Every morning, before he leaves the house for work, Jim Connell stops at a small table in his hall, lights a candle and says a prayer in memory of his son Darren.
‘It’s a memorial table, with all his Gaelic football medals and a scrapbook that his friends made to remember happy times together,’ says Jim, 47, from Oldcastle in County Meath in the Republic of Ireland.
And every night before he goes to bed, Jim – who is married to Vera, 49, with whom he has four other children – does the same thing again. ‘My last thought before I go to sleep is always Darren – and I know it’s the same for Vera,’ says Jim, who works in the dairy industry.
In September 2019, just a few weeks after his 17th birthday, Darren took his own life.
It was so out of the blue that the family were at an utter loss to explain why their charismatic and popular son, who was looking forward to studying sports science at college and had no history of depression, would kill himself.
In September 2019, just a few weeks after his 17th birthday, Darren took his own life
‘He was always looking forwards – incredibly driven and such an enormous presence in our home,’ says Jim, who came home early from work to find Darren’s body in the garage one morning after being notified by school that he hadn’t turned up.
But in the search for clues as to what led to Darren’s tragic loss, one clear suspect soon emerged. Just two weeks before his death, Darren’s GP had prescribed him a drug called doxycycline to treat acne, after he developed a few spots on his face.
The antibiotic – which he’d never taken before – has been around since the 1960s and has been taken by tens of millions of people globally for everything from chest infections and acne to sexually transmitted infections and malaria prevention.
But while most patients tolerate the drug well, some studies show it can cause sudden suicidal thoughts and behaviour, even in those with no history of mental illness. In Darren’s case, he went from being a vibrant, optimistic and fitness-mad teen to just another suicide statistic in little more than a fortnight.
For Jim and his family, the only explanation for this catastrophic decline is the doxycycline. ‘Darren was the last person you would ever think this would happen to,’ says Jim. ‘We’ve been racking our brains to remember if there were any signs we missed.’
But it’s not just his distraught parents who blame the drug.
In October last year, the coroner for County Meath, in his report on Darren’s death, described the evidence that doxycycline played a part in Darren’s death as ‘compelling’ and called on the Health Products Regulatory Authority (which monitors drug safety in the Republic) to consider whether patient information leaflets for doxycycline should be revised to warn of the risk of sudden suicidal tendencies.
Now Good Health can reveal that the European Medicines Agency (EMA) – which vets the safety and effectiveness of prescription drugs across the European Union – is investigating doxycycline’s psychiatric safety.
The agency announced on its website in July that it was reviewing the evidence on the drug because of a ‘steady stream of reports’ that previously mentally stable people were taking their own lives, often within days or weeks of starting the drug.
Launching the probe, the EMA said: ‘Recent concerns have been raised about the potential neuropsychiatric side-effects of doxycycline, particularly regarding suicidality.
Some studies have suggested a possible link between doxycycline and enhanced risks of depression and anxiety, which are known risk factors for suicidality. Assessing this potential association is crucial for understanding the full safety profile of doxycycline and ensuring patient safety.’
The study review, due to be completed in the next few weeks, is comparing suicide (and attempted suicide) rates among people taking doxycycline with patients on other antibiotic or acne drugs, such as erythromycin, azithromycin and amoxicillin.
At Darren’s funeral, family and friends took the coffin – draped in the colours of Oldcastle football club (his local team) – to the pitch where he played so often
If the EMA finds doxycycline does carry an increased risk – as the families of victims suspect – it may demand that the packaging and patient information leaflets warn of the potential dangers.
Any changes are likely to influence the UK regulator, the Medicines and Healthcare products Regulatory Agency (MHRA), to do the same here. At present, doxycycline labelling makes no mention of mental health risks or suicidal tendencies.
Darren’s story bears worrying similarities with that of Alana Cutland, the 19-year-old Cambridge University student who fell from a light aircraft 5,000 ft over Madagascar in July 2019 after taking doxycycline for 11 days to ward off malaria.
Alana, who was studying biological natural sciences, was on a research trip and became ill within days, showing signs of paranoia and becoming withdrawn. Her worried parents had arranged for flights home, and the plane was transferring her to the main airport.
At her inquest, Milton Keynes coroner Tom Osborne concluded – after consulting experts who were investigating doxycycline’s effects on psychiatric wellbeing – that the drug triggered a ‘psychotic reaction’ and called on the MHRA to review the information given to patients on doxycycline’s dangers.
In a statement to Good Health the MHRA said it ‘continuously monitors’ the safety of all medicines – ‘including the potential safety signal associated with doxycycline and the risk of suicidal thoughts’.
It added: ‘Any emerging evidence is routinely considered, alongside other sources of information, including suspected adverse reactions’. But while the MHRA is still gathering evidence, more studies are highlighting the drug’s apparent psychotic effects, and not just in teens or adults.
In July, researchers at the China Pharmaceutical University published a review of the safety of a class of antibiotics called tetracyclines – which includes doxycycline, often used to treat acne – for children aged eight to 18.
Researchers trawled through almost 20 years’ worth of data from the U.S. Food and Drug Administration’s Adverse Event Reporting System, a catalogue of adverse drug reactions reported by doctors and patients.
Their findings, published in the journal Frontiers in Pharmacology in July, showed that with side-effects such as skin reactions or tummy upsets, doxycycline was no more likely to be a trigger than two other drugs in the same class, minocycline and tigecycline.
But with psychiatric reactions, it was a different story. Out of more than 1,900 adverse reactions of all kinds, there were 44 cases of suicidal thoughts or attempted suicide – and doxycycline accounted for 35 of these. Minocycline, on the other hand, was linked with eight, tigecycline none.
The researchers said: ‘Our study indicates a potential increase in psychiatric risks associated with the use of doxycycline in children, which is not currently mentioned in prescribing information.
‘Specifically, they suggest a possible link between doxycycline and symptoms such as depression, suicidal ideation and suicide attempt. This study appears to be the first to identify the psychiatric risks in children – previous reports documented several severe psychiatric reactions to doxycycline in adults.’
It’s unclear why doxycycline or other drugs in this class could have this effect, but previous studies suggest they may trigger complex interactions with chemicals in the brain that control mood and mental wellbeing, disrupting their mechanism so rapidly and severely that in some cases it leads to sudden mental decline.
Another possibility is that they increase levels of stress hormone cortisol in the brain, which somehow adversely affects behaviour.
David Healy, a former professor of psychiatry at Bangor University in Wales, who was consulted as an expert witness by the coroner in both Darren and Alana’s cases, first raised concerns about the potential harmful effects of doxycycline in 2013.
He told Good Health: ‘There is accumulating evidence that doxycycline can cause problems. I don’t know if the EMA will say we’ve got to mention this on the drug label. But even if it does, it won’t make a huge difference; doctors won’t change the way they practise as a result.
‘They hand this drug out for acne, chest infections or malaria – and they never warn patients.
‘I don’t think doxycycline should be banned, but doctors should be saying to patients ‘if you feel psychologically unwell at any time on the drug then stop taking it immediately’.’
At Darren’s funeral, family and friends took the coffin – draped in the colours of Oldcastle football club (his local team) – to the pitch where he played so often.
‘It was one of the biggest funerals ever seen in this area,’ says Jim, who has met with representatives of the EMA who are carrying out the review to give a detailed account of what happened to his son. ‘Sometimes we’ll go and sit in his bedroom and hold his football jersey close to our faces just to get a sense of his smell. We know nothing is going to bring him back, but doing nothing is not the answer.
‘All we want is safer prescribing guidelines. If Darren had known he was taking a tablet that could have made him depressed, anxious or suicidal, he would have understood the way he was feeling – but there was nothing to warn him.’
If you or anyone you know is at risk, call the Samaritans for free from a UK phone on 116 123 or go to samaritans.org.
