Sarah bravely shares her late brother’s akathisia-induced death so that others might be better informed regarding adverse drug effects. MISSD appreciates Sarah’s insightful guest post.

If you’d like to submit a guest post to MISSD, please contact share@missd.co.

I celebrated my 47th birthday in May. It was my first birthday without my brother. Last year I had a brother, Jon, who was a successful lawyer, a fantastic father and uncle, a cherished son and one of the closest people in my world. Jon and I got on incredibly well. He was intensely clever and I had basked in his reflected glory throughout my life. He was hilarious and brilliant at times – and occasionally demanding too – but unfortunately, despite everything he was and had achieved, he battled with depression, something I realised the full extent of all too late.

Not long before his death, he had been promoted to the most senior job role of Managing Partner at his global law firm. Yet he had also decided to return to London within the year as he was missing his children terribly and was feeling increasingly alienated in Hong Kong.

Growing up, I was always the one who suffered with depression although Jon had a couple of periods at different times in his life. He knew I had taken antidepressants at times in my life and had always tried to persuade me to cease them. Jon, in contrast, had always tried to alter his own mood using alternative methods, whether that be acupuncture, therapy, or veganism.

On August 29th, 2018, my brother felt he could no longer cope with the pressures of life. Feeling overwhelmed by imagined money issues and his imminent divorce, he went to see a GP in Hong Kong. The doctor told my brother that he thought he was depressed and gave him citalopram, an antidepressant. My brother didn’t really want to take it and go down ‘that road,’ but we agreed that it may just get him through this bad patch. He started taking citalopram on Thursday (30th August). On Friday he called me in a very anxious, uncharacteristic state: paranoid and extremely worried about many things. I tried to reassure him, but I was becoming very concerned myself as this was not Jon’s normal behaviour.

On Saturday Jon started to say disturbing things – for example, he told our father, a brilliant pianist even at 85 years old, to carry on playing the piano and to look after our mother. He talked for a long time to me about mistakes he had made in his life and how he wished that he had left Hong Kong sooner. As well as these regretful comments he worried over imagined things and became increasingly paranoid. He paced. He could not eat.

I called and texted the GP and the psychiatrist in Hong Kong urging them to review the drugs. They agreed that my brother had taken a turn for the worse and so they gave him more and different drugs. On Sunday I booked flights to Hong Kong to rescue my brother. My oldest boy was starting secondary school on Monday so we decided to fly on Tuesday, 4th September. This detail returns to haunt me every day, as I keep asking myself: ‘what if I had flown on Monday?’ I sent my brother a photograph of my son looking so handsome and proud in his new uniform: I was trying, constantly, to keep Jon’s spirits up until I could reach him. Jon replied and said he was a great boy.

What we didn’t realise was that Jon had akathisia and was experiencing psychosis. We (my partner Kyri and I) boarded a flight at Heathrow on Tuesday night feeling happy that we were going to get Jon and bring him home.  One hour before we landed in Hong Kong, however, I had a video call from my brother’s maid, Barbara, screaming hysterically. My brother and she had been waiting for a taxi to take them to the psychiatrist’s, when Jon said he had forgotten something. He then ran and jumped from the roof of his building. Barbara had tried to stop him but could not.

The next thirty minutes I spent texting Barbara, Jon’s friend and the doctor to hear if my brother was still alive. They replied by saying they wanted to help me and asked me to come to the clinic. Jon had died on impact.

We left Hong Kong within 24 hours of arriving, deeply shocked and in an utter daze. My brother’s law firm upgraded us to business class upon our return to London, recognizing we could not have comfortably sat near others.

This time last year on my birthday, I was in Majorca with my brother, his children, my children, and our parents. We had just completed ‘the challenge’ – a hair-raising obstacle course involving jumping off cliffs and swimming through caves. Grief of this kind is unlike anything I have ever experienced. It has been long, intense and at times unbearable. Eleven months later, life is still hard but I am stronger. I have fallen apart and am gradually building myself up again for all those who remain in my life.

My message is this: don’t automatically assume that antidepressants will help you. Be aware that some people cannot synthesise them, so they are actually poisoned by their medication and may develop prescription-drug-induced psychosis which can cause suicidal thoughts. This can happen to anyone of any age. Akathisia is an adverse drug effect that is sometimes misdiagnosed as a symptom of an underlying mental health problem. If you or anyone you know are considering taking antidepressants, I direct you to missd.co to learn more about the possible effects.

I am not saying that antidepressants don’t help some people. They do – including myself, ironically. But I am saying that it is essential to make sure you know the warning signs if something is wrong – a knowledge that, sadly, the doctors did not display with my brother.

My brother was indeed depressed, but I believe that what happened to him was a tragic accident, not a suicide. Jon was hallucinating. He was psychotic within hours of starting the medication, and it was a reaction completely beyond his control.

Be in peace my J.