Paragraphs 4 & 5 read: "When her frightened parents sought a therapist's help, Kaitlyn was prescribed the antidepressant Zoloft on Jan. 17. From an initial modest dose, she was later bumped gradually up to 150 milligrams, near the maximum dose."
"On Feb. 21, Kaitlyn hanged herself."
Behind Kaitlyn's suicide
Family questions antidepressant's role in teen's deathBy Carey Goldberg, Globe Staff | June 27, 2004
''Dear everyone: I'm so sorry. I can't take living anymore," 16-year-old Kaitlyn Kennedy wrote in big, urgent, red crayon letters. ''I love you so much, please don't be sad."
In the garage of her family's home in small-town Medway, she took a rope. She made a loop with a metal clip. She mounted a low stool.
Kaitlyn had been ground down in recent months by an intense, on-and-off relationship with her controlling 20-year-old boyfriend, her parents say. Once a sunny comedian surrounded by friends, she had grown isolated, depressed, and anxious. She had taken to cutting herself. In January, she had swallowed a nonfatal overdose of Tylenol and prescription drugs.
When her frightened parents sought a therapist's help, Kaitlyn was prescribed the antidepressant Zoloft on Jan. 17. From an initial modest dose, she was later bumped gradually up to 150 milligrams, near the maximum dose.
On Feb. 21, Kaitlyn hanged herself.
''She did have anxiety, she did have depression, but I do believe the impulse -- the agitated behavior and killing herself -- was due to the drugs," said Kathleen Kennedy, Kaitlyn's mother. ''I do believe that. I don't believe she got the proper care she should have had."
Always unfathomable, the suicides that are the third most common cause of death among adolescents ages 10 through 19 have recently begun to prompt one additional, tormenting question for those left behind:
Could it have been the antidepressant?
American psychiatric authorities emphasize that antidepressants help a great many teens, and say that there is no proven link between drugs like Zoloft -- known as selective serotonin reuptake inhibitors -- and suicide.
But the US Food and Drug Administration is examining the possible connection, amid much media attention, and is expected to come to a finding by this fall.
The agency also issued a warning in March --the month after Kaitlyn killed herself -- that patients taking antidepressants could turn suicidal and should be closely watched. Britain, citing the suicide risk, has banned all the SSRIs for youngsters, except Prozac.
Kaitlyn Kennedy's parents say they heard about the possible SSRI-suicide link for the first time in the media, not from her doctors. On the day before the night Kaitlyn killed herself, her father, Alan, brought a newspaper clipping about the possible risks to her therapist, who ''kind of blew it off," he said.
The Kennedys do not recall any of Kaitlyn's therapists or doctors warning them about the dangerous agitation that sometimes accompanies antidepressants. Her father, a sound technician, said Kaitlyn described feeling like she was ''crawling out of her skin" -- typical of such agitation.
The pull of the antidepressant theory for heartbroken parents like the Kennedys is clear: It offers a possible explanation for an unbearable mystery. Because otherwise, despite the paper trail of Kaitlyn's death -- journals, medical records, e-mail messages, and the note, all of which her parents shared with the Globe -- her suicide is all but impossible to understand.
''There are so many questions I want to ask her, and it's so hard not being able to," said Shannon Sullivan, 17, Kaitlyn's best friend. Shannon, Kaitlyn's parents, and her journals all point to relationship problems as the root of Kaitlyn's depression.
When she was 14, she began going out with a boy whom Shannon and others described as controlling and troubled. The boy's mother, when contacted by the Globe, declined to pass on a request for an interview, or to comment herself.
In her journals, Kaitlyn goes back and forth between saying how much she loves him and how much she hates him. Days before her death, she broke up with him and started going out with another boy. But Kaitlyn was still in contact with her old boyfriend, and he was the last person to see her the night she died, Kaitlyn's parents say.
Twice in her journals, Kaitlyn talks about suicide as a way to hurt him. On Valentine's Day, she wrote: ''I hope [the boy] kills himself. I would smile. If I get home and my friends are the same, like just blah, I'm going to hang myself. My suicide note will say this is because of [the boy] and I hope you kill yourself too . . ."
But, while briefly hospitalized in late January, she had also written about killing herself if she was forbidden to see him.
Kaitlyn's journal entries depict an oppressive relationship. To bolster her plan to break up, she wrote a list of ''Pros." They include: no control, laughing, not on phone 24/7, alone time, no more depression, parents off back, no feeling guilty, no lying, no checking up, and no more fights. And, underlined, ''BEING FREE!"
Her journals also describe other problems. She was fighting with her parents about her boyfriend, and she was having trouble concentrating in school. She describes a high state of rapid-heartbeat anxiety as she faced tests she expected to fail and peers who might think ill of her.
She talked in her journals of getting a tutor or some kind of home-schooling. In January, she described retreating often to the school walk-in center, where she felt comfortable with the school adjustment counselor, Meredith Poulten.
Poulten, a former board member of the Samaritans, a suicide prevention group, respects the Kennedys' need for answers. The suicide of a child ''is the most devastating thing in the world," she said.
At the same time, she said, specialists on suicide agree that in general, there are no simple answers: ''It's never one thing or one person -- it's usually a combination of anxiety, relationships, mental health issues, medications, and you add everything together and come up with a horrendous result."
Kaitlyn was clearly affected by her relationship problems, Poulten said; she also showed signs of clinical depression and anxiety. But she asked for help and her parents were trying to get it for her. ''Everyone thought Katie was getting better," she said. ''We don't know what happened from there. I think it was an impulsive act. I think it's not clear that she intended to go through with it."
In fact, just hours before she killed herself, Kaitlyn had been e-mailing her sister, Jennifer Olson, about dresses she might wear to her junior prom in May, Olson said.
And Kaitlyn's suicide note in some places sounds like it is the farewell note of a runaway. It reads, in part, ''Please don't call the police. I'll be fine. Please trust me. I love you so much. I'll be back someday." Kathleen Kennedy says Kaitlyn had packed a bag that night, as well.
The Kennedys received Kaitlyn's medical records from Westwood Lodge in Westwood, where she was hospitalized for a week after she cut her arm with a paper clip badly enough to drip blood on Feb. 10. It was her 18-month anniversary with her boyfriend. Her journal entry from that day reads ''THIS IS HOW MY [expletive] DAY WENT" and the page is smeared in blotches of blood.
Her Westwood Lodge discharge summary notes that when she was admitted on Feb 11, she said, ''I thought about hanging myself or killing myself with a razor." She also said she had been waking up at night and ''hears voices telling her to kill herself."
The summary notes that her Zoloft dose had been raised from 100 to 150 milligrams per day while in the hospital. Her Seroquel -- an antipsychotic drug -- was also increased.
There is no hint in the records of any suspicion that Kaitlyn might be reacting badly to Zoloft. One nurse wrote on Feb. 11, a week after Kaitlyn's Zoloft had been raised to 100 milligrams a day, that the patient ''reports increase in emotional lability, irritability and anxiety," but did not link it to the drug.
Kaitlyn was diagnosed as having a mood disorder and possibly a borderline personality disorder, and a nurse's notes include recent stressors: ''ex-boyfriend threatened to kill himself yesterday" as well as ''conflicts with mother" and ''school failure, social isolation from friends, related to controlling ex-boyfriend."
One note also mentions that Kaitlyn needed a ''tattered, crocheted baby blanket" from home for comfort.
After six days in the hospital, three of them on a holiday weekend, Kaitlyn was discharged, over her parents' protests that it was too early, said Kathleen Kennedy, who works as a companion to the elderly.
They got no explanation for the timing of the discharge, she said, and none of the staff members told her what she later read in Kaitlyn's medical record: that she had repeatedly described her plan to hang herself.
It was Feb. 17 when Kaitlyn was sent home. Four days later, she was dead.
The Kennedys plan to ask a forensic psychiatrist to evaluate Kaitlyn's case to see if there are grounds for a lawsuit, Alan Kennedy said. They are still awaiting more information, including the toxicology report on Kaitlyn.
Judith Merel, spokeswoman for Arbour Health System, the parent company of Westwood Lodge, said she could not comment on a patient's case because of confidentiality concerns.
Pfizer, which makes Zoloft, ''cannot comment on individual cases," said spokeswoman Shreya Prudlo.
When Dr. Joseph Glenmullen, a Harvard psychiatrist and prominent critic of manufacturers of antidepressants, was told the basic outlines of Kaitlyn's case, he responded that it was ''very reasonable" for the family ''to ask whether or not the drug played a role" in her death. It is known that patients are particularly vulnerable to suicidal impulses when they have just started on an antidepressant or the dose has just been increased, he said.
Dr. David Fassler, an authority for the American Psychiatric Association on the issue of SSRIs and suicide, responded to a description of Kaitlyn's case by noting that, ''We do not have data which clearly demonstrates an association between SSRI medication and increased risk of suicide." In all the studies of SSRIs that the FDA is reviewing, he said, none of the more than 4,000 children and teens enrolled in the studies actually committed suicide .
One top FDA epidemiologist has reported that the 22 studies, involving seven SSRI-type drugs, indicate that children on the drugs were twice as likely to have suicidal thoughts and feelings as those on a placebo. But the agency has yet to issue an official opionion on the matter.
''Clearly any suicide is a tragedy, and any family is going to look at all possibilities to try to find an explanation," Fassler said. ''And usually there are no simple answers."
The state Department of Mental Health is conducting a fact-finding investigation into Kaitlyn's death because she killed herself so soon after being discharged from a hospital, said Lester Blumberg, the department's chief of staff.
Asked whether it would look into the possible Zoloft connection, Blumberg said it would probably note that Kaitlyn was taking the drug. But ''it would be unlikely to result in corrective action because the Commonwealth and the FDA have not said, 'Don't prescribe it,' " he said.
The last entry in Kaitlyn's journal reads in part:
''2/21 I've done a complete 180. I'm so happy! [Happy face] I weigh 135 now! [another happy face] I hung out with [her new boyfriend] last night [heart symbol] I have therapy today in 45 minutes. . . . I love Chingy [a rap artist]. i need to wash."
She and her new boyfriend watched a movie together that night. Some time after he left, her old boyfriend stopped over. Around 11, she stopped by her parents' bedroom to say goodnight, Kathleen Kennedy recalled.
''Goodnight, Kate, see you in the morning," her mother replied.
Carey Goldberg is reachable at firstname.lastname@example.org