1470 1 IN THE UNITED STATES DISTRICT COURT 2 DISTRICT OF WYOMING 3 -------------------------------------------------------- 4 THE ESTATES OF DEBORAH MARIE TOBIN and ALYSSA ANN TOBIN, deceased, by 5 TIMOTHY JOHN TOBIN, personal representative; and THE ESTATES OF 6 DONALD JACK SCHELL and RITA CHARLOTTE SCHELL, deceased, 7 by NEVA KAY HARDY, personal representative, 8 Plaintiffs, Case No. 00-CV-0025-BEA 9 vs. May 31, 2001 Volume VIII 10 SMITHKLINE BEECHAM PHARMACEUTICALS, 11 Defendant. ----------------------------------------------------------- 12 13 14 TRANSCRIPT OF TRIAL PROCEEDINGS 15 16 Transcript of Trial Proceedings in the above-entitled 17 matter before the Honorable William C. Beaman, Magistrate, 18 and a jury of eight, at Cheyenne, Wyoming, commencing on the 19 21st day of May, 2001. 20 21 22 23 Court Reporter: Ms. Janet Dew-Harris, RPR, FCRR Official Court Reporter 24 2120 Capitol Avenue Room 2228 25 Cheyenne, Wyoming 82001 (307) 635-3884 1471 1 A P P E A R A N C E S 2 For the Plaintiffs: MR. JAMES E. FITZGERALD Attorney at Law 3 THE FITZGERALD LAW FIRM 2108 Warren Avenue 4 Cheyenne, Wyoming 82001 5 MR. ANDY VICKERY Attorney at Law 6 VICKERY & WALDNER, LLP 2929 Allen Parkway 7 Suite 2410 Houston, Texas 77019 8 For the Defendant: MR. THOMAS G. GORMAN 9 MS. MISHA E. WESTBY Attorneys at Law 10 HIRST & APPLEGATE, P.C. 1720 Carey Avenue 11 Suite 200 Cheyenne, Wyoming 82001 12 MR. CHARLES F. PREUSS 13 MR. VERN ZVOLEFF Attorneys at Law 14 PREUSS SHANAGHER ZVOLEFF & ZIMMER 225 Bush Street 15 15th Floor San Francisco, California 94104 16 MS. TAMAR P. HALPERN, Ph.D. 17 Attorney at Law PHILLIPS LYTLE HITCHCOCK 18 BLAINE & HUBER, LLP 3400 HSBC Center 19 Buffalo, New York 14203 20 INDEX TO WITNESSES DEFENDANT'S PAGE 21 MARK SUHANY, M.D. Deposition of Mark Suhany, M.D. Read 1487 22 J. JOHN MANN, M.D. 23 Direct - Mr. Preuss 1527 24 25 1472 13:33:38 1 P R O C E E D I N G S 13:33:38 2 (Proceedings convened in chambers 13:33:38 3 1:15 p.m., May 31, 2001.) 13:33:38 4 THE COURT: Mr. Vickery. 13:33:38 5 MR. VICKERY: Your Honor, good morning -- it is 13:33:38 6 afternoon, isn't it? 13:33:38 7 MR. GORMAN: Yeah, someplace. 13:33:38 8 MR. VICKERY: We asked to see you this morning about 13:33:38 9 two things, and I've told Mr. Zvoleff and Mr. Preuss about 13:33:38 10 them already. 13:33:38 11 One of them is to give you a heads-up on an issue I 13:33:38 12 expect to arise tomorrow morning or Monday and that is we'll 13:33:38 13 offer the deposition testimony of Dr. Casey from the Miller 13:33:38 14 case in rebuttal in this case and I have a very short trial 13:33:38 15 brief as to why we would offer it and what the legal 13:33:38 16 authority is for offering that. 13:33:38 17 This is the man that was the chairman -- you will 13:33:38 18 recall Dr. Wheadon's testimony about the PDAC that met in 13:33:38 19 1991. And this man was the chairman of that committee and 13:33:38 20 Dr. Wheadon mentioned him by name in his testimony. And we 13:33:38 21 have his deposition which is important rebuttal evidence for 13:33:38 22 us. 13:33:38 23 THE COURT: His deposition in another case? 13:33:38 24 MR. VICKERY: Right, Rule 804(b)(1) addresses the 13:33:38 25 applicability of it, that and the advisory committee minutes, 1473 13:33:38 1 and I hope that when the Court reads my brief, you will 13:33:38 2 conclude that it is proper for us to do that. 13:33:38 3 But I wanted to let you know and them know now so 13:33:38 4 that -- where is Mr. Mathes -- so the Court would have time 13:33:38 5 to look at that issue before tomorrow afternoon. 13:33:38 6 THE COURT: Who is responding to this? Mr. Zvoleff 13:33:38 7 is sitting here on the edge of his chair. 13:33:38 8 MR. PREUSS: He is ready, Your Honor. 13:33:38 9 MR. ZVOLEFF: We're obviously opposed to it, Your 13:33:38 10 Honor. There's no justification for admitting this 13:33:38 11 deposition from another case in this case. We obviously were 13:33:38 12 not at the deposition, had no opportunity to attend it, to 13:33:38 13 cross or in any way develop the testimony of Dr. Casey. 13:33:38 14 But even more fundamentally, I have no idea -- there 13:33:38 15 is a brief description in the brief that we've been handed as 13:33:38 16 to why it should come in here and then he says he wants 13:33:38 17 Dr. Casey's deposition admitted. That's a pretty broad 13:33:38 18 request. I don't know what specific parts of it he wants 13:33:38 19 admitted, how he's going to argue that something in fact 13:33:38 20 rebuts something. 13:33:38 21 And finally, obviously this is not one of the 13:33:38 22 witnesses that was listed. It is a complete surprise at this 13:33:55 23 point. And it is totally inappropriate to admit in this case 13:33:55 24 without warning to us ahead of time a deposition in another 13:33:55 25 case from another party's expert. 1474 13:33:55 1 THE COURT: Is he offered as an expert, a rebuttal 13:33:55 2 expert? 13:33:55 3 MR. VICKERY: No, a fact witness. Mr. Zvoleff and I 13:33:55 4 did discuss Dr. Casey before this trial ever started. I had 13:33:55 5 said I intend to offer it in our case in chief and we 13:33:55 6 discussed it and he said he would object to it, and I backed 13:33:55 7 down and didn't offer it in my case in chief. I decided 13:33:55 8 based on Dr. Wheadon's testimony that it was appropriate 13:33:55 9 rebuttal testimony. And it is factual, not expert. 13:33:55 10 Secondly, the deposition itself is being Fed-Exed 13:33:55 11 from my office and I thought I would have it by 10:00 this 13:33:55 12 morning but I will have the proffers and an edited video 13:33:55 13 which probably is going to run 15 minutes or 20 at max. 13:33:55 14 THE COURT: A deposition and a video or it is a 13:33:55 15 deposition video? 13:33:55 16 MR. VICKERY: It is a deposition video. But I should 13:33:55 17 have that by Fed-Ex any moment. And of course, Mr. Zvoleff 13:33:55 18 will have the opportunity today or this evening to look at 13:33:55 19 that before we get to that point. 13:33:55 20 So -- 13:33:55 21 THE COURT: How does he cross-examine this witness? 13:33:55 22 MR. VICKERY: That's a very good question. And the 13:33:55 23 official commentary to Rule 804(b)(1) specifically says that 13:33:55 24 mutuality as an aspect of identity is now generally 13:33:55 25 discredited and the requirement of identity of the offering 1475 13:33:55 1 party disappears except as it might affect motive to develop 13:33:55 2 the testimony. 13:33:55 3 THE COURT: What does that mean? 13:33:55 4 MR. VICKERY: Well, what the rule itself says is that 13:33:55 5 you can use depositions from another case if the party in 13:33:55 6 that case had a similar motive and opportunity to develop it 13:33:55 7 by cross-examination. 13:33:55 8 Well, Phizer in that case did have a similar motive 13:33:55 9 and opportunity to develop it by cross-examination, as 13:33:55 10 SmithKline Beecham does in this case. 13:33:55 11 THE COURT: How do I know that? 13:33:55 12 MR. ZVOLEFF: Let me respond to that briefly. I 13:33:55 13 mean, he's Phizer's expert in the other case. The deposition 13:33:55 14 is a deposition of their expert. 13:33:55 15 THE COURT: Whose expert? 13:33:55 16 MR. ZVOLEFF: Of Phizer's expert. He's saying Phizer 13:33:55 17 had the motivation to develop the testimony. In the real 13:33:55 18 world I'm sure Phizer didn't even ask him any questions. 13:33:55 19 MR. VICKERY: They did. They did ask him questions. 13:33:55 20 MR. ZVOLEFF: At an expert's -- your own expert's 13:33:55 21 deposition what your motives are are quite different from 13:34:09 22 what your motives are in crossing a fact witness. 13:34:09 23 Now he's proffering him as a fact witness. And we 13:34:09 24 certainly are not in Phizer's shoes here where they were at 13:34:09 25 an expert depo of their own expert and we've had no 1476 13:34:09 1 opportunity to cross him, whatever facts he wants to bring 13:34:09 2 out, to put them in context. 13:34:09 3 Now, his trial brief -- let me touch one other thing 13:34:09 4 briefly. It is true he told me before the trial started he 13:34:09 5 wanted to proffer Dr. Casey's depo in his case in chief. And 13:34:09 6 in effect our discussion was, "You've got to be kidding me. 13:34:09 7 You can't do that. It is a deposition from another case. 13:34:09 8 There's no basis for it." 13:34:09 9 We didn't discuss it really in any more detail than 13:34:09 10 that and then he withdrew the proffer which I think was the 13:34:09 11 proper thing to do and is still the proper thing to do. 13:34:09 12 His trial brief argues that what he needs it for is 13:34:09 13 some testimony with respect to the PDAC panel. 13:34:09 14 Now, as he knows, Dr. Mann is here today who was an 13:34:09 15 advisor to that panel. If he wants to develop some of the 13:34:09 16 facts, he certainly has his cross today and I wouldn't be at 13:34:09 17 all surprised if it includes just this topic. 13:34:09 18 THE COURT: Well, let's wait until we see the 13:34:09 19 deposition, but I will tell you right now I don't think I 13:34:09 20 favor this at all. I have a concern about the nature of this 13:34:09 21 deposition testimony from the standpoint is it really factual 13:34:09 22 or does it get into the area of expertise. And of course our 13:34:09 23 procedure here is no expert rebuttal with a new expert that 13:34:09 24 hasn't been designated. 13:34:09 25 So is this really a 701 witness who is giving lay 1477 13:34:09 1 opinions or no opinions at all, just going to report, "I was 13:34:09 2 at a meeting. This thing transpired. Period"? If that's 13:34:09 3 what you're representing all he's going to say, that's fine 13:34:09 4 from the standpoint if he were here live, he could testify to 13:34:09 5 those things, and maybe you could bring him live. Cost you 13:34:09 6 lots of money. 13:34:09 7 MR. VICKERY: Couldn't get him. He's beyond the 13:34:09 8 subpoena power of the court and is a Phizer expert. There's 13:34:09 9 no way he would ever come. Nor would it be proper for me to 13:34:09 10 contact Phizer's expert and ask him to testify. 13:34:09 11 It may become moot if Dr. Mann acknowledges what the 13:34:09 12 facts are as Dr. Casey testified to them. 13:34:26 13 THE COURT: Well, the facts as you view them. 13:34:26 14 MR. VICKERY: No, as Dr. Casey testified to them. 13:34:26 15 Not as I view them, Your Honor. 13:34:26 16 THE COURT: That would be wonderful. In all 13:34:26 17 seriousness, Counsel, right now just from the arguments I've 13:34:26 18 heard back and forth, this is not something I'll probably go 13:34:26 19 along with. My mind isn't 100 percent closed, Mr. Vickery. 13:34:26 20 I will read what you have, take a look at the deposition. I 13:34:26 21 don't know if you want to supply anything in response other 13:34:26 22 than what you've said here, but it is going to take a lot to 13:34:26 23 get me to turn over on that -- 13:34:26 24 MR. VICKERY: I understand. 13:34:26 25 THE COURT: -- under these circumstances. 1478 13:34:26 1 MR. VICKERY: I wanted to give us lead time built in 13:34:26 2 to do that. 13:34:26 3 The other thing I think may well be moot but I wanted 13:34:26 4 to apprise the Court and counsel for SmithKline Beecham of a 13:34:26 5 matter that could generate additional local publicity, and I 13:34:26 6 didn't know if they would want some further instruction or 13:34:26 7 not. 13:34:26 8 Last Thursday there was a case decided by a 13:34:26 9 Magistrate judge in New South Wales. It is the case of Queen 13:34:26 10 versus David John Hawkins. It is a remarkably similar case 13:34:26 11 factually: Man was on Zoloft for one day, strangled his 13:34:26 12 wife. It is a criminal case, but the reason I was concerned 13:34:26 13 about it was, of course, this Court has been so sensitive 13:34:26 14 about publicity that might affect our jury. 13:34:26 15 I got three or four calls yesterday in my office and 13:34:26 16 my partner is monitoring all of that and didn't take any of 13:34:26 17 them, but my guess is that it is the kind of thing -- it is 13:34:26 18 big news, big news internationally because the judge 13:34:26 19 concluded that the Zoloft made this man murder his wife after 13:34:26 20 one day. 13:34:26 21 And so I wanted to alert you to it. I have a copy of 13:34:26 22 the judge's opinion if you would like it. I've given a copy 13:34:26 23 to Mr. Zvoleff. I thought they might want additional 13:34:26 24 admonition from the Court. He tells me they don't. 13:34:26 25 THE COURT: To whom? 1479 13:34:26 1 MR. VICKERY: To our jury to be extra sensitive. I 13:34:26 2 know you've told the jury not to listen to anything about 13:34:26 3 this case, but I was thinking if a Denver paper or a Cheyenne 13:34:26 4 paper picked up and started writing about some case in New 13:34:26 5 South Wales, a juror might read through the whole thing at 13:34:26 6 the end. 13:34:40 7 THE COURT: I'm smiling and looking at the local 13:34:40 8 counsel. Our newspaper pick that up? It wouldn't happen in 13:34:40 9 a hundred years unless somebody came and published it for 13:34:40 10 them. 13:34:40 11 MR. VICKERY: We're certainly not going to do that. 13:34:40 12 THE COURT: And really, they don't pick up on those 13:34:40 13 things at all. It might be of some international concern, 13:34:40 14 New Jersey or someplace like that, but other than this case 13:34:40 15 pending here, it would have to be big bold print in a black 13:34:40 16 box on the wire. 13:34:40 17 MR. VICKERY: It is moot, then? 13:34:40 18 THE COURT: I think so. 13:34:40 19 MR. VICKERY: My only concern is that it is likely to 13:34:40 20 be on the AP wire and the UPI wire. I read it this morning 13:34:40 21 and I thought I ought to bring it to the attention of the 13:34:40 22 Court and counsel. That's all I'm doing. 13:34:40 23 THE COURT: I appreciate that. And when I -- if I 13:34:40 24 don't forget to give them their usual admonition I'll tell 13:34:40 25 them again to be sure to ignore any media about such matters. 1480 13:34:40 1 I don't know if I want to say related matters. It almost 13:34:40 2 suggests that there's something else going on. So unless I 13:34:40 3 slip... 13:34:40 4 But that's fine. There's a remote chance that the 13:34:40 5 Casper Star-Tribune could pick this up. They're a little 13:34:40 6 more aggressive than our paper. But again, these things 13:34:40 7 would have to come out of the Denver media to get any 13:34:40 8 attention here, hopefully. 13:34:40 9 MR. VICKERY: Okay. 13:34:40 10 THE COURT: So I'm trying to be -- 13:34:40 11 MR. VICKERY: Just being cautious. 13:34:40 12 THE COURT: I'm being optimistic about that. 13:34:40 13 MR. VICKERY: Do you want that opinion, Your Honor? 13:34:40 14 THE COURT: No, even though that's a real Magistrate. 13:34:40 15 MR. GORMAN: I have one issue we need to discuss and 13:34:40 16 some information I just found out. As the Court will recall, 13:34:40 17 yesterday in my examination of Mrs. Lafferty about the 13:34:40 18 neighbor, Mrs. Powers, Dee Powers -- and I was a little 13:34:40 19 surprised -- I wasn't surprised now, but I shouldn't have 13:34:40 20 been surprised at the reaction I got from Jim and Andy when 13:34:40 21 that name even surfaced. 13:34:40 22 Well, who Mrs. Powers is, Mrs. Powers was a neighbor 13:34:40 23 of Don Schell's and had a dog they kept in their yard because 13:34:40 24 the dog barked at people who came into the alley. 13:34:40 25 This angered Mr. Schell, and he -- a person, a man, 1481 13:34:40 1 started calling the Powers' home. And they started out with 13:34:40 2 threats that "I'm going to kill the dog." They went to 13:34:40 3 threats that "I'm going to hurt the children, your children," 13:34:57 4 and threats that I'm going to hurt you. 13:34:57 5 So Mrs. Powers had the -- called the police, had told 13:34:57 6 them about the calls that she was getting and had the -- a 13:34:57 7 trace put on her phone and the trace revealed that it was Don 13:34:57 8 Schell making these calls. 13:34:57 9 THE COURT: It did? 13:34:57 10 MR. GORMAN: Yes, it did. It did. 13:34:57 11 THE COURT: It traced the phone number, correct? 13:34:57 12 MR. GORMAN: It traced it back to Mr. Schell. 13:34:57 13 THE COURT: Their telephone number? 13:34:57 14 MR. GORMAN: Their telephone number. 13:34:57 15 They went -- the policeman came, the policeman went 13:34:57 16 and talked to Don Schell about it because of the trace. 13:34:57 17 Now, what is significant about this, I found this 13:34:57 18 information out just before Mrs. Lafferty went on the witness 13:34:57 19 stand. I was puzzled at the response I got from the 13:34:57 20 plaintiff's counsel when the word "neighbor" was mentioned. 13:34:57 21 Both were on their feet. 13:34:57 22 I now have learned that this information was given to 13:34:57 23 Andy several weeks ago by Mrs. Lafferty herself when Andy 13:34:57 24 called her first to encourage her to come and testify in the 13:34:57 25 plaintiff's case in chief. And when she found out -- when he 1482 13:34:57 1 found out this information, according to Mrs. Lafferty, 13:34:57 2 discouraged her from coming at all. 13:34:57 3 MR. VICKERY: What? 13:34:57 4 THE COURT: Just a minute. 13:34:57 5 MR. VICKERY: I'm sorry, Judge. 13:34:57 6 THE COURT: Just a minute. Let's hear this out and 13:34:57 7 I'll take care of it. Don't you worry. 13:34:57 8 MR. GORMAN: So we would like to -- we have found 13:34:57 9 Mrs. Powers. We would like to call her because we think this 13:34:57 10 evidence is important. Certainly she would have been called 13:34:57 11 if we had known this evidence prior to trial. 13:34:57 12 And I think this falls into the same category as what 13:34:57 13 happened yesterday with Peggy Deans, Mrs. Deans and the 13:34:57 14 conversation Andy heard about before he put her on that the 13:34:57 15 Court let in. 13:34:57 16 So we would like to call Mrs. Powers before the end 13:34:57 17 of the week and get this testimony in the record. 13:34:57 18 THE COURT: What's the timeline of this occurrence? 13:34:57 19 MR. GORMAN: This happened in the early 1980s. 13:34:57 20 THE COURT: Early 1980s? 13:34:57 21 MR. GORMAN: Yes, around the time when he -- remember 13:34:57 22 we traced the depression back to '84? I think it was '81, 13:34:57 23 '82, in that time frame, Judge. 13:34:57 24 THE COURT: Well, without any recriminating comments, 13:34:57 25 I will hear your response. 1483 13:34:57 1 MR. VICKERY: I'm sorry. Judge, I did talk to Miss 13:34:57 2 Lafferty to try to encourage her to come and testify in our 13:34:57 3 case in chief. Miss Lafferty told me something that was very 13:35:11 4 alarming. She said a lady told her husband who told her that 13:35:11 5 Don Schell had shot a gun through her window. It sounded 13:35:11 6 like he had fired a bullet through his neighbor's window. 13:35:11 7 And I said, "Holy smokes. That doesn't sound like 13:35:11 8 Don Schell that everybody else has talked about. Let me get 13:35:11 9 to the bottom of this." 13:35:11 10 "You didn't talk to this lady, your husband did?" 13:35:11 11 That's what Mrs. Lafferty told me. I said fine. 13:35:11 12 I did get to the bottom of it, and the best I can 13:35:11 13 tell the bottom of it from Miss Hardy was there was some 13:35:11 14 incident with some dog and Don Schell shot a BB gun out of 13:35:11 15 his own window trying to chase the dog away. He did not fire 13:35:11 16 a .357 magnum through his neighbor's window. 13:35:11 17 With regard to Mrs. Lafferty, I urged her to come 13:35:11 18 testify in our case in chief. She sent me an e-mail that I 13:35:11 19 can show the Court saying she wasn't coming to testify in my 13:35:11 20 case because she didn't believe Paxil was responsible. I 13:35:11 21 sent her an e-mail in response -- she said, "I'm coming to 13:35:11 22 testify in the defense case." 13:35:11 23 I sent her an e-mail in response and I said, "My only 13:35:11 24 concern is that maybe the defense will decide all of a sudden 13:35:11 25 they don't want you. I think your testimony is important for 1484 13:35:11 1 the jury to hear. Would you please come on anyway?" 13:35:11 2 That was the reason for my outburst, because I urged 13:35:11 3 her to come on anyway. Since she is like 90 percent of the 13:35:11 4 defense witnesses, a may-call witness, I feared the defense 13:35:11 5 might say, "We're not going to call her." And so if she 13:35:11 6 declined to come for me the jury would not have her 13:35:11 7 testimony. 13:35:11 8 This incident, if it were a felony, it is beyond the 13:35:11 9 period it can be used for impeachment of a witness under the 13:35:11 10 rules of evidence. I don't see how it could possibly have 13:35:11 11 any probative value 20 years or 18 years before this 13:35:11 12 happened. 13:35:11 13 And certainly Miss Lafferty has been on the defense 13:35:11 14 witness list. They could have interviewed her as I did. 13:35:11 15 They could have heard the specious tale and tracked it down 13:35:11 16 as I did. But to allow it now, it is delayed in time, it has 13:35:11 17 no probative value. It is a surprise for them to put on 13:35:11 18 Miss Powers. 13:35:11 19 THE COURT: It is a surprise and it has limited 13:35:11 20 probative value. 13:35:11 21 MR. GORMAN: Well, as was the conversation that 13:35:25 22 Mrs. Deans testified about yesterday. It does have some 13:35:25 23 probative value in terms of we've heard a lot of testimony 13:35:25 24 from a lot of plaintiffs' witnesses on what a laid-back, 13:35:25 25 docile, loving kind of man Don Schell was. And the fact that 1485 13:35:25 1 this happened in '81 or '82 maybe goes to its weight and I 13:35:25 2 assume Andy or Jim can bring that out on cross-examination. 13:35:25 3 The reality is we did -- we had talked to 13:35:25 4 Mrs. Lafferty. We had talked to her several times. 13:35:25 5 Mrs. Lafferty never mentioned this to us. I was not aware of 13:35:25 6 this until immediately before she went on the witness stand. 13:35:25 7 And immediately before I came up here this afternoon I had 13:35:25 8 the chance to talk to her on the phone and learned from her 13:35:25 9 for the first time then that she was the source of that 13:35:25 10 information back to Andy. 13:35:25 11 THE COURT: She? 13:35:25 12 MR. GORMAN: Mrs. Lafferty. We have talked to 13:35:25 13 Mrs. Powers, and Mrs. Powers still lives in Gillette and told 13:35:25 14 us that if after today's visit with the Court, if the Court 13:35:25 15 allowed her to testify, she would. 13:35:25 16 THE COURT: I didn't say it was of no probative 13:35:25 17 value, I said it was of limited probative value because of 13:35:25 18 the time factor. I think it has more to do with anger over a 13:35:25 19 barking dog that angers lots of people under any 13:35:25 20 circumstances. But I know you want to offer it to refute the 13:35:25 21 testimony of numerous witnesses, as you said, Mr. Gorman, 13:35:25 22 about the personality traits of Mr. Schell. 13:35:25 23 It is a surprise to the plaintiff, at least 13:35:25 24 partially, that you're going to offer that information. I 13:35:25 25 will accept the fact that the defendant just found out about 1486 13:35:25 1 it. Under the circumstances it won't delay the trial. I 13:35:25 2 will let you offer Miss Powers as a witness for whatever it 13:35:25 3 is worth. 13:35:25 4 MR. GORMAN: Thank you, Judge. We will make the 13:35:25 5 arrangements to get her here. 13:35:25 6 THE COURT: This is probably going to be the last 13:35:25 7 time I'm going to do something like that in this case. No 13:35:25 8 more surprises, notwithstanding what you've found out. We're 13:35:25 9 about to wrap this up and you've done a real nice job so far. 13:35:25 10 I commend you all. You've tried a real nice case, so to put 13:35:25 11 it in the vernacular, we don't want to muck it up any more 13:35:25 12 than we've had the chance to do already. 13:35:25 13 We still going to run a little bit late. Want to go 13:35:25 14 to 5:30, quarter to 6:00? 13:35:25 15 MR. VICKERY: I don't know how long the direct will 13:35:38 16 be with Dr. Mann. 13:35:38 17 MR. GORMAN: We have that deposition to finish. 13:35:38 18 We're on page 16 of a 60-page deposition, so probably it 13:35:38 19 would be good to go a little late. 13:35:38 20 THE COURT: I'd tell you to read fast but I would be 13:35:38 21 thumped on the head by Miss Harris. 13:35:38 22 Let's go to work. We've already lost 15 minutes. 13:35:38 23 (Proceedings recessed in chambers 1:30 p.m. and 24 reconvened in the presence of the jury 13:42:26 25 1:40 p.m., May 31, 2001.) 1487 13:42:26 1 THE COURT: I believe when we recessed we were 13:42:28 2 reading the deposition of Dr. Suhany. If you want to resume, 13:42:33 3 you may do so. 13:42:36 4 MS. WESTBY: Thank you, Your Honor. 13:42:48 5 MR. ZVOLEFF: Good afternoon, Your Honor. 13:42:50 6 THE COURT: Afternoon. 13:42:52 7 MR. ZVOLEFF: We will resume reading at page 16, line 13:42:54 8 10. 13:42:57 9 Q. "Then it is my understanding that he would have switched 13:42:59 10 to Prozac at some point in between those two visits; is that 13:43:03 11 correct? 13:43:04 12 A. In between 1/23 and 2/2, yes. In fact, it says that he's 13:43:10 13 switched eight days before 2/2, so that must be very shortly 13:43:14 14 after he left the other appointment. 13:43:16 15 Q. Okay. Was it -- was it your -- would it have been your 13:43:19 16 instructions to him to switch to the Prozac if he were not 13:43:23 17 getting the relief that he needed or the effect from Desyrel? 13:43:28 18 A. It looks like that's what we both agreed at the 1/23 13:43:32 19 visit. 13:43:32 20 Q. Okay. Did the switch from Desyrel to Prozac have anything 13:43:36 21 to do with his thoughts of death? 13:43:39 22 A. No. 13:43:39 23 Q. Okay. Okay. Let's go on to 2/9 of '90. 13:43:45 24 A. Individual psychotherapy. Trial of increased Ativan, 6 13:43:48 25 milligrams per day. Caused too much sedation. 1488 13:43:52 1 Q. Doctor, excuse me for interrupting for a minute, but 13:43:57 2 Misha, did you all finish the 2/2 entry? I'm kind of going 13:44:02 3 along with you here." 13:44:09 4 MR. ZVOLEFF: Then the witness. 13:44:10 5 A. "Yes, is there something that --" 13:44:12 6 MR. ZVOLEFF: "Miss Westby: Yeah, I think we did, 13:44:15 7 Andy." 13:44:15 8 And skipping some, and back to the witness, line 13. 13:44:23 9 MR. VICKERY: Don't skip that, please. 13:44:26 10 MR. ZVOLEFF: Mr. Vickery, I apologize. 13:44:27 11 Q. "Maybe I just didn't get it but it says obvious -- 13:44:31 12 A. Somatic anxiety today. 13:44:32 13 Q. -- anxiety today? 13:44:33 14 A. Yes. 13:44:34 15 Q. Okay. 13:44:35 16 A. I can reread that if you would like. 13:44:37 17 Q. What's the word before anxiety, obvious something, anxiety 13:44:43 18 today? 13:44:43 19 A. Obvious somatic. That means of the body. 13:44:45 20 Q. Got you. 13:44:46 21 A. Okay. 13:44:46 22 Q. Thank you. 13:44:48 23 A. Sure. Ready for 2/9? 13:44:51 24 Q. Yes. 13:44:51 25 A. 2/9/1990. Individual psychotherapy. Trial of increased 1489 13:44:56 1 Ativan to 6 milligrams per day caused too much sedation and 13:45:00 2 memory loss. Anxiety relieved with 4 milligrams per day with 13:45:04 3 few side effects. Depression improving somewhat. Agreed to 13:45:07 4 continue Prozac trial. Discussed loss of, quote, drive, 13:45:12 5 unquote, related to achieving, quote, top, unquote, of 13:45:15 6 profession. Children grown. Financially stable. Will 13:45:18 7 continue to explore this. And schedule appointment 2/14. 13:45:22 8 Q. Okay. Now you're -- in this entry you talk about the fact 13:45:26 9 that the anxiety was relieved with the 4 milligrams of 13:45:29 10 Ativan; is that correct? 13:45:31 11 A. Yes. 13:45:32 12 Q. Okay. So there's no notation or no indication in this 13:45:36 13 record that he had increased anxiety on this day, correct? 13:45:40 14 A. Correct. In fact, the entry states that his anxiety is 13:45:43 15 relieved. 13:45:48 16 Q. Okay. And he is still taking Prozac at this time, 13:45:51 17 correct? 13:45:52 18 A. Yes, he would be taking Prozac and Ativan. What this 13:45:54 19 entry says is that Ativan, 6 milligrams a day, was too much, 13:45:59 20 but Ativan at 4 milligrams a day seemed to be working very 13:46:02 21 nicely. 13:46:03 22 Q. Okay. And since you had mentioned in the 2/2 entry that 13:46:06 23 the increased anxiety and decreased appetite or loss of 13:46:09 24 appetite were potentially side effects of Prozac and we get 13:46:18 25 down to 2/9 and the anxiety is relieved, is that an 1490 13:46:21 1 indication that the increased anxiety was not a side effect 13:46:25 2 of Prozac? 13:46:26 3 A. To my professional -- no. To my professional experience 13:46:30 4 the connection between anxiety and depression is difficult to 13:46:33 5 sort out. There are many cases of depression in which 13:46:36 6 anxiety is a prominent feature and the -- so that I think in 13:46:40 7 this -- in Mr. Schell's case, the anxiety being so prominent, 13:46:44 8 that's why I have recommended treating both with an anxiety 13:46:48 9 medication as well as with an antidepressant. 13:46:51 10 Q. Okay." 13:46:52 11 MR. VICKERY: Excuse me, Mr. Zvoleff. Would you 13:46:54 12 reread that last sentence? It was antianxiety. 13:47:00 13 A. "...treating both with an antianxiety medication as well 13:47:04 14 as with an antidepressant. 13:47:06 15 Q. But you would agree that he was experiencing anxiety prior 13:47:11 16 to the time he began taking Prozac, correct? 13:47:19 17 A. Oh, yes. In fact, I believe he's having anxiety even at 13:47:19 18 the initial consultation. 13:47:19 19 Q. And then he just seems to be going through cycles of 13:47:21 20 increased or decreased anxiety during his trial on Prozac or 13:47:25 21 his treatment on Prozac, would you agree with that? 13:47:29 22 A. Yes. And actually, that's common. 13:47:31 23 Q. Okay. And so basically what you're saying to me is that 13:47:37 24 anxiety may just be a function or a factor in his depression, 13:47:42 25 is that a fair statement? 1491 13:47:43 1 A. Yes. The anxiety symptoms may be from a -- from an 13:47:46 2 anxiety disorder that is separate from depression. The 13:47:49 3 anxiety symptoms may be part of the symptoms of depression, 13:47:53 4 and symptoms that look like anxiety can be due to side 13:47:56 5 effects of medication, so that's what I would be trying to 13:47:59 6 sort out with him. 13:48:00 7 Q. But you never made any specific finding that these were 13:48:03 8 side effects or that the increased anxiety was a side effect 13:48:07 9 of Prozac, correct? 13:48:11 10 A. And to this point in the record; that is correct. 13:48:14 11 Q. Okay. Let's go on to 2/14 of '90. 13:48:18 12 A. Okay. Individual psychotherapy. Overall improved, 13:48:22 13 although had increased anxiety during the weekend. And then 13:48:25 14 there's a notation S, which is without identified 13:48:29 15 precipitants. Continued to explore loss of drive and loss of 13:48:33 16 self-confidence. Discussed possibility of returning to work 13:48:36 17 part time. Will continue current treatment. Prescription 13:48:38 18 for Ativan, 1 milligram, 75. No refill. And an appointment 13:48:44 19 for 2/23. 13:48:48 20 Q. Okay. Let's go on to February 23rd of 1990. 13:48:52 21 A. Individual psychotherapy. Continued improved although had 13:48:55 22 increased anxiety yesterday without apparent precipitant. 13:49:00 23 Focused on fears surrounding return to work. Emphasize 13:49:03 24 progress he's made and he emphasized the importance of wife's 13:49:07 25 support. Plan to return to work 2/26. Will continue 1492 13:49:10 1 treatment and schedule appointment in one to two weeks. 13:49:13 2 Prescription for Prozac, 20 milligrams, number 30, no refill. 13:49:19 3 Prescription for Ativan, 1 milligram, number 50, no refill. 13:49:23 4 Q. Okay. When he's expressing specific dates or instances of 13:49:27 5 increased anxiety, what does that mean to you about the rest 13:49:31 6 of the time or what kind of anxiety he's experiencing, if 13:49:36 7 any, the rest of the time? 13:49:38 8 A. In general a notation like 'increased anxiety' by me would 13:49:42 9 indicate that there is some change in his condition that he 13:49:46 10 identified. And he identified it as occurring the previous 13:49:50 11 day. And then I would have asked what may have triggered 13:49:54 12 this, and apparently he could not identify anything. 13:49:56 13 Q. Let's go on with 3/2 of '90. 13:49:59 14 A. Individual psychotherapy. Unable to remain at work. 13:50:02 15 Increased anxiety. This week has developed trembling in 13:50:06 16 hands which seems unrelated to anxiety. Question, side 13:50:09 17 effect Prozac. However, depression continues to improve. 13:50:12 18 Will recommend continued Prozac and Ativan and will 13:50:15 19 supplement with trial Inderal for tremor. 13:50:18 20 And then I have written a prescription for Inderal, 13:50:22 21 20 milligrams, number 15, no refill. And schedule an 13:50:25 22 appointment for the following week. 13:50:26 23 Q. You note in this entry a hand tremor. Does that -- or no, 13:50:31 24 trembling in the hands? 13:50:34 25 A. Right. 1493 13:50:34 1 Q. Does that -- how do you -- how do you describe these kinds 13:50:37 2 of conditions? Could there possibly have been other things 13:50:41 3 going on? Is that going to be the most serious symptoms? 13:50:44 4 Tell me -- explain to me how you -- how you describe these 13:50:48 5 kinds of things in your notes. 13:50:51 6 A. The phrase 'developed' signals that this is something new 13:50:55 7 that either the patient is complaining about or that I 13:50:57 8 noticed myself in the consultation. Ordinarily, although, of 13:51:01 9 course, these are brief notes, I would try to write down any 13:51:04 10 change, any new symptom, any worsening symptoms. So if there 13:51:09 11 had been other new symptoms, I would likely have recorded 13:51:12 12 them. 13:51:12 13 Q. So then it would be your impression from these notes, the 13:51:15 14 trembling in hands was the only new symptom; is that correct? 13:51:19 15 A. That would be my impression. 13:51:21 16 Q. But you continued Prozac at this time? 13:51:23 17 A. Yes, even though I questioned to myself whether or not the 13:51:26 18 trembling in the hands might be a side effect of the Prozac. 13:51:30 19 Q. And this occurred, it looks like, approximately a month or 13:51:33 20 a little bit longer after he had initially started taking the 13:51:37 21 Prozac; is that accurate? 13:51:39 22 A. Yes, about a month. 13:51:40 23 Q. And what is Inderal? 13:51:41 24 A. Inderal is a medication that in this context can be 13:51:45 25 helpful in controlling hand tremors. Inderal is primarily 1494 13:51:50 1 used for the treatment of high blood pressure. 13:51:52 2 Q. Let's go to the next notation, 3/9 of '90. 13:52:01 3 A. Individual psychotherapy. Continued tremors until 13:52:01 4 Wednesday. P with a slash, that's post, meaning after first 13:52:03 5 dose of Inderal. However, dizziness and tiredness 13:52:11 6 secondary -- that's 2 with a little sort of degree -- that's 13:52:12 7 secondary to Inderal. And then I have a notation to myself. 13:52:16 8 It looks like a parenthesis with an exclamation point which 13:52:20 9 would be like a surprise to me. That's... 13:52:22 10 Discussed in detail advantages, disadvantages of 13:52:26 11 trial of new antidepressant; with incomplete effectiveness 13:52:31 12 and difficult side effects have recommended D/C, which is 13:52:35 13 discontinue, Prozac and continue trial of imipramine. 13:52:39 14 And then I have parentheses, depression mixed with 13:52:43 15 anxiety, close parentheses. Effects, side effects explained. 13:52:46 16 Patient understands. 13:52:48 17 Plan, then, is to discontinue Prozac, begin 13:52:51 18 imipramine, 50 milligrams advancing to 75 milligrams at 13:52:55 19 bedtime. Prescription for imipramine, 25 milligrams, number 13:52:59 20 25. No refill. To continue the Ativan and to schedule an 13:53:02 21 appointment on 3/15. And there's a box, Call Dan Mainprize, 13:53:09 22 it looks like, and a telephone number, 3/23. 13:53:12 23 Q. So then this is the point in your treatment of Don Schell 13:53:15 24 when you discontinued Prozac, correct? 13:53:17 25 A. Yes. 1495 13:53:18 1 Q. And up until this point the only motor response that you 13:53:21 2 had noticed was a hand tremor; is that correct? 13:53:24 3 A. According to my notes, yes. 13:53:25 4 Q. And you would not describe this as akathisia, would you? 13:53:29 5 A. I would not. 13:53:34 6 Q. Okay. Let's go on to the next note, 3/15 of 1990. 13:53:40 7 A. Individual psychotherapy. Reports significant improvement 13:53:44 8 since Monday. Improved mood, decreased anxiety, increased 13:53:49 9 concentration, increased appetite, even increased libido. 13:53:53 10 HA -- that would be headaches -- gone and tremors markedly 13:53:56 11 decreased. Has also decreased Ativan to 4 milligrams a day. 13:54:01 12 Again discussing themes of loss, especially 13:54:03 13 self-confidence. Will continue IMI -- that's imipramine -- 13:54:06 14 prescription, 25 milligrams, number 30. No refill. 13:54:09 15 Prescription Ativan, 1 milligram, number 60. No refill. May 13:54:12 16 increase imipramine to 100 milligrams at bedtime if needed. 13:54:18 17 Next appointment, one week, 3/22. 13:54:21 18 Q. And before we get too far in these records, I just wanted 13:54:24 19 to ask you one other question about the Prozac. 13:54:27 20 A. Yes. 13:54:28 21 Q. You describe in your notes of 3/9/90 incomplete 13:54:32 22 effectiveness of Prozac, but would you agree or wouldn't you 13:54:36 23 agree that there was some improvement with Prozac or that it 13:54:40 24 had some -- some value in the treatment of Don Schell? 13:54:43 25 A. According to the notes, he had received some benefit from 1496 13:54:45 1 Prozac, yes. 13:54:47 2 Q. Let's go on, then, to the notes of 3/20. 13:54:51 3 A. Okay. 3/20. This says a draft letter to Mildred Ramsey, 13:54:55 4 RN, OXY-U.S.A., Medical Department, P.O. Box 300, Tulsa, 13:55:01 5 Oklahoma, 74102. This seems to be not a session with Don 13:55:06 6 Schell but the draft of a letter that I'm sending to this 13:55:09 7 person. And this also talks about Dan Mainprize. 13:55:14 8 Dan Mainprize with the EAP contacted me Monday and 13:55:17 9 requested this letter. Don Schell has been under my care for 13:55:20 10 treatment MDD -- that means major depressive disorder -- 13:55:23 11 since 1 of '90. Unable to work since 1/26/90. Originally 13:55:28 12 had moderate positive response to Prozac but developed 13:55:31 13 significant side effects including tremor, agitation, 13:55:34 14 headache. Also depression did not respond completely to 13:55:37 15 Prozac. 13:55:38 16 Then little symbol would be like next paragraph. 13:55:41 17 Accordingly, I recommended a trial of imipramine early, 3 of 13:55:45 18 '90. At last appointment, 3/15, he demonstrated substantial 13:55:50 19 positive response. Next appointment is 3/22. If positive 13:55:53 20 response continues he may be able to return to work week of 13:55:56 21 3/26. 13:55:57 22 And then another paragraph symbol. Thank you, 13:56:00 23 advance assist. Kind of standard closing thing. 13:56:03 24 I will contact DP, presumably Dan Mainprize, after 13:56:08 25 next week appointment with DS, Donald Schell. Further 1497 13:56:11 1 assist, et cetera, kind of a closing. That was a letter. 13:56:14 2 Q. The next note looks like 3/22 of '90. 13:56:18 3 A. Yes. Individual psychotherapy. Continues to do well, 13:56:22 4 underlined. No major symptoms, depression. Decreased 13:56:25 5 anxiety. Variable mood rather than flat. Actually had done 13:56:28 6 paperwork at the office about two hours a day for three days. 13:56:32 7 And then a symbol of surprise. 13:56:35 8 No complaints side effects. Did increase imipramine 13:56:38 9 to 100 milligrams. That is HH, recommended. Will continue 13:56:48 10 current treatment and plan half day of work next week. 13:56:48 11 Prescription for imipramine, 50 milligrams, number 13:56:48 12 30, two at bedtime. No refill. Next appointment 3/29, it 13:56:53 13 looks like. 13:56:54 14 Q. Then it looks like the note from 3/27 is another letter; 13:56:57 15 is that correct? 13:56:58 16 A. Yes, it looks like it is. 13:57:00 17 Q. Okay. 13:57:00 18 A. Draft letter to Mildred Ramsey, RN. This letter will 13:57:04 19 update you on Donald Schell's condition. At last 13:57:09 20 appointment, 3/22, he was responding well to new medication. 13:57:12 21 He will be able to return to work half days begin 3/26. 13:57:15 22 Next paragraph. His next appointment is 3/29 and we 13:57:19 23 will review his readiness to return to work full time. 13:57:22 24 Next paragraph, thank you for your cooperation. 13:57:25 25 Continue -- or contact further info, kind of a standard close 1498 13:57:29 1 again. 13:57:29 2 Q. And then 3/29? 13:57:32 3 A. Individual psychotherapy. Returned to work. First few 13:57:37 4 days quite good but in last two days has increased anxiety, 13:57:41 5 depression, self-doubts. Explored connections between old 13:57:45 6 job and these feelings. Also explored probable relationship 13:57:50 7 between these feelings and desire not to make same, quote, 13:57:54 8 trade-offs, unquote, as before. 13:57:57 9 Plan to continue half days next week. Next 13:58:00 10 appointment one week, 4/5. 13:58:03 11 Q. Do you know what -- can you be more specific about your 13:58:06 12 entry about 'old job' and 'same feelings' and 'trade-offs'? 13:58:09 13 Do you have any more information or remember anything more 13:58:11 14 about that entry? 13:58:13 15 A. I don't remember anything other than what's written. I 13:58:16 16 don't. 13:58:16 17 Q. All right. Let's go to 4/5. 13:58:18 18 A. Individual psychotherapy. Continues to do well. Work 13:58:22 19 fine with 7-hour days and even one 11-hour day in the field. 13:58:26 20 He knows he is, quote, thinking clearly, unquote, now and 13:58:31 21 wasn't able to before. One noticeable change is certainly 13:58:35 22 that he's less critical and demanding of himself. Did have 13:58:38 23 increased depressive period on Sunday, perhaps connected with 13:58:43 24 DA's -- that would be daughter's -- visit/departure and 13:58:49 25 perhaps with anxieties about work. 1499 13:58:51 1 Overall quite improved and ready to return to work 13:58:54 2 full time next week. Will continue current medication. 13:58:57 3 Prescription for imipramine, 50 milligrams, number 60, two at 13:59:01 4 bedtime. No refill. Prescription Ativan, 1 milligram, 13:59:04 5 number 100, tid to qid, three times a day to four times a 13:59:09 6 day. No refill. Next appointment two weeks, 4/19. 13:59:14 7 Q. Did it seem significant to you this was the first time he 13:59:18 8 had noted a potential connection to his depression with his 13:59:21 9 daughter's visits or departures? 13:59:23 10 A. At the time it must have seemed significant since I wrote 13:59:26 11 it down, and in this context this would be because the 13:59:29 12 patient himself had noticed it or at least we had connected 13:59:32 13 it together. 13:59:33 14 Q. Okay. And that would have been related to depression and 13:59:37 15 anxiety; is that correct? 13:59:39 16 A. Yeah. The notation says, 'Did have increased depressive 13:59:43 17 period on Sunday perhaps connected with daughter's 13:59:47 18 visit/departure and possibly with anxieties about work.' 13:59:53 19 Q. Let's continue on to 4/9. 13:59:55 20 A. That also appears to be a letter, draft letter to Mildred 13:59:58 21 Ramsey, RN. This letter updates you on Donald Schell and 14:00:03 22 confirmed phone 4/6. He continues to respond well to current 14:00:07 23 treatment. Half days at work have been successful. He will 14:00:10 24 be able to return to work full time 4/9. He will continue 14:00:14 25 follow-up treatment with me. 1500 14:00:16 1 Paragraph. Thanks, cooperation. Contact, further 14:00:19 2 info, et cetera. 14:00:20 3 Q. Then 4/9? 14:00:21 4 A. Yes. Individual psychotherapy. Reports first week of 14:00:25 5 work, quote, good. This week quote, not very good, unquote. 14:00:29 6 He has noticed increased anxiety, increased depression, 14:00:33 7 decreased self-confidence, again centered at work. No 14:00:37 8 obvious precipitants outside of work. Continued to discuss 14:00:41 9 how hardest on himself and made cognitive plans to make 14:00:46 10 changes. Will check serum imipramine level and continue 14:00:50 11 current medications pending results. Next appointment in two 14:00:52 12 weeks, 5/3. 14:00:54 13 Q. So he's still showing cycles of increased anxiety at this 14:00:57 14 point; is that correct? 14:00:58 15 A. Yes, according to the notes. 14:01:00 16 Q. And he is on imipramine at this point; is that correct? 14:01:04 17 A. Imipramine and Ativan, yes. 14:01:06 18 Q. Okay. Let's go to 4/23 of '90. 14:01:10 19 A. Okay. Phone call to patient. Serum IMI plus DMI -- 14:01:17 20 that's imipramine, and DMI is desmethylimipramine. That's a 14:01:23 21 metabolite of imipramine -- equals 88 NG, which is nanograms, 14:01:30 22 per milliliter. 14:01:31 23 I have the indication that that's low, meaning that's 14:01:33 24 below the therapeutic range, so advised to increase 14:01:40 25 imipramine to 150 milligrams at bedtime and keep scheduled 1501 14:01:41 1 appointment. 14:01:42 2 Q. Okay. 5/3 of '90? 14:01:44 3 A. Individual psychotherapy. Reports significant improvement 14:01:47 4 with increased imipramine to 150 milligrams at bedtime. 14:01:51 5 Depression decreased, anxiety much decreased. 14:01:54 6 Self-confidence returning. Concentration improved. Has 14:01:57 7 noted positive changes both at work and with family. 14:01:59 8 Beginning to review episode of depression and feels, quote, I 14:02:03 9 can be a better person because of this, unquote. Open 14:02:07 10 parentheses, that is, more concerned with others and not as, 14:02:10 11 quote, harsh, unquote, close parentheses. 14:02:14 12 No complaints of side effects. Will continue 14:02:16 13 imipramine at current dose and schedule appointment in three 14:02:20 14 weeks, 5/24. Prescription for imipramine, 50 milligrams, 14:02:23 15 100 -- number 100, three at bedtime. No refill. And note 14:02:28 16 that the patient has self-tapered Ativan to 2 and a half to 2 14:02:32 17 milligrams a day. 14:02:34 18 Q. Okay. Let's go on to the next page. I have the first 14:02:37 19 notation as 5/24 of '90. 14:02:41 20 A. Yes. Individual psychotherapy. Reports he is doing V -- 14:02:46 21 that would be in this context very well. No sustained 14:02:49 22 depressive symptoms, no significant anxiety. Increased 14:02:52 23 self-confidence. Tried to taper below Ativan 2 milligrams a 14:02:57 24 day, but anxiety increased too much. Resumption of 2 14:03:01 25 milligrams a day resolved all symptoms. Reviewed his 1502 14:03:05 1 increased comfort in handling work problems. But also 14:03:09 2 continue to support his ability to set limits and not 14:03:09 3 overextend himself. 14:03:10 4 Will continue current medications. Schedule 14:03:13 5 appointment one month, 6/21. 14:03:16 6 Prescription, imipramine, 50 milligrams, number 100, 14:03:19 7 three at bedtime. No refill. And prescription, Ativan, 1 14:03:23 8 milligram, number 60, one twice a day. No refills. 14:03:26 9 Q. Okay. 6/27/90. 14:03:30 10 A. Individual psychotherapy. Continues to do very well 14:03:33 11 without depressive symptoms, without significant anxiety. 14:03:36 12 Work going well. Received a raise. He, his wife and 14:03:40 13 daughter have all noticed positive changes in his 14:03:42 14 personality. There's a colon which would mean, for example, 14:03:45 15 less demanding, less critical, less irritable, more willing 14:03:50 16 to listen. 14:03:50 17 He tried decreasing Ativan to 1 milligram a day but 14:03:54 18 developed increased anxiety. Discussed plans to taper more 14:03:58 19 gradually, for example, to 1 and a half milligrams a day. 14:04:02 20 Will continue current medications. 14:04:04 21 Prescription, imipramine, 50 milligrams, 100, three 14:04:08 22 at bedtime. That's a monthly supply. No refill. And 14:04:11 23 prescription, Ativan, numbering 60, one twice a day. That's 14:04:13 24 again a monthly supply. No refill. With an appointment the 14:04:16 25 following month on 7/26. 1503 14:04:19 1 Q. Okay. And then the notation from 7/26. 14:04:23 2 A. Individual psychotherapy. Continued stable improvement. 14:04:27 3 No symptoms of depression, no significant anxiety. Work and 14:04:30 4 family fine. Beginning to talk of fears of relapse. 14:04:33 5 Education given regarding signs and treatment. Ativan 14:04:37 6 decreased to 1 milligram a day, occasionally 1 and a half 14:04:40 7 milligrams a day. Will continue current treatment. 14:04:44 8 Prescription, imipramine, 50 milligrams, number 100, 14:04:47 9 three at bedtime. No refill. And next appointment 9/6. 14:04:51 10 Q. Since you increased the dosage to 150 milligrams of 14:04:56 11 imipramine has Don Schell been on the same level since that 14:04:59 12 point? 14:05:00 13 A. Yes. 14:05:01 14 Q. Okay. The next note is 9/13. 14:05:05 15 A. Individual psychotherapy. Doing very well. No symptoms 14:05:09 16 depression or significant anxiety. Feels better than he has 14:05:12 17 in two-plus years. Now feels better than when he had last, 14:05:16 18 quote, recovered, unquote, on Prozac. Does have fears of 14:05:19 19 relapse during approaching winter. Plan to continue 14:05:22 20 imipramine into early next year. Ativan use decreased to 14:05:26 21 five per week, and then will continue current treatment. 14:05:29 22 Prescription, imipramine, 50 milligrams, number 10, 14:05:32 23 three at bedtime. Prescription, Ativan, 1 milligram, number 14:05:35 24 25. Next appointment in six weeks at -- on 10/25. 14:05:41 25 Q. Do you have any independent recollection or can you shed 1504 14:05:44 1 any light on Don Schell's previous treatment with Prozac that 14:05:47 2 you have noted here and other times in the records? 14:05:52 3 A. I don't have any independent recollection. The record 14:05:55 4 showed that he had taken Prozac previously when he had this, 14:05:58 5 quote, depressive reaction after he was taking Tylenol after 14:06:01 6 a growth had been removed from his eye. That was with the 14:06:05 7 previous psychiatrist. 14:06:06 8 And then of course we had -- and I mean, I -- Don 14:06:11 9 Schell and I had our own trial of Prozac with him for about 14:06:19 10 four or five weeks. So that's what I would mean by, quote, 14:06:19 11 recovered. In this context that would be his perception; 14:06:21 12 that is, that he feels better than he had when he had last, 14:06:24 13 quote, recovered on Prozac. 14:06:28 14 Q. Okay. The next entry is 10/25/90. 14:06:31 15 A. Individual psychotherapy. Continues to do very well. 14:06:35 16 Quote, I didn't think I could feel even better but I do, 14:06:38 17 unquote. Now beginning to sort out some of the precipitating 14:06:41 18 events. And then I have a bracket around, apparently, some 14:06:44 19 of these precipitating events: Brother-in-law died in 1987. 14:06:49 20 Didn't grieve. Quote, strong one, unquote, until 1988. Rs, 14:06:55 21 I'm thinking in this context meaning his wife, Rita's, 14:07:00 22 depression, '88 to '89, secondary to her mother's CA, in this 14:07:06 23 context presumably cancer; daughter's, quote, bad Pap smear, 14:07:09 24 unquote. And then there's a notation, now resolved, and then 14:07:12 25 that quote continues to the following page. 1505 14:07:14 1 Also has renewed self-confidence at work. Will be on 14:07:19 2 vacation three weeks in the next two months. Since doing 14:07:22 3 well will schedule appointment in two months, on 12/18. 4 And then my prescription for imipramine, 50 14:07:26 5 milligrams, number 100. One refill. That is a month's 14:07:30 6 supply and one refill. That's the end of that note. 14:07:33 7 Q. And it looks like the final note is 2/18 of '90. 14:07:37 8 A. Actually, it is 12/18 of '90. 14:07:41 9 Q. 12/90? I'm sorry. 14:07:44 10 A. Yes. Individual psychotherapy. Continues in complete 14:07:47 11 remission of depression. Has taken no Ativan for -- that's 14:07:50 12 times one month and feels very good about this. Facing 14:07:54 13 possible major change at work including possible relocation 14:07:57 14 with confidence rather than anxiety. Still plan to continue 14:08:00 15 medications throughout the winter. 14:08:02 16 Prescription, imipramine, 50 milligrams, number 100, 14:08:05 17 three at bedtime. One refill. Is to call for appointment in 14:08:10 18 about two months. 14:08:11 19 Q. So that would have been enough imipramine for two months, 14:08:13 20 correct? 14:08:14 21 A. Yes. That is a one-month supply of his current dose of 14:08:18 22 imipramine and one refill. 14:08:20 23 Q. And do you know if he ever called for that appointment in 14:08:23 24 two months? 14:08:25 25 A. I -- I don't know. In my records there's nothing to 1506 14:08:28 1 indicate one way or another, and I don't have any independent 14:08:32 2 recollection of that. 14:08:33 3 Q. Okay. And did you ever see Don Schell again following the 14:08:37 4 visit on 12/18 of '90? 14:08:40 5 A. According to my record, no. And I have no independent 14:08:44 6 recollection of anything different. 14:08:45 7 Q. According to the records -- or your records, the only 14:08:49 8 notations regarding ideas of death are in the first note of 14:08:54 9 1/16/1990. You never observed any suicidal or homicidal 14:09:00 10 ideation or behavior while Don was being treated with Prozac; 14:09:03 11 is that correct? 14:09:05 12 A. According to my notes, I would say that is correct. 14:09:08 13 Q. Okay. 14:09:09 14 A. Since I didn't note it down as a positive finding, which I 14:09:12 15 would certainly expect to do if it had been present. 14:09:15 16 Q. And was it your observation that work was a significant 14:09:19 17 stressor for Don Schell? 14:09:21 18 A. Clearly, all the way from the initial consultation to his 14:09:24 19 difficulties in returning to work. Clearly in his own mind 14:09:27 20 the depression and anxiety were quite related to work and his 14:09:30 21 ability to either be able to work or not. 14:09:32 22 Q. So you would also agree that work was a source of his 14:09:35 23 anxiety? 14:09:37 24 A. According to my notes and the way I understand them, yes. 14:09:40 25 It seems that on more than one occasion when he was either 1507 14:09:43 1 returning to work or getting ready to return to work that 14:09:46 2 some anxiety symptoms increased. That was the connection 14:09:50 3 that he made and that as he reported I would write down. 14:09:54 4 Q. And was work a significant component of his depression? 14:09:58 5 A. Well, I'm not sure what you mean by that. 14:10:00 6 Q. Well, okay. Would you -- it appears to me from the 14:10:04 7 records that work is the most frequently mentioned stressor 14:10:07 8 or cause of his problems. Would you agree with that? 14:10:11 9 A. I would say that it is the most frequently mentioned 14:10:13 10 stressor, yes. 14:10:15 11 Q. And do you believe that it was a significant cause or led 14:10:19 12 to his depression? 14:10:20 13 A. Cause is a difficult word for me in this context. The -- 14:10:24 14 a diagnosis that I made, major depressive disorder, in my 14:10:28 15 thinking then as well as my current thinking, is a 14:10:30 16 biological/biochemical illness. So to say that a particular 14:10:35 17 stressor, including a set of stressors at work, is causative 14:10:40 18 is not a link that I'm prepared to make. 14:10:43 19 On the other hand, as I also indicated in my 14:10:45 20 first consultation note -- and I still look at these issues 14:10:48 21 this way -- the psychological issues or the psychological 14:10:58 22 impact is important besides the alteration in the brain 14:10:58 23 chemistry. And so I approached Mr. Schell then from both 14:10:58 24 perspectives of trying to manage the biochemical 14:11:00 25 abnormalities with medication and trying to help him 1508 14:11:02 1 understand stressors and his response to them through 14:11:05 2 psychotherapy. 14:11:06 3 Q. Okay. Did you ever meet" -- 14:11:24 4 MR. ZVOLEFF: Mr. Vickery, can I skip the colloquy? 14:11:27 5 Start at 40, line 1. 14:11:29 6 Q. "Do you recall -- I don't remember hearing you mention it 14:11:31 7 in any of the records, but do you recall after having gone 14:11:35 8 through those records if you ever met Rita Schell or if she 14:11:40 9 was ever present at any of these visits? 14:11:43 10 A. According to my records, she would not have been present 14:11:46 11 at any of the visits because they're all labeled individual 14:11:50 12 psychotherapy. Whether or not she may have come to the 14:11:53 13 office and I may have met her incidentally, I have no 14:11:56 14 independent recollection. 14:11:58 15 Q. Okay. Did you -- 14:11:59 16 A. If I had seen -- excuse me. If I had seen them together 14:12:01 17 in terms of any kind of joint counseling session, I would 14:12:04 18 have recorded that information. 14:12:05 19 Q. Did you know the Schells socially at all? 14:12:08 20 A. No, I didn't. 14:12:09 21 Q. And you never saw Don Schell outside of the office? 14:12:11 22 A. I can't say with certainty. Gillette, when I was there, 14:12:15 23 is certainly a small community and I may have seen him in 14:12:19 24 passing, but I don't know whether I did or not. 14:12:22 25 Q. Do you recall anything, independent of the records from 1509 14:12:24 1 your visits with him, anything that struck you as unusual, 14:12:27 2 any particular concerns you had, anything that may be of 14:12:31 3 assistance to us? 14:12:33 4 A. No. 14:12:34 5 Q. And I think that we've already discussed this, but I just 14:12:37 6 want to make sure that it is clear for the record. Would you 14:12:40 7 describe what Don Schell experienced on Prozac as akathisia? 14:12:45 8 A. According to the information that I have in my record, I 14:12:48 9 would not describe it as akathisia." 14:12:53 10 MR. ZVOLEFF: Now switching to Mr. Vickery's 14:12:55 11 questions on line 15. 14:12:58 12 Q. "Doctor, this is Andy Vickery. Can you hear me okay? 14:13:02 13 A. Yes, sir, I can hear you fine. 14:13:04 14 Q. Why on earth would a guy leave Dallas, Texas and go to 14:13:09 15 Gillette, Wyoming? 14:13:10 16 A. Well, that -- we're on the record, right? 14:13:12 17 Q. No, I'm just joking. I'm just joking. They're both very 14:13:18 18 nice places. 14:13:19 19 A. Actually, Dallas was too big for us, we thought, and 14:13:23 20 Gillette turned out to be way too small. 14:13:27 21 Q. I hope you found the midpoint. 14:13:29 22 A. Well, I don't know -- I don't know if Las Vegas is the 14:13:30 23 midpoint, but it's suiting us just nicely right now. 14:13:30 24 Q. It is a very nice town. I assume from the fact that you 14:13:33 25 now live and work in Las Vegas that you will not be available 1510 14:13:37 1 to testify in Cheyenne, Wyoming in May of this year in this 14:13:40 2 trial? 14:13:40 3 A. I would prefer not. 14:13:42 4 Q. Okay. Well, if you're not available, then we can use this 14:13:47 5 deposition. I just had to make it clear on the record that 14:13:50 6 you did not plan on being there and would prefer not to be 14:13:53 7 there. 14:13:53 8 A. Yes, I would prefer that my deposition would suffice for 14:13:56 9 my physical presence. 14:13:58 10 Q. Now, let me ask this, sir. You are, of course, a trained 14:14:02 11 psychiatrist, right? 14:14:03 12 A. Yes, I am. 14:14:04 13 Q. And when you have someone with a major depressive disorder 14:14:07 14 such as you diagnosed for Donald Schell, are you always 14:14:10 15 sensitive to the possibility that that person would be 14:14:12 16 thinking about harming themselves or others? 14:14:15 17 A. Yes. 14:14:16 18 Q. Is that something that you look for, not only at the 14:14:19 19 initial intake session but periodically throughout your 14:14:22 20 treatment of that person? 14:14:26 21 A. Yes, typically. 14:14:27 22 Q. Did you ever see anything in Donald Schell that would 14:14:29 23 indicate that this patient was a risk for harming himself or 14:14:32 24 anyone else? 14:14:34 25 A. According to what I have detailed in my records, no, with 1511 14:14:38 1 the exception of the mention at the initial consultation that 14:14:41 2 he had been thinking about death, although not specifically 14:14:44 3 about suicide. 14:14:45 4 Q. And if I understood what you were saying there, looking 14:14:47 5 back on the first page of your records, there is a -- in your 14:14:51 6 shorthand way, a progression of thoughts, beginning with 14:14:54 7 thoughts of death being the most mild and ending with an 14:14:59 8 active suicide plan or attempt as the most severe, correct? 14:15:02 9 A. Yes. Plan is the most serious; plan and means to carry 14:15:05 10 out the plan. 14:15:06 11 Q. But when you say on the January 16th, 1990, visit, 14:15:10 12 positive ideas about death but without suicidal ideation or 14:15:16 13 other info, does that mean plan? 14:15:19 14 A. Actually, that's intent. 14:15:21 15 Q. Intent? 14:15:21 16 A. Yes. 14:15:22 17 Q. Does that mean that you affirmatively questioned him at 14:15:24 18 that time about that? 14:15:25 19 A. Yes, that would mean that. And that would be my standard 14:15:28 20 practice. 14:15:30 21 Q. Dr. Suhany, I note in going through these records that 14:15:33 22 apparently you saw this man about 18 different times for 14:15:37 23 individual psychotherapy throughout 1990? 14:15:40 24 A. I will accept your count of that, yes. 14:15:42 25 Q. About how long would you see him each time? 1512 14:15:45 1 A. Probably about an hour. Perhaps in some of the later 14:15:48 2 visits it was shorter than that, but certainly the early 14:15:55 3 visits would be about an hour. That was my standard of 14:15:56 4 private practice at that time in 1990. 14:15:58 5 Q. Tell us, if you would, just in your own words after 14:16:02 6 spending 18 hours with this man what adjectives would you use 14:16:05 7 to describe him? 14:16:07 8 A. Do you mean when he first came to see me or do you mean 14:16:10 9 toward the end of what appeared to me to be a successful 14:16:13 10 treatment? 14:16:14 11 Q. Let's take them both. When he first came to see you, how 14:16:17 12 would you describe, generally speaking, Donald Schell? 14:16:21 13 A. According to what my notes reflect, an anxious, depressed, 14:16:24 14 hard-working man. 14:16:25 15 Q. And did you believe that the anxiety and depression 14:16:28 16 related to the particular situation he was facing at work 14:16:32 17 then? 14:16:33 18 A. According to my notes, and, you know, also just trying to 14:16:37 19 understand what I've written, that the depression and anxiety 14:16:40 20 would have been related to concerns about his job, yes. 14:16:44 21 Q. Sir, I didn't see anything in your notes that -- let me 14:16:47 22 ask you this from your memory. Throughout the course of your 14:16:51 23 treatment of this man for a year did you ever see any 14:16:53 24 indication that he had problems with his marriage or with his 14:16:55 25 family? 1513 14:16:57 1 A. I have no independent recollection of that outside of my 14:17:00 2 notes. The notes talk about at one point that he values his 14:17:04 3 wife's support. There are a couple of notes about his 14:17:06 4 daughter. And beyond that, I have no other recollection and 14:17:09 5 there's nothing in the notes to indicate that. 14:17:12 6 Q. I noticed that when we went through. And when you write 14:17:15 7 down something like 'values his wife's support,' does that 14:17:18 8 mean that he is getting that support and appreciates it? 14:17:23 9 A. Well, let's see. Do you know which -- 14:17:25 10 Q. Yes, sir, I think I highlighted it for you. 14:17:31 11 A. All right. 14:17:31 12 Q. It is in the 2/23/90 visit. 14:17:34 13 A. Okay, actually the actual words he emphasized are the 14:17:38 14 importance of wife's support. That is -- the whole sentence 14:17:41 15 says emphasized progress he's made and he emphasized 14:17:46 16 importance of wife's support. 14:17:47 17 In that context it appears to me he believes his wife 14:17:50 18 is supportive and that that's been important to him. 14:17:54 19 Q. Did you believe he needed both the medication as well as 14:17:57 20 the individual psychotherapy? 14:17:58 21 A. Yes, I did. 14:17:59 22 Q. Can you explain why, why it is in your judgment that it is 14:18:03 23 helpful for someone to have both of these forms of therapy 14:18:06 24 together? 14:18:07 25 A. Yes. My experience to that point in 1990 had taught me 1514 14:18:11 1 that patients with clinical illness like major depression 14:18:14 2 need or will do better with a combination of treatment. Not 14:18:17 3 only the appropriate medication to regulate whatever 14:18:20 4 biomechanical/biological abnormality may be present, but also 14:18:25 5 psychotherapy, both to identify maladaptive ways of dealing 14:18:29 6 with stressors, as well as identify better coping skills, as 14:18:34 7 well as a relationship with a treating professional to 14:18:37 8 understand the clinical problem, and also, as we talk about 14:18:42 9 later on in the course of Mr. Schell's treatment, 14:18:44 10 understanding what needs to be done to prevent or minimize 14:18:47 11 relapse. 14:18:48 12 Q. Now, is that what -- what you in your profession refer to 14:18:53 13 as a therapeutic alliance? 14:18:55 14 A. Yes. 14:18:55 15 Q. And can you just sort of put that in plainspeak for us. 14:18:58 16 What is therapeutic alliance? 14:18:59 17 A. In plainspeak, a therapeutic alliance is a working 14:19:03 18 relationship between the patient and his doctor in which both 14:19:06 19 respect and trust each other. 14:19:07 20 Q. Did you believe that you had a good therapeutic alliance 14:19:10 21 with Donald Schell? 14:19:12 22 A. Absent any evidence to the contrary in my notes, yes. 14:19:15 23 Q. I didn't see any, but I just wanted your testimony on it. 14:19:19 24 Did this man want your help and did he want to get better? 14:19:22 25 A. I believe he did, both in terms of that it would appear 1515 14:19:25 1 that he himself contacted my office and that he was quite 14:19:29 2 faithful in working with me over a period of almost a year. 14:19:32 3 Q. Was he a compliant patient? 14:19:34 4 A. According to the record, yes. 14:19:36 5 Q. And what do we mean by that? 14:19:37 6 A. What I would mean by that is that when I have proposed a 14:19:41 7 plan he appears to have followed it, and what I also mean by 14:19:44 8 that is that he continued treatment with me. What I also 14:19:47 9 mean by that is it would appear from my record that he was 14:19:50 10 using the medication appropriately and not requesting extra 14:19:53 11 or saying, 'I don't need it because I didn't take as much,' 14:19:57 12 or anything like that. 14:19:59 13 That is, there seems to be no evidence like that in 14:20:01 14 the record and the prescription amounts would appear to be 14:20:05 15 consistent with what would be needed from visit to visit. 14:20:08 16 Q. Okay, sir. Now, let me ask you something. You mentioned 14:20:11 17 a Dr. B that had apparently given him some Prozac briefly in 14:20:16 18 the spring of '89. 14:20:18 19 A. Yes. 14:20:18 20 Q. Would that have been Dr. Buchanan rather than 14:20:21 21 Dr. Bresnahan? 14:20:24 22 A. It could have been. I have no independent recollection of 14:20:31 23 that. Dr. Bresnahan is a psychiatrist that I believe was in 14:20:31 24 town at that time, but if you have information that it was 14:20:34 25 Dr. Buchanan, that -- I have no way of knowing. 1516 14:20:40 1 Q. Do you know Dr. Buchanan? 14:20:43 2 A. I don't recall. 14:20:43 3 Q. Now, let's get specifically to the medications, if we can. 14:20:47 4 A. Yes. 14:20:48 5 Q. At the time he first came to see you he had already been 14:20:50 6 started by his GP on Desyrel and Ativan, correct? 14:20:55 7 A. Yes, that is correct. 14:20:56 8 Q. Can you tell me what classification of drugs Desyrel is 14:21:00 9 in? 14:21:00 10 A. Yes. It is an antidepressant. 14:21:04 11 Q. What kind? 14:21:04 12 A. What kind? 14:21:05 13 Q. Is it a tricyclic? 14:21:07 14 A. No, it is -- at the time in 1990 it was in class by 14:21:11 15 itself. It was not a traditional tricyclic antidepressant. 14:21:16 16 It was not the new kid on the block, SSRI, Prozac. And it 14:21:20 17 was not an even older type of medication, monoamine oxidase 14:21:27 18 inhibitor, MAOI. So it was in a class by itself. 14:21:31 19 Q. Did it have any effects, insofar as you can recollect, on 14:21:34 20 the serotonin system? 14:21:37 21 A. Certainly. It was designed to enhance serotonin, as most 14:21:39 22 antidepressants are. 14:21:41 23 Q. But in a different way rather than blocking the reuptake, 14:21:44 24 right? 14:21:45 25 A. I'm not sure. 1517 14:21:45 1 Q. In any event, you continued him on the Desyrel for a 14:21:49 2 period of time but then switched over to Prozac, correct? 14:21:53 3 A. That is correct. 14:21:54 4 Q. Was Prozac, to use your words, the new kid on the block in 14:21:59 5 1990? 14:21:59 6 A. I believe it was. I don't know if it was the newest 14:22:02 7 antidepressant in 1990, but it was certainly one of the newer 14:22:06 8 ones. And it was the first of what is now recognized as the 14:22:09 9 class of SSRIs, serotonin selective reuptake inhibitors. 14:22:15 10 Q. Dr. Suhany, have you, since Paxil came out in 1992, had 14:22:18 11 occasion to prescribe Paxil for patients? 14:22:21 12 A. Yes, I have. 14:22:21 13 Q. And I believe it is also an SSRI, right? 14:22:23 14 A. Yes, it is. 14:22:24 15 Q. How about Zoloft which also came out in '92? Have you had 14:22:29 16 occasion since 1992 to prescribe that for patients? 14:22:33 17 A. Yes, I have. 14:22:34 18 Q. And can you tell me whether or not Paxil is a more potent 14:22:39 19 inhibitor of the reuptake of serotonin than Prozac? 14:22:42 20 A. I don't know. 14:22:52 21 Q. All right. Now, let's back up a minute. At the time he 14:22:56 22 first came to you, in addition to being on the antidepressant 14:23:00 23 Desyrel, he was also on Ativan, correct? 14:23:03 24 A. That is correct. 14:23:03 25 Q. Is that in a classification of drugs known as 1518 14:23:06 1 benzodiazepines? 14:23:07 2 A. Yes, it is. 14:23:07 3 Q. Are they generally thought to be antianxiolytic 14:23:12 4 medication? 14:23:13 5 A. Yes, anxiolytic medications. 14:23:18 6 Q. That's a tenpenny word, too. Can you put that in 14:23:20 7 plainspeak for us? What do they do for you? 14:23:24 8 A. Antianxiety, depress anxiety. 14:23:26 9 Q. Do they also have a sedative or calming effect on a 14:23:30 10 person? 14:23:30 11 A. Yes, that would be another way of describing its 14:23:33 12 antianxiety effect, sedative effect reference to the fact it 14:23:42 13 helps people sleep at bedtime. 14:23:44 14 Q. Doctor, had you had occasion prior to Donald Schell to 14:23:48 15 prescribe Prozac for someone else? 14:23:52 16 A. I believe so, yes. 17 Q. Was it typical in your practice at that time, when you 14:23:53 18 were starting someone on Prozac, to give them Ativan or some 14:23:55 19 other benzodiazepine concomitantly; in other words, the first 14:24:00 20 period of time? 14:24:01 21 A. That would not have been my common practice in 1990 and it 14:24:05 22 isn't my common practice now. 14:24:08 23 Q. Were you aware of the fact in the spring of 1990 that the 14:24:11 24 maker of Prozac, Eli Lilly, had a warning in the Federal 14:24:15 25 Republic of Germany that recommended that doctors give 1519 14:24:20 1 sedatives along with Prozac in the initial period in order to 14:24:24 2 reduce the risk of suicide? 14:24:26 3 A. No, I was not aware of that. 14:24:28 4 Q. In any event, you start him on Prozac, let's see, when? 14:24:32 5 You start him on the 23rd of January; is that correct? 14:24:39 6 A. Sometime between the 23rd of January and the 22nd of 14:24:42 7 February. It looks like much closer -- 14:24:44 8 Q. You gave a prescription for Desyrel and Prozac, and he was 14:24:47 9 to, what, taper down on the Desyrel and if that didn't work, 14:24:51 10 then go to Prozac? 14:24:53 11 A. Yes, that was our plan as of 1/23. 14:24:56 12 Q. Now, when you see him on February 2nd, the next time after 14:25:00 13 that, would you just tell me there what are the two things 14:25:02 14 that you think may be side effects of Prozac according to 14:25:06 15 your entry? 14:25:07 16 A. Increased anxiety and loss of appetite. 14:25:10 17 Q. Okay, sir. When you write under February 2nd, 14:25:13 18 increased -- I'm sorry -- obvious somatic anxiety today, is 14:25:17 19 that an observation that you're making objectively rather 14:25:25 20 than reporting subjectively? 14:25:25 21 A. With the use of the word 'obvious' and the use of the word 14:25:26 22 'today,' I believe it is an observation that I'm making 14:25:29 23 rather than a self-report by the patient. 14:25:31 24 Q. Can you tell me what you would have seen or heard 14:25:33 25 typically from a patient like Mr. Schell to cause you to make 1520 14:25:37 1 that entry, obvious somatic anxiety today? 14:25:42 2 A. The kinds of things -- and I can't be certain that these 14:25:46 3 were present in Mr. Schell, but the kinds of things that I 14:25:48 4 would -- that I would mean by that kind of notation is really 14:25:52 5 physical signs of anxiety, such as trembling in hands, such 14:25:56 6 as like tapping fingers incessantly, you know, on a desk or 14:26:01 7 something, frequent and incessant-like foot tapping or other 14:26:04 8 jittery motions of the body, possibility some difficulties 14:26:08 9 with speech, like rapid speech or possibly, you know, a lot 14:26:11 10 of sighing, something that would indicate problems with 14:26:13 11 anxiety or nervousness. 14:26:14 12 Q. All right. But, in other words, something that you could 14:26:17 13 physically see; is that right? 14:26:18 14 A. My understanding of that notation would be that it was 14:26:23 15 something I saw that day, yes. 14:26:24 16 Q. And would it be fair to say that 11 years later, you know, 14:26:28 17 you don't recall specifically which one of those outward 14:26:31 18 symptoms you saw? 14:26:32 19 A. It is definitely fair to say that. I do not have 14:26:35 20 independent recollection. 14:26:37 21 Q. All right. Now, that is on February the 2nd, and the -- a 14:26:40 22 month later, on March the 2nd, you make another entry about 14:26:44 23 increased anxiety and also say, 'This week he has developed 14:26:50 24 trembling of hands.' What was -- 14:26:52 25 A. In, I believe that is. 1521 14:26:55 1 Q. What -- the fact that he had developed trembling of hands 14:26:58 2 recently? 14:26:58 3 A. The significance would be, first of all, that it was 14:27:01 4 something new; secondly, that either he had noticed it and 14:27:06 5 complained about it or that I had noticed it. 14:27:08 6 Q. Can you tell from your records which one that was, whether 14:27:12 7 it was something he reported to you or whether it was 14:27:14 8 something you observed? 14:27:15 9 A. I cannot tell based on the entry. 14:27:19 10 Q. Can you tell whether or not you believe that this was a 14:27:21 11 side effect of Prozac? 14:27:23 12 A. I questioned myself whether it was. 14:27:25 13 Q. And you gave him some medication that day to help deal 14:27:27 14 with that side effect, didn't you? 14:27:29 15 A. Yes, which makes me assume, although I will caution you it 14:27:32 16 is an assumption, that I myself saw a tremor or a trembling 14:27:37 17 that day since I had recommended a specific treatment. 14:27:39 18 Q. The treatment that you gave was a category of medicines 14:27:42 19 known as beta-blockers, correct? 14:27:45 20 A. That is correct. 14:27:45 21 Q. And specifically a medicine called Inderal? 14:27:48 22 A. Yes. 14:27:49 23 Q. Can you just explain for us in plain terms what a 14:27:52 24 beta-blocker is? 14:27:54 25 A. Beta-blockers are used primary for difficulties in 1522 14:27:58 1 cardiovascular systems, particularly in patients with high 14:28:02 2 blood pressure. And it slows down their heart rate and so it 14:28:06 3 makes their blood pressure decrease. In this context, 4 beta-blockers have been know for a long time to decrease what 14:28:08 5 are usually called bodily or somatic symptoms of anxiety, 14:28:12 6 particularly tremors, butterflies in the stomach, difficulty 14:28:16 7 with speech. Some patients have been given Inderal for 14:28:20 8 so-called performance anxiety. 14:28:24 9 Q. Is propranolol a beta-blocker? 14:28:31 10 A. Propranolol is the generic form of Inderal. 14:28:35 11 Q. Have you -- 14:28:35 12 A. It is the same medication 14:28:37 13 Q. Have you seen in the literature recommendations that 14:28:38 14 beta-blockers be used to treat SSRI-induced movement 14:28:41 15 disorders? 14:28:41 16 A. You mean did I have that information in 1990? 14:28:44 17 Q. Well, your point is well taken. Did you have that 14:28:47 18 information in 1990? 14:28:48 19 A. I believe I did. 14:28:49 20 Q. Have you subsequently in the years since then learned that 14:28:56 21 that is a selective treatment for SSRI-induced movement 14:29:00 22 disorders? 14:29:01 23 A. I'm aware of some of those kinds of reports. 14:29:04 24 Q. Now, Miss Westby asked you whether or not you would 14:29:08 25 diagnose this trembling you noticed as akathisia. Have you 1523 14:29:11 1 ever made a diagnosis in any patient of akathisia? 14:29:14 2 A. Yes, I have. 14:29:15 3 Q. Can you tell us what are the diagnostic criteria for 14:29:17 4 akathisia? 14:29:18 5 A. Yes. The primary feature of akathisia is an inability to 14:29:22 6 sit down or otherwise control gross motor behavior. Along 14:29:25 7 with that, patients themselves report intense discomfort and 14:29:29 8 inability to stop themselves from, like, pacing around or 14:29:32 9 from sitting down -- or not being able to sit down, actually. 14:29:35 10 So it is both a physical symptom as well as a discomfort that 14:29:39 11 patients feel. 14:29:40 12 Q. And are those diagnostic criteria taken from a big, old 14:29:44 13 book you have in your office called the DSM-IV? 14:29:48 14 A. Well, I don't think that akathisia is described in the 14:29:50 15 DSM-IV since it is not a clinical syndrome, but it is, 14:29:54 16 rather, a side effect of medications. 14:29:56 17 Q. Actually, I think you will find it under 14:29:58 18 neuroleptic-induced akathisia in the new version, but in any 14:30:02 19 event, is akathisia by definition something that is drug 14:30:05 20 induced? 14:30:13 21 A. Yes. 14:30:13 22 Q. Were you in early 1990 familiar with the literature 14:30:13 23 concerning Prozac and akathisia? 14:30:13 24 A. No. 14:30:13 25 Q. In February of '90, that's when you had him on Prozac, 1524 14:30:16 1 right? 14:30:17 2 A. Yes, that's when we started. 14:30:20 3 Q. And in that very month an article came out in a journal by 14:30:24 4 Dr. Teicher and Dr. Cole about suicides, the possible 14:30:27 5 connection between Prozac and suicide. Did you read that 14:30:30 6 article then? 14:30:33 7 A. I don't know. 14:30:33 8 Q. Are you aware of that article now? 14:30:35 9 A. Not by the information that you've given me." 14:30:36 10 MR. ZVOLEFF: Okay, sir. 14:30:43 11 MR. VICKERY: Down to line 21. 14:30:46 12 Q. "Dr. Suhany, in your practice in Gillette would drug 14:30:50 13 representatives periodically call on you to tell you about 14:30:53 14 their medications? 14:30:54 15 A. Not commonly in my private practice. 14:30:56 16 Q. Do you know whether or not anyone from Eli Lilly had ever 14:30:59 17 contacted you prior to February of 1990 to give you 14:31:03 18 information or promotional literature about Prozac? 14:31:06 19 A. I don't know for sure, but I would expect, yes." 14:31:12 20 MR. ZVOLEFF: Now to Miss Westby's follow-up 14:31:15 21 questions on line 16. 14:31:18 22 MS. WESTBY: Yes. 14:31:19 23 Q. "You were talking with Dr. Vickery about the entry on 14:31:22 24 2/2/90, obvious somatic anxiety today? 14:31:26 25 A. Yes. 1525 14:31:26 1 Q. The only actual description of a physical symptom in any 14:31:29 2 of your notes is the trembling in the hands, is that correct, 14:31:33 3 which occurs in your note on 3/2 of '90? 14:31:36 4 A. Yes, as near as I can tell and remember in looking at 14:31:39 5 those notes today. 14:31:40 6 Q. Okay. So when you were describing some of the typical 14:31:44 7 physical symptoms that generally represent anxiety or 14:31:48 8 physical or somatic anxiety, you don't know specifically what 14:31:51 9 you meant by that entry, those were just some general ideas 14:31:56 10 of what may have been meant by that entry; isn't that 14:31:59 11 correct? 14:31:59 12 A. Yes, as I think I tried to say earlier. But that is what 14:32:02 13 I meant. 14:32:03 14 Q. Okay. 14:32:04 15 A. I can't be certain what exactly I observed on 2/2. I was 14:32:08 16 listing categories of things I might have observed that would 14:32:12 17 lead me to make that entry. 14:32:14 18 Q. But you don't have any specific entry about any kind of 14:32:17 19 physical symptom on 2/2; is that correct? 14:32:23 20 A. That is correct. 14:32:23 21 Q. And the only entry that appears anywhere in the records is 14:32:26 22 on 3/2 and that is trembling in hands; is that correct? 14:32:30 23 A. 3/2, and I think there's some mention in the next 14:32:33 24 appointment, 3/9, that the tremors continued until after he 14:32:37 25 took Inderal, but then he couldn't take Inderal." 1526 14:32:51 1 MS. WESTBY: I will start on 24 -- "That's all the 14:32:53 2 questions" -- 14:32:54 3 MR. ZVOLEFF: 61, line 1. 14:32:55 4 A. "Oh just -- I was just looking, just to be completely 14:32:58 5 fair. On 3/15 there also is a mention that the tremors have 14:33:01 6 markedly decreased. That's after the switch to imipramine. 14:33:05 7 Q. Okay. But still the only physical symptom that's noted is 14:33:09 8 trembling in hands and either the fact that it is there or it 14:33:13 9 is decreasing; is that true? 14:33:14 10 A. That is true." 14:33:16 11 MR. ZVOLEFF: Now, down to line 20 on 61, by 14:33:22 12 Mr. Vickery. 14:33:24 13 Q. "Doctor, the entry on 2/2/90, the list of symptoms that 14:33:29 14 you ran down that would cause you to write obvious somatic 14:33:32 15 anxiety today, first of all, they're all some kind of outward 14:33:38 16 manifested motor movement, correct? 14:33:40 17 A. I believe so, yes. 14:33:41 18 Q. And they include both foot tapping and jitteriness, right? 14:33:46 19 A. I believe I mentioned that, yes." 14:33:56 20 MR. ZVOLEFF: That's all, Your Honor. 14:33:56 21 THE COURT: Thank you very much. 14:34:06 22 Mr. Preuss, call your next witness. 14:34:08 23 MR. PREUSS: Yes, Your Honor. Defendant will call 14:34:10 24 John Mann at this time. 25 (Witness sworn.) 1527 1 THE CLERK: Please state your name and spell it for 14:35:33 2 the record. 14:35:33 3 THE WITNESS: My name is John Mann, 14:35:39 4 M A N N. 5 6 JOHN MANN, M.D., Ph.D. 7 called as a witness on behalf of the Defendant, being first 8 duly sworn, testified as follows: 9 DIRECT EXAMINATION 14:35:41 10 Q. (BY MR. PREUSS) Good afternoon, Dr. Mann. 14:35:42 11 A. Good afternoon. 14:35:43 12 Q. You're a physician? 14:35:44 13 A. I am. 14:35:45 14 Q. Medical doctor? 14:35:46 15 A. That's correct. 14:35:46 16 Q. Where were you born and raised, sir? 14:35:49 17 A. I was born and raised in Australia, northern Australia. 14:35:53 18 Q. Did you receive your education there, sir? 14:35:55 19 A. Yes, I did; went to high school, medical school, did 14:36:00 20 postgraduate studies there, residency training. 14:36:04 21 Q. All right. And in what area did you do your residency, 14:36:08 22 sir? 14:36:09 23 A. First I did internal medicine and then I did psychiatry, 14:36:13 24 and then I did a doctorate in neurochemistry. 14:36:16 25 Q. And both your internal medicine and psychiatry residency 1528 14:36:20 1 was at the Royal Melbourne Hospital; is that correct? 14:36:24 2 A. Yes, that's correct. 14:36:25 3 Q. And then you went on from there to get a doctorate at the 14:36:28 4 University of Melbourne? 14:36:31 5 A. Yes, I did. 14:36:33 6 Q. And what was the thesis of your doctorate, sir? 14:36:36 7 A. It was looking at aspects of brain chemistry involved in 14:36:39 8 certain psychiatric conditions such as depression, 14:36:43 9 schizophrenia and some neurological disorders like 14:36:48 10 Huntington's disease. 14:36:49 11 Q. Now, are the degrees of educational achievement in 14:36:58 12 Australia the same as they are here and if not, could you 14:36:58 13 tell us how you would translate those? 14:36:58 14 A. Well, in Australia you graduate with a degree called a 14:37:01 15 Bachelor of Medicine and Bachelor of Surgery. And then if 14:37:04 16 you do a doctorate, it is a Doctorate of Medicine. 14:37:08 17 Q. Would that be like our Ph.D.? 14:37:10 18 A. It is similar to the M.D./Ph.D. designation in the states. 14:37:15 19 Q. So you were licensed to practice medicine, psychiatry in 14:37:19 20 particular, in Australia, then? 14:37:21 21 A. Yes, I was actually -- I have done the board examinations 14:37:24 22 in both internal medicine and psychiatry. 14:37:28 23 Q. What happened to make you come to this country, sir? 14:37:32 24 A. I wasn't chased out. I was interested in pursuing a 14:37:39 25 career in medical research, so that in Australia you go into 1529 14:37:44 1 medical school straight out of high school, so by the time 14:37:47 2 you finish medical school you're still a kid. And I thought 14:37:53 3 it is a long way from the rest of the world. I thought it 14:37:56 4 would be interesting to spend a couple of years doing 14:37:58 5 research overseas. 14:38:01 6 And there was an Australian guy from the States came 14:38:07 7 and gave a lecture, and I talked to him about it and he gave 14:38:11 8 me a job. 14:38:12 9 Q. Where was that job, sir? 14:38:14 10 A. That was in New York, New York University Medical School. 14:38:18 11 Q. And that was -- what was the nature of the job you had 14:38:20 12 there? 14:38:20 13 A. Well, I came as a research fellow and then after a while 14:38:25 14 got promoted to assistant professor. 14:38:28 15 Q. About what time are we talking about when you came here 14:38:31 16 and started that? 14:38:32 17 A. That was 1978, and at the end of -- in 1980 he left for a 14:38:38 18 position as chairman in another state. And I wasn't sure 14:38:45 19 what to do because in Australia people generally got 14:38:52 20 educated, grew up, got married, had their job and retired all 14:38:56 21 in the same place. Nobody ever moved from one state to 14:38:59 22 another. That was pretty unusual. 14:39:00 23 So I was pretty surprised when he got up and left 14:39:04 24 after two years. But I was fortunate, somebody gave me a 14:39:08 25 position at Cornell to do a similar type of work, and so I 1530 14:39:12 1 stayed on. 14:39:13 2 Q. All right. So you moved then from New York University 14:39:16 3 Medical School to Cornell? 14:39:18 4 A. That's correct. I was there for ten years, and by then I 14:39:24 5 had three kids that had been in the States too long to pick 14:39:29 6 up and move back to Australia, so here I am. 14:39:33 7 Q. So you've been here ever since? 14:39:35 8 A. That's correct. 14:39:36 9 Q. And what was your research interest while you were at 14:39:40 10 Cornell, sir? 14:39:42 11 A. Well, all along the department where I trained in 14:39:46 12 Australia had a tradition of studying depression, and in 14:39:52 13 particular the treatment of depression. Lithium, that a lot 14:39:58 14 of people in the courtroom probably have heard of which is 14:40:01 15 used for the treatment of manic depression, was discovered by 14:40:06 16 an Australian in that department. 14:40:08 17 So the first clinic for the use of the lithium in 14:40:11 18 people with depression and manic depression was in a 14:40:17 19 hospital. So I developed an interest in depression, and with 14:40:21 20 the doctorate I got sort of into the chemical side of 14:40:24 21 depression and how depression worked. 14:40:30 22 Q. After Cornell where did you go, sir? 14:40:33 23 A. I was there for ten years, which is a long time, and the 14:40:36 24 research was going pretty well. I got a center grant at 14:40:40 25 Cornell and discovered something about the States, which is 1531 14:40:43 1 that there's a sort of free agent market out there. And I 14:40:50 2 got an offer and went to the University of Pittsburgh which 14:40:52 3 was very active in promoting research at the time. 14:40:55 4 Q. And you continue to pursue your research activities at the 14:40:59 5 University of Pittsburgh? 14:41:00 6 A. I was there for five years. The kids weren't too happy 14:41:04 7 because they liked New York. They had grown up there. Their 14:41:07 8 friends were there. So, you know, we liked to have kids at 14:41:12 9 home so we -- or nearby, not too far away, so I looked for 14:41:18 10 another job and got a job back in New York at Columbia. And 14:41:22 11 I've been there ever since, seven years. 14:41:24 12 Q. So you and your family live in New York? 14:41:27 13 A. Yes, pretty much everybody. 14:41:28 14 Q. What are the ages of your children, sir? 14:41:31 15 A. Well, I have a daughter who is 27, a son who is 25 and a 14:41:37 16 21-year-old son. 14:41:40 17 Q. The 21-year-old is the last one at home? 14:41:42 18 A. Yes, right. We're not in a rush to let him go. 14:41:49 19 Q. Now, since coming to the United States have you 14:41:51 20 licensed -- have you licensed yourself to practice medicine 14:41:55 21 here, sir? 14:41:56 22 A. Yes, I have a medical license in New York state and in the 14:42:00 23 Commonwealth of Pennsylvania. 14:42:02 24 Q. And have you been board certified in this country? 14:42:05 25 A. I have, in psychiatry and neurology with the specialty in 1532 14:42:09 1 psychiatry. 14:42:13 2 Q. All right. What are your present positions at Columbia 14:42:16 3 University, sir? 14:42:18 4 A. I'm a professor of psychiatry and radiology and chief of 14:42:25 5 the Division of Neuroscience in the university, but also I 14:42:26 6 have an appointment at New York State Psychiatric Institute 14:42:29 7 which is part of the medical campus of Columbia University 14:42:32 8 and there I head one of the departments. 14:42:39 9 Q. You mentioned radiology. How does that tie into your 14:42:42 10 pursuit of psychiatry? 14:42:44 11 A. I spent a let of time studying about the chemistry of 14:42:47 12 conditions like depression and the biochemical factors that 14:42:51 13 predispose people to suicide. I became interested in trying 14:42:55 14 to figure out ways of imaging the brain so that clinicians 14:43:01 15 could do biochemical radiological assessments of patients and 14:43:05 16 try to figure out which depressed patients are going to be at 14:43:07 17 risk for suicide. 14:43:09 18 Q. Basically looking into the brain, then? 14:43:11 19 A. That's correct, taking a picture of the biochemistry of 14:43:15 20 the brain. We can do that now. 14:43:17 21 Q. You indicated that you were chair or chief of the 14:43:22 22 Department of Neuroscience at New York Psychiatric Institute; 14:43:26 23 is that correct? 14:43:27 24 A. It is. 14:43:27 25 Q. And that's affiliated with Columbia, right? 1533 14:43:31 1 A. That's correct. 14:43:31 2 Q. And what kinds of responsibilities do you have as the 14:43:34 3 chief of that department, sir? 14:43:36 4 A. I'm responsible for about 150 staff and faculty, for the 14:43:44 5 productivity of those individuals in terms of science, for 14:43:48 6 the quality of the work, for compliance with the regulations 14:43:53 7 involving the ethics of doing research with patients and so 14:43:58 8 on and so forth, the safety of the research. 14:44:01 9 Q. Now, do you have a private practice, sir? 14:44:04 10 A. Yes, I do. 14:44:05 11 Q. And what does that involve? 14:44:07 12 A. That involves some hours in the later part of the day, in 14:44:12 13 the evenings a few days a week taking care of patients who 14:44:15 14 suffer from almost all -- mostly depressions, fairly severe 14:44:21 15 depressions, often with suicidal feelings or history of 14:44:25 16 suicidal behavior. 14:44:27 17 Q. And do you use antidepressants for therapy of those 14:44:30 18 patients, sir? 14:44:30 19 A. Yes, I do. 14:44:31 20 Q. Would that include SSRIs? 14:44:34 21 A. Yes. 14:44:34 22 Q. And Paxil? 14:44:36 23 A. It includes Paxil. 14:44:39 24 Q. Now, I see from your CV, sir, that you published a number 14:44:43 25 of articles in the medical journals; is that correct? 1534 14:44:47 1 A. Yes. 14:44:49 2 Q. Well over 200, I believe. How many of those focus on your 14:44:52 3 interest in suicide and depression? 14:44:57 4 A. The vast majority would be on either suicide or 14:45:02 5 depression. 14:45:02 6 Q. And you serve, I see, on ten different editorial boards. 14:45:06 7 Is that correct? 14:45:07 8 A. It is possible. 14:45:08 9 Q. And what does it mean to serve on an editorial board of a 14:45:11 10 journal, sir? 14:45:12 11 A. Mostly it involves reviewing papers that are submitted to 14:45:19 12 the journal by people who want to publish in that journal. 14:45:24 13 There are editorial meetings usually once a year and there's 14:45:28 14 discussion as to what the direction of the journal should be, 14:45:34 15 what papers it should try to attract, the quality of papers 14:45:37 16 it is attracting and publishing. 14:45:39 17 Q. I see that you're the biological editor for the Journal of 14:45:43 18 Suicide and Life-Threatening Behavior. What responsibilities 14:45:46 19 do you have as a biological editor, sir? 14:45:48 20 A. It means that I tend to see all of the biological papers, 14:45:56 21 papers that look at the biology of suicidal behavior, why 14:45:59 22 people commit suicide, why they don't commit suicide. 14:46:06 23 Q. And your CV indicates that you've had a number of honors. 14:46:09 24 Can you tell me about the Erma T. Hershal Trust Research 14:46:14 25 Science Award? What did that involve, sir? 1535 14:46:18 1 A. That was an award to help a young investigator develop a 14:46:24 2 research career. It provides funding for research for a 14:46:31 3 number of years, so instead of spending all day seeing 14:46:33 4 patients and trying to make a living, there was some 14:46:36 5 opportunity to have a few hours off to do some more research. 14:46:40 6 Q. And it looks like you were the recipient of that award for 14:46:43 7 a four-year period? 14:46:45 8 A. That's correct. 14:46:46 9 Q. How about the award of being a fellow of the American 14:46:50 10 Psychiatric Association? What did that involve? 14:46:54 11 A. That's an honorific promotion given by the American 14:47:02 12 Psychiatric Association to a limited number of individuals 14:47:03 13 each year. 14:47:05 14 Q. And in 1996 you received an award from the American 14:47:08 15 Association of Suicidology known as the Lewis Dublin Award. 14:47:13 16 What did that involve, sir? 14:47:16 17 A. That was for research into the factors that predispose 14:47:20 18 people to suicidal behavior. 14:47:22 19 Q. Are you still pursuing your research interests at this 14:47:26 20 time, sir? 14:47:27 21 A. Yes, I am. 14:47:28 22 Q. And what's your main focus at this time, sir? 14:47:36 23 A. I've devoted my career, really, to trying to discover the 14:47:39 24 reason why people who have become depressed are at risk for 14:47:44 25 suicidal behavior. Not everybody who is depressed is at risk 1536 14:47:54 1 for suicidal behavior. Most people who are depressed never 14:47:54 2 make a suicide attempt, but a lot do. And there are many 14:47:56 3 people who have depression every year in the United States 14:47:59 4 and they account for over 20,000 suicides each year. So I've 14:48:03 5 dedicated my career to trying to find out why they do that 14:48:06 6 and how to prevent it. 14:48:08 7 Q. And do you obtain grants from time to time to pursue that 14:48:12 8 interest, sir? 14:48:13 9 A. Yes, we try to do that. 14:48:15 10 Q. Have you received any from GlaxoSmithKline for your 14:48:18 11 research? 14:48:19 12 A. No. 14:48:23 13 Q. Tell me why you have chosen to devote your professional 14:48:27 14 life toward the study of suicide and why it occurs and how it 14:48:30 15 can be treated. 14:48:31 16 A. Suicide is not a consequence of stressors in life. It 14:48:38 17 almost invariably occurs in people who already have a 14:48:41 18 psychiatric illness, and we know that by many studies that 14:48:46 19 have gone and interviewed the families to find out why people 14:48:51 20 killed themselves. 14:48:51 21 It turns out that you read in the paper that someone 14:48:55 22 killed himself and he was the most popular kid in school and 14:48:58 23 a great athlete and doing well academically. When you 14:49:02 24 interview the family and find out more about this sad death, 14:49:05 25 you find it is not like that at all. 1537 14:49:08 1 It turns out that in young people and in older 14:49:11 2 people, by far the commonest association of suicide is with a 14:49:16 3 psychiatric illness. In fact, we find there is a diagnosable 14:49:20 4 psychiatric illness in over 90 percent of people, so that the 14:49:23 5 path, the way in which you're going to prevent suicide, is 14:49:26 6 not by improving parenting in the U.S. or by cutting down 14:49:33 7 violence on television. 14:49:34 8 It is first and foremost by treating psychiatric 14:49:38 9 conditions better and getting people better because people 14:49:42 10 who don't have a psychiatric illness almost never commit 14:49:45 11 suicide. It is exceedingly rare. 14:49:49 12 Q. Doctor, we talked about your work on editorial boards and 14:49:54 13 some of your achievements. Have you been asked to serve on 14:49:57 14 any task forces that have focused their investigation on the 14:50:01 15 causes and prevention of suicide? 14:50:08 16 A. Well, I served on -- as an ad hoc member of an advisory 14:50:15 17 committee for the FDA in 1991 which looked at the question of 14:50:20 18 whether antidepressants, in particular Prozac, had an effect 14:50:26 19 in promoting suicidal behavior. 14:50:29 20 I was the chairman of a task force set up by the 14:50:33 21 American College of Neuropsychopharmacology, which is a bit 14:50:37 22 of a mouthful. I'm sorry. But it is a group of about 4 or 14:50:41 23 500 individuals that are supposedly the main experts in the 14:50:45 24 country on the action of medications on the brain. 14:50:49 25 And this organization was also interested in the 1538 14:50:52 1 question of whether -- what medications did in terms of 14:50:57 2 preventing or perhaps promoting the risk for suicidal 14:51:02 3 behavior that were being used by doctors. And that was -- 14:51:05 4 that report was completed in 1992. 14:51:11 5 Most recently, as we speak now, there's a committee 14:51:14 6 of about 10 or 12 individuals -- I'm not sure of the exact 14:51:18 7 number -- which has been convened by an organization called 14:51:21 8 the Institute of Medicine which is probably the leading 14:51:28 9 organization in the country -- it is located in Washington -- 14:51:30 10 that provides advice to the government on major health 14:51:32 11 issues. 14:51:36 12 And it has been commissioned by the Centers for 14:51:39 13 Disease Control in Atlanta and Surgeon General's office and 14:51:43 14 the National Institute of Mental Health, the National 14:51:45 15 Institute of Drug Abuse and so on to produce a report on 14:51:50 16 suicide in the United States to try and see what do we know 14:51:54 17 about suicide, what causes suicide, what more research needs 14:51:59 18 to be done and what can we do best to prevent it. 14:52:03 19 Q. Can we refer to the second task force, of the American 14:52:07 20 College of Neuropsychopharmacology as the ACNP? 14:52:12 21 A. Yes, ACNP. 14:52:14 22 Q. Thank you. Let's talk a little bit about depression and 14:52:18 23 suicide, Doctor. Is depression a serious health concern in 14:52:23 24 this country? 14:52:24 25 A. Depression, meaning depression the illness, is a major 1539 14:52:26 1 health concern in the United States and worldwide. It has 14:52:32 2 been estimated that depression is the leading cause of 14:52:35 3 disability throughout the world. 14:52:37 4 In other words, it is -- depression, the illness, 14:52:43 5 causes more disability than heart disease, infectious 14:52:47 6 diseases, cancer, malnutrition worldwide, recurrent unipolar 14:52:54 7 depression, just exactly the sort of illness, the same 14:52:59 8 illness that the late Donald Schell suffered from. 14:53:04