I have heard that there is now data that, for metabolic reasons that
are not very clear, post mortem blood levels of some psychotropic meds
rise exponentially, and are not an accurate assessment of the blood
level prior to death.  Studies by Lilly Pharmaceuticals and the Los
Angeles Poison Control Center were referenced, but not cited. 
Apparently one study involved Zyprexa, and another cited a wider range
of psychotropic meds.  I would be interested in (1) finding any
original research and (2) a lay-person explanation of same.  My
particular interest would be in paroxetine, if possible, but any of
the above studies would be helpful.

---

Clarification of Question by agp1071-ga on 07 Feb 2005 21:31 PST

Thanks for your comment, pinkfreud.  I should probably clarify that I
am looking for information to present to a Medical Examiner who has
listed a cause of death as paroxetine intoxication, when there was
absolutely zero possibility of this (I am positive -- not just
hopeful.)  The post-mortem paroxetine level was off the charts, so
that's how the ME ruled.  I want to be able to present evidence of the
research I referred to in my question which shows recent findings that
the pre and postmortem levels can be distinctly different, so we can
look at finding the real cause of death.  The anniversary of death is
just a little over a month away, so I am under the gun in trying to
get this info as there is very possibly a wrongful death here. 
Thanks.

---

Request for Question Clarification by pinkfreud-ga on 07 Feb 2005 21:44 PST

Several hours of searching has not turned up anything specific to
paroxetine. I hope another Researcher will be able to help you. It's
an interesting subject, so my time was well spent even if I don't
qualify for the "prize."

Have you considered hiring an expert to testify? Has the evidence been re-tested?

---

Request for Question Clarification by pinkfreud-ga on 07 Feb 2005 21:56 PST

One thing that is worth mentioning is that death from a paroxetine
overdose is extremely rare.

"Paxil was approved by the FDA in 1993 to treat depression,
generalized anxiety disorder, social anxiety disorder, panic disorder,
obsessive compulsive disorder, and post traumatic stress syndrome.
GlaxoSmithKline is the pharmaceutical giant responsible for Paxil
production.

Since the approval of this drug, more than 350 cases of accidental or
deliberate Paxil overdose have been reported worldwide. Of these
reported Paxil overdose cases, about fifty patients died as a result.
In seventeen cases the patient died from a Paxil overdose that
involved only the use of Paxil and eight deaths were caused by Paxil
overdose and the ingestion of other drugs or alcohol or in the
presence of compounding comorbid disorders."

http://www.onlinelawyersource.com/paxil/overdose.html

---

Request for Question Clarification by pinkfreud-ga on 07 Feb 2005 22:01 PST

One more thing: it might be useful to Researchers to know whether the
drug in question was paroxetine hydrochloride or paroxetine mesylate.

---

Clarification of Question by agp1071-ga on 08 Feb 2005 19:22 PST

pinkster, many thanks again for your time.  You are one relentless
researcher, and I appreciate your energy and perspective.  I think I
have pretty much decided not to sue, so an expert is not necessarily
what I need (despite my reference to time limit and wrongful death)  I
only want the death investigated, and want to give some rationale for
that -- not sure exactly if there is a time-limit on getting that to
happen, but don't want to take any chances.  Finding the research I've
heard about (from an acquaintance who is on a psychopharmacology
bulletin board with other docs) is the best way I know to help educate
those who should already know this, but don't yet, because the
information is so brand new (just came across the bulletin board a
month or so ago).  BTW, I have no way to follow that thread -- only to
go after the sources they cited (i.e., Lilly and LA Poison Control). 
Thanks again for trying :)

---

Request for Question Clarification by pinkfreud-ga on 08 Feb 2005 23:06 PST

I'm still taking periodic stabs at this, but I'm not catching
anything. Are you quite certain that the drug studies you're seeking
show some kind of recently noted phenomenon that is unique to
psychotropic drugs, and not post-mortem redistribution, as mentioned
in the link I posted below? It just seems odd to me that a new
discovery such as this would be so difficult to find on the Web. I
would expect there to be numerous write-ups of it. You might want to
query your friend who is on the psychopharmacology forum in more
depth. If the studies were demonstrating post-mortem redistribution,
finding them probably wouldn't be all that useful, since post-mortem
redistribution should be something with which the M.E. is quite
familiar.

---

Clarification of Question by agp1071-ga on 09 Feb 2005 18:14 PST

re: pinkfreud's Feb 8th comments/request for clarification: Thanks
again, pinkfreud.  My certainty regarding the recency and specificity
of the elusive research rests only with my assessment of the integrity
of my source, a psychiatrist acquaintance who sent me the exact text
of the psychopharmacology board posts.  It did seem to suggest very
new findings, which I don't even know had been made public yet.  I'm
hard-pressed to know where to start finding that (I have asked the
acquaintance if he is able to query the board for specifics, but so
far he hasn't.  He has several practices in different parts of the
state and is stretched beyond belief.) At any rate, if this research
is not yet ready for prime-time, I don't know how to get to it.  But,
again, thanks for your thoughts and your time.  It is baffling.  What
I haven't done is called LA Poison Control or Eli Lilly, maybe that's
the next step?

A phenomenon called post-mortem redistribution can be responsible for
an increase or a decrease in blood concentrations of some drugs.

This may be of interest to you:

"The considerable increase in analytical detection limits has
outstripped our ability to interpret the results. In fact, over the
last twenty years, we have come to appreciate that post mortem blood
concentrations are not more or less uniform throughout the body. In
instances of overt drug overdose, postmortem concentrations are often
sufficiently elevated to make a diagnosis of fatal intoxication
unmistakable. In some cases, however post mortem redistribution of
drugs may markedly affect the interpretation of the analytical
findings.

Alarm bells in this area were first sounded by Vorpahl and Coe
followed by the comprehensive work of Prouty and Anderson. Their
findings prompted the now established view that drugs with large
volumes of distribution may show significant variation in post mortem
blood concentration, particularly with respect to the time interval
between death and specimen collection.

This work led to today?s rules :

1. Post mortem drug concentrations are site-dependent.

2. Blood samples taken from the same site show different
concentrations at different times after death.

3. No realistic calculation of the dose absorbed can be made from a
single post mortem drug concentration measurement.

I believe that the passive release of drugs from areas of high tissue
concentration is not the only mechanism operating. There may also be
release of drugs from tissues, or absorption of drugs by tissues
consequent upon the acid-base changes that occur after death."

Syva Drug Monitor: Drugs and Driving
http://ramindy.sghms.ac.uk/~ltg/monit3_2.pdf

You probably don't want my laymen explaination of how I see your
question but here goes:
1) Your deceased friend evidently was prescribed Paxil (Paroxetine)
and maybe even Zyprexa (Olanzapine) by his primary mental health care
provider.
2) His remains were sent to the ME (medical examiner) as his death was
of suspicous or unknown causes.
3) You are way too impatient to wait for the ME's report (which only a
judge can allow you to see it) or do not agree with them as you want
to seek civil litigation (tort) or some sort of class-action suit
against the pharm. companies and providers.

I'm sorry if I have totally misintrepreted your question. However, it
appears to me that your friend was suffering from schizophrenia or a
form of it. With the disorganized thinking, audio, and visual
dellusions associated with this universally baffling disease it is not
unreasonable to assume that he was "self-medicating" - as most dual
diagnoses victims do. This in the form of overdosing his meds or the
taking of others which were not legal (i.e. crystal-meth, cocaine,
crack, THC (marijuana), etc.). Most of the meds for his disease are
SSRI's (Selective Serotonin Reuptake Inhibitors). Zyprexa, however is
not an SSRI. It works differently on the brain and has been relatively
effective since 1996. Side-effects have been hyperglycemia. It is
unlikely that Zyprexa can cause death from overdosing it. Also it is
VERY expensive.

Overdosing on a SSRI could have some very bad side-effects on
teenagers and younger adults. Maybe even suicide. Your friend could
have overdosed on an SSRI. This could be detected by a
blood-toxicological test done by the ME as SSRIs should remain in
system for weeks if not theorectically years in your fat cell's
prions.

An over abdunance of a SSRI does not in and of itself indicate the
cause of death. Suicide brought on by a SSRI overdose is caused by
another death dealing mechanism NOT the drug (i.e. a gun, jump, etc.).
So you have a big up hill battle since the US Senate (i.e. R-side) is
meeting TODAY to try and kill class-action and tort cases - or at
least put a big hurtin' on it. The big companies such as
GlaxoSmithKline will be a battle royale for you. LEAVE THIS RESEARCH
WORK TO YOUR LAWYER. He/she has a vested interest (33.3% fee) here and
will probably resent your potential interference here...

Hey, I could be wrong and probably am...! ;->

Re: spookysr's comment:  Thanks for the time you took to give your
perspective.  It all made sense to me.  Here's some clarification to
illustrate what didn't fit:  First, I already have the ME's report. 
Second, decedent was only on Paroxetine (my reference to Zyprexa was
specific to the research I have heard about -- never to the decedent
-- I haven't heard of anything specific to Paroxetine, but I am
interested in securing the research on Zyprexa and psychotropic meds
as a general category, which are the two research reports I *have*
heard about, because they show a general tendency for psychotropic
drugs to act differently postmortem.  Third, there was no possibility
of an accidental or intentional overdose of paroxetine.  I mentioned
this in my original post -- that I am positive of this, not just
hopeful or in denial.  I could cite many reasons for my certainty (no
access, pills have been counted, no access, gentleman was never out of
eyesight, no access, nobody else had access, etc.) but it's not worth
the time -- it is just a fact, and it is the reason I am in search of
evidence to support the off-the-chart levels of other psychotropic
meds.  Fourth, I am not interested in suing the drug companies. 
Fifth, I am not intersted in suing anybody, so I wouldn't be getting
in my lawyer's way.  Sixth, I know that others (whom I have no way of
reaching) have cited such evidence to THEIR medical examiners, who
have subsequently changed cause of death in light of new information. 
If this is what fits here, I want that to happen.  And I want the
death investigated to learn what really went on (my theory is heart
attack, at a facility that should have had a defib but didn't -- yet
is probably getting off the hook due to the ME's misguided cause of
death.)

Again I know you don't want to hear this but there is a considerable
"undertow" of secret dealings going on between the big pharms, old
politcal families, and even medical examiners. Case in point: In 1990,
a tobacco company put together a plan to stop medical examiners or
coroners from listing tobacco as a cause of death on death
certificates: http://www.thetruth.com/issues/crazyworld/files/cwfacts.pdf

More than one journalist has uncovered corrupt connections between the
a certain old family, psychiatry, and Eli Lilly & Company, the giant
pharmaceutical corporation:
http://zmagsite.zmag.org/May2004/levine0504.html

I believe as you do that the ME is either up to something illegal or
is incompetent or both. Here is some background info on Zyprexa:
http://www.citizen.org/eletter/drugprofiles/olanzapine.htm and
http://www.mentalhealth.com/drugrs/t33-o02.html

http://cjlabs.com/CoolComment ?

Just for any researchers who may be legitimately trying to answer this
question, I want to clarify that I do not think the ME has done
anything illegal or incompetent.  She declared the cause of death in
June, after 90 days of tox testing.  The research I am still trying to
get my hands on only surfaced within the last month or so.  I will
appreciate any researchers who can focus on finding the aforementioned
studies.

Just a note but this site is a good resource on the topic of dual
diagnosis and related conditions. http://www.dual-diagnosis.net