To Sara Carlin's family, a prescription drug meant to cure her anxiety triggered a deep depression that led her to hang herself. To the company that makes the drug, the Oakville teen was already troubled and her medication was working.
These were the competing narratives at the close of a coroner's inquest into Ms. Carlin's death.
Ms. Carlin, who had just finished her first year at the University of Western Ontario, hanged herself with an electrical cable in the basement of the family home in May, 2007.
A lawyer for Ms. Carlin's family attempted to draw a strong link between her death and Paxil, a selective serotonin reuptake inhibitor (SSRI) medication that the young woman had been taking for over a year when she died.
"Paxil put Sara Carlin on a downward spiral, starting almost as soon as she was on it," Gary Will told the inquest jury. Before she was prescribed the drug in February, 2006, he said Ms. Carlin was a happy, athletic woman with ambitions of becoming a doctor.
Over the months after she began taking Paxil, he said, she told friends she was suicidal, wrote a note in which she said she was tired of life and later landed in hospital after a session of drinking and cocaine use.
Mr. Will also presented a Health Canada report that showed 26 people between ages 12 and 19 had committed suicide while taking an SSRI between 1993 and 2009 and cited federal government warnings that such drugs could cause suicidal thoughts for teens.
A lawyer for Paxil manufacturer GlaxoSmithKline, however, argued that Ms. Carlin had been depressed before she was given the drug.
The teen told one doctor she had been sad and anxious since mid-2004 and sometimes experienced three panic attacks a day by February, 2006, said Teresa Walsh. Over the months after Ms. Carlin began taking Paxil, Ms. Walsh said, her doctors testified that she reported sleeping better and was more engaged with school.
"On each occasion, she talked about the fact that she was feeling some better, in some cases, much better," Ms. Walsh said.
She suggested several other possible reasons for Ms. Carlin's depression, including pressure at school and the death of her brother, who suffered a drug overdose on New Years' Eve 2000, which continued to haunt her.
Outside court, her father disputed this characterization. "All through high school, this kid was at the top of her class," said Neil Carlin. "We never saw her as depressed."
While the inquest cannot assign blame in her death, it can make recommendations to prevent similar deaths in the future.
Mr. Will asked the jury make several such recommendations, including that doctors be forced to inform patients about the possible side-effects of prescription drugs; that pharmaceutical companies be compelled to publish the results of every study into the efficacy of a drug and that the government set up a new agency to regulate prescription drugs.
Michael Blain, counsel to the coroner, presented jurors with recommendations calling for better monitoring of patients taking prescription drugs and that Health Canada work harder to inform doctors of the risks associated with such drugs.
The inquest is the culmination of a three-year fight by Ms. Carlin's parents to shine a spotlight on their contention that her death was caused by Paxil.
"I am feeling much more hopeful about the future than I was before the inquest," said Rhonda Carlin after the proceedings. "I feel more hopeful for other families and that helps just a little bit."