student, parent, or teacher, from K-10 would agree that Dexter was skilled in many things but also known for kindness, confidence, cooperation, effort, and a friendly supportive attitude.
Jan 10, 2022. On Monday morning, we dropped his brother off at his high school, then as usual I took Dexter to Winston Churchill High School. The high school mattered to him a great deal. I have never had to tell him to study (this was true for him, ages 4-15, as any teacher knows). He always kept up, was fascinated with learning. His silver and then gold in the regional Kangaroo Math contest during elementary school correctly foretold his abilities later. He received honours and academic achievement every year, without anxiety, and excelled in band. That morning, he told me to pick him up later than normal, so he could stay after school and help with the coming Shrek play preparations, making sets. At 5 pm he texted that he was done, and I picked him up (the Shrek play program later had a photo and dedication to him, in the program.) He stayed downstairs except for light supper, played a little on his saxophone, and texted online with friends. We saw later that he played the computer game Terraria online, discussed with friends, downloaded a trial of MuseScore3 and tried some composing, and googled a graphics card he wanted. Dexter planned to live. This is a person with short-term and long-term plans. I stayed up and worked on a Powerpoint for a webinar I had agreed to give at 8:15 the next morning. I asked the boys to be ready 10 minutes early Tuesday morning so I could get to a computer to do the webinar. They both agreed. (The people signed up for the webinar, hundreds I was told, would be left waiting.)
By chance we had an annual appointment with our family doctor set up for Jan 12 but I didn’t anticipate much to do except renew my blood pressure prescription and set up separate appointments for the boys. We had no indication of any special questions or issues, other than vaccination and general health.
Jan 11, 2022. Early on Tuesday, I made them breakfast, put it on the table, nothing unusual, and copied my presentation file to a USB to get ready for the webinar an hour later. I started the car, and called out that I’ll wait for them there, in a bit more hurry than usual. We came out to the car, but no Dexter. I said “Where is he? And why is his light off, and the bathroom light off?” He had never slept in or been late in 10 years, that I could recall. I texted his cell, then phoned him. I went inside to see where he was and suddenly got the alarming feeling that Dexter might be sick in bed with his door closed. I was suddenly worried because years before, when he had just turned 7, Jan 19, 2013, by luck I heard him gasp “Dad!” at 2 am. He could not breathe at all, and we tried to get him air. I called 911, and rushed my two boys to the hospital. It was serious enough that it recurred, and they kept Dexter for two nights. Later he wrote about it in his elementary school journal, how lucky we were. After that, it cleared up with inhaler medication and medical appointments regarding managing asthma. We moved two camping cots into the living room to sleep, where I could hear him if he had trouble again, and he felt much safer like that, for a year. We liked it, and talked and sometimes read.
In the hallway, Tuesday, Jan 11, 2022, 0750, I phoned his cell again and knocked. He had never been late for school. I had not looked into his room in a long time; I give them their privacy. (If I had ever searched it, I would have discovered the secret, and prevented what came next.) I tried the knob, and it was locked. I knocked harder and worried, so turned the knob so hard it gave way and opened. I was shocked to see him pale and noticed blood on his chin. I suddenly thought that he might have some respiratory blockage, or maybe Covid I thought. He was lying on his bed, no covers, in long pants (unusual for him), and no shirt. And why is the room cold? I shouted his name but he didn’t move and I grabbed his arm to shake him and possibly resuscitate. He was cold and stiff, obvious rigor mortis, obviously gone, all night. When I hit the light switch, I saw what he had done. How can psychosis like this come from nowhere, no indication, no hint, no warning sign? No note, no word to me or his friends, just on impulse. In the first wrong thing he had ever done, he had stolen an older target gun from lockup, obviously some time before because my desk is by the safe and it could not be removed while I was there in the evening. I could see now that he had put it under his chin and taken his own life. But how? Everything was always triple-locked but he was smart and in shooting classes, and had competed in the provincial air rifle before the pandemic and started the rifle team just as the closures hit. He had all the safety training and more, even attended range officer training, well-informed and serious. But the trigger lock and target gun case lock were on the floor. Somehow he diverted it from the safe earlier or found a way to take it out and hide it.
I could see that Dexter was long gone, probably since midnight. There was no saving Dexter, obviously, so I calmed myself and went to the car. I am still grateful to fate that only I was in the house to see it. I still feel that it gave Dexter some dignity that I was the one to find him, and clean the room alone later once police and hearse had left. I headed home, calling 911. My iPhone has never been able to start a call in under a minute (Telus would not fix it) so I messaged a friend, “Help - calling 911. Phone not working”. We both got through, and my friends (a couple) arrived as did the ambulance and police. I showed the ambulance staff and several police in. The police came out to ask questions.
Discovery by the police of ‘fluoxetine’ medication prescribed to Dexter
I was briefly on my knee in front of the front door, but recovered and went to the lawn. The police spoke with me on the front lawn, while the ambulance staff were inside attending to Dexter’s body. A police officer asked me “Why is he on medication?” I said “He isn’t on any medication.”
“We found it in his room”, they responded.
“You must be looking at his inhalers from when he was little, and had asthma for a while.”
They showed me a photo they had just taken, on a police cell phone, that showed several vials full of pills of different sizes and colours, pills and vials I had never seen before.
I gawked at the photo and peered to read the labels, and I asked “What is it? Fluozetine? Fluoxetine? What’s that?”
The senior constable said that they had “googled it. It’s Prozac.” I said “Prozac? Prozac? Whose is it?” “It’s his.” I said “Who would give him Prozac?” I had not even heard the name Prozac for a decade, since it was in the news about psychiatry and some fines or lawsuits, and a book whose title I had forgotten. “Where is it from?”
We could see the SHOPPERS name on the top of the label.
All I could make out of the doctor’s name on the curve around the vial in the photo was “Dr.”, and then the photo was gone. I asked if I could see the bottles. They said no, we removed them already. They will go with him to the medical examiner.
This discussion stopped when a car arrived with his brother. I had hoped he would spend the day at school unaware, to find out about this at the end of the day. I put my arm around him and walked with him down the alley and told him. The hearse came and took Dexter away, to be taken to Calgary for an autopsy. We had no warning and no information about what might have caused this. We stood in shock. One officer came and asked for the safe combination.
I kept asking how did this happen? What is going on? What was he taking it for? How could I have stopped it? Why did he do this? The police officers left, but texted me “You didn’t do anything wrong, Dan.”
After Dexter’s body was taken to Calgary, I received a call from the Medical Examiner, telling me that they would do the autopsy. I asked if they would test for Prozac because we had been told after he died that he had some. The Medical Examiner seemed surprised that I was not sure and had just found out, and said “We screen for 200 drugs and toxins. It takes about 6 months for the report.” I asked if I could have the empty vials. She said no, they will be destroyed. I said I don’t even know where they came from, except “Dr. H.” She read me the name of the prescribing doctor and said I could ask him why a teen would have been prescribed that medication.
It took months to receive any medical explanation from BC. I later made a FOIP request to the Lethbridge police for the photos, and on the second try, the photos were provided, July 18, 2022. The police have been sympathetic and supportive. They also returned Dexter’s phone to me.
I, and his older siblings, slowly discovered more about it later. Dexter’s action to take his life was a spur-of-the-moment delirious act. Something made him fragile for a moment, and took away the inhibition. He left no note, no text to a friend, no warning or hint for help, no concern for his family, dog, music, school, or future. He was not suicidal, although it turns out that over months, a side effect made him reveal these thoughts to a doctor I had never heard of. Poor Dexter told friends he felt sad lately but preferred to tell nobody and had heard of medication to try. Since then, I have read about cases of iatrogenic (drug-induced) suicide, and suicidal thoughts, and I have talked to suicide prevention workers and psychiatrists. This is typically how it happens, with the use of SSRI antidepressants (selective serotonin reuptake inhibitors, based on the baseless hope that depression is related to a serotonin imbalance, as opposed to life situations). When SSRI antidepressants rates are high or recently increased, sometimes even with monitoring (which we had none of), adolescent suicide is a known risk, on the label. Scientific papers and reviews back this up, and calculate the odds of increased suicidal thoughts and suicide, based on evidence. The SSRI antidepressants (which have been shown to be ineffective for adolescents anyway), especially after a change of dosage or an accidental increase, can leave the young person in a fragile state with some disinhibition caused by the “emotional blunting”. If some minor crisis occurs in this condition, like a lost job, an unkindness from a friend, trouble with the law, or end of a relationship, the numbed brain sees suicide as a reasonable and immediate way out. The inhibition to die is lowered; for a short time it seems like a solution, and there is no going back. In some cases, family monitoring can head off these sudden urges (or at least remove some of the easy opportunities for suicide), and that is why the duty to warn and inform are emphasized and required. But in other cases, even full awareness cannot stop the sudden suicidal decision. My heart goes out to my friends whose son was put on a related SSRI, which is prescribed for various reasons and even minor OCD. They were not properly warned of the danger, and one day he made a sudden choice to jump in front of a train, as they describe on his public story, bravely told so others might be saved. I now know of similar sudden deaths. In Dexter’s case, he seemed fine that day, which is also reported by his teachers, but then suddenly made a plan to die alone in his bed in the dark, over some short-term personal disappointment. The fluoxetine increased this risk. He had a high concentration (the toxicological report indicated that a literature review showed the typical range of blood content in patients prescribed fluoxetine is 0.025 to 0.20 mg/l, and Dexter was found to have a blood concentration of 0.430 mg/l). I had no information from any doctor or anyone that he might be taking it at all. Four months later, I learned that Dexter’s dosage had been increased to the high rate of 40 mg daily on Dec 29, the day my arrangement to pick him up was cancelled. The prescription was a secret from me, with no monitoring or involvement in his home, no regard for day-to-day patient safety, no concern for the label warning. We are sorry that Dexter hoped it would all go away, and likely felt it was not his place to take over and tell us.
I see now that his symptoms at the end might indicate the high rate affects. When I found him, he was lying in his bed with long pants but no shirt, and had blocked the heat duct and cracked the window open slightly (-2 C that night). This could indicate difficulty with regulating body heat, a possible symptom of too much serotonin. It is well known that serotonin is unrelated to depression or sadness, but the belief in the myth lingers on despite zero evidence. Prescriptions of fluoxetine are known to be ineffective for adolescents, in any case, so there is risk but essentially no benefit. However, fluoxetine itself does disrupt changes in serotonin level, so although it does not cure any chemical imbalance, it certainly subjects the patient to one. It was all for nothing.
The Black Box Warning at the top of the Prozac label:
Like the label warning, health agencies and departments indicate that monitoring and involvement of the family in the home (and family doctor, and sometimes school) are required. Advice and research agree. Colon et al (2022) emphasized the crucial importance of monitoring. They examined retrospective cohort study data, and concluded that age and sex (m/f)
“were significantly associated with the rate of readmission: younger and male patients had an increased risk of readmission due to suicide-related events within 90 days of discharge after starting SSRI, or SNRI, to treat depressive disorders. These results support the importance of monitoring patients started on SSRI or SNRI, with particularly careful consideration in depressed young male patients.”
Quote from Spielmans et al., 2020, “Duty to Warn: antidepressant black box suicidality warning is empirically justified”. Frontiers in Psychiatry 11:18. “Based on the sum of this evidence, regulatory warnings regarding antidepressant-linked suicidality are clearly warranted. When a clear body of evidence points to increased treatment-linked risk, patients and healthcare providers should be made aware of these risks. To suggest otherwise both breaches the ancient injunction of primum non nocere (first, do no harm) and is not aligned with the practice of evidence-based medicine.”
The recommendations in Canada and the USA make it clear. For example,
Product information, from Health Canada, fluoxetine:
“Not indicated for use in patients below the age of 18 years. Close supervision of high-risk patients should accompany drug therapy and consideration should be given to the possible need for hospitalization.”
Mayo Clinic:
“The highest risk of suicidal thinking and behavior occurs:
• During the first few months of treatment with an antidepressant.
• When the dosage is increased or decreased.
Parents and caregivers should closely observe the child on a daily basis during these transition periods and watch for worrisome changes for the whole time the child takes antidepressants.”
Dexter had apparently been given several full vials to control by himself. We found an additional empty vial that said October, 2021, at Thanksgiving. I wondered what else he was prescribed, how much, when, and for what. I inquired from pharmacies but information has not been shared with me. I feel the toxicology report is the final word, and he was likely prescribed only fluoxetine.
The funeral was held in Lethbridge the following week, January 21, 2022, during Covid restrictions which limited attendance to 50 people. We reserved one open seat for Dexter’s mother in case she attended, and gave priority for the rest to students, teachers, and family friends. We thank everyone involved, especially our family members, Reverend Izumi, Rev. Canon Erin Phillips, University of Lethbridge pianist and instructor Bente Hansen, graphic artist Mahsa Miri, Martin Brothers Funeral Home (who kindly arranged his awards and instruments, and allowed his dog to attend), those who know us from the schools, teachers, students, coworkers, and all who kindly watched online then or later, or attended. The funeral video has been watched by more than 3,000 people, a testament to how much he was loved in the community. We are grateful.
Obituary: https://www.mbfunerals.com/obituary/Dexter-Johnson
Video: https://www.youtube.com/watch?v=x1pbRpmsSNs&t=32s
Photos: https://www.mbfunerals.com/obituary/Dexter-Johnson#tributewall
Program (prepared by Mahsa Miri with Sam, Eric, Christine, Stephanie, Dan, and Scott):
https://s3.amazonaws.com/CFSV2/obituaries/media/8286/847339-JohnsonDextermemorialcard.pdf
After the funeral, his friends and their parents told me that they have texts sent by Dexter from his appointments. They provided me with the texts. One said he was feeling sad and “I guess I have to tell my mom now” (because he was in BC) but he felt from what he saw online maybe some medication will solve it. He felt private about it and wanted to solve it. One text in July said
"okay ____ thinks getting refils here and keeping it from our dad is a good option"
"____ says we might have to extend our time here cause finding an actual doctor"
I had no idea who this was or what it meant. Later with the help of his friends, we discovered what we could, and requested information, which was refused. Dexter did not have the knowledge to decide. I am sorry that Dexter’s life was put at risk over out-of-date and poor understanding of the science related to depression, or even general sadness and situations.
Dexter’s August vacation with me had also been cancelled over a “checkup” without explanation, and now we know why. When I picked up Dexter at the end of August, he seemed embarrassed and said the checkup was nothing important. The text messages to his friends at that time said he would tell his dad but he is embarrassed, and that his dad would be fine with it (“he’s good”) but “it’s a long story”. Dexter died because he thought the cure would be quick and he would not have to be embarrassed about explaining why he had medication from BC. That reluctance was turned into a narrative about Dexter’s silence likely being based on a bad “relationship with his father”. Anyone in Lethbridge would first laugh at that narrative, and then feel shocked that it was meant to be serious.
Patient safety was disregarded. BC might be unlike other provinces, but in Alberta, if a teen says they have thought of suicide, or a teen is prescribed a black box warning medication such as this one, saying “WARNING: SUICIDAL THOUGHTS AND BEHAVIORS. Increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants. Monitor for worsening and emergence of suicidal thoughts and behaviors”, then the parent or parents they live with must be informed. This has been confirmed multiple times by Alberta medical professionals, and Alberta schools.
If I, or our family doctor in Lethbridge, had ever heard a word about “fluoxetine”, or “suicide”, or a BC doctor’s name in 2021, Dexter would not have died in January, 2022, after returning home. I would have participated by setting up counselling, having gentle discussions with him about the future that he loved to plan, arranging a local psychologist and possibly psychiatrist, speaking confidentially to the school counsellor, and clearing the house of every rope, wire, razor knife, gun (all locked but they would have been in a new second safe or gone), power tool, etc. I was denied a chance to save his life. The school, his siblings, our family doctor, and concerned friends were all denied a chance to save his life. What possible reason was there?
The best recommendations are clear and often stated in psychopharmacology: “First line prescription of antidepressants for youth is not advisable...The black box and international warnings on pediatric use of antidepressants are warranted. Wider availability of psychosocial options for depressed youth is recommended.” (Sparks and Duncan 2013). It is not new. Healy and Aldred (2005) wrote “From this data, we conclude that there is a clear signal that suicides and suicidal acts may be linked to antidepressant usage. It would seem likely that explicit warnings and monitoring in the early stages of treatment could greatly minimize these hazards.”
Dexter’s lack of scientific knowledge also made him a willing subject for trying antidepressants. He was 15, and not in charge of ensuring science-based medicine or patient safety.
