21-year-old Elisa Lam
This is a blog about the bizarre case of 21-year-old Elisa Lam, a Canadian student at the University of British Columbia in Vancouver, whose body was recovered from a water tank atop the Cecil Hotel in Downtown Los Angeles on February 19, 2013.
Many readers may have already seen the related YouTube video which was released by the LAPD. It has gone viral with over 24 million views.
In the footage, below, Lam is seen exiting and re-entering the elevator, talking and gesturing in the hallway outside, and sometimes seeming to hide within the elevator, which itself appears to be malfunctioning. Her actions caught on CCTV prompted many theories about her disappearance and death which include speculations that she was either murdered, died by suicide, or experienced some sort of paranormal activity.
The LAPD was contacted by Lam's parents from their Vancouver home. After an investigation into her whereabouts revealed nothing, the police issued a Missing Person's poster (Fig 1)
(Fig 1)
Sometime after the LAPD publicly released the video, guests at the Cecil Hotel had complained about low water pressure and that the water was black. Upon investigation of the rooftop tanks, Lam's body was found naked with her clothes floating next to her.
Two days later the Los Angeles coroner's office issued a finding of accidental drowning, with bipolar disorder as a significant factor. In June of the same year, a full coroner's report was released. This is where we, for the first time, have access to Lam's toxicology report. The full report lists Lam's death as an "accident."
Before reading it, it's interesting to note that days prior to her death, Lam was room sharing at the hotel. The other two roommates complained to hotel management that Lam's behaviour was "odd". Lam was then moved to a room on her own.
Here's the toxicology report that piqued my interest. (Click on images to enlarge)
As you can see, Lam was medicated with Wellbutrin, Lamictal, Seroquel and Effexor, four potent psychiatric drugs. Four drugs, when taken together, throw up major interactions, as seen here.
Given Wellbutrin, Effexor and Lamictal were found in her system (Fig 2), a logical question is did Lam abruptly stop taking Seroquel?
Tiffany Hahn, a licensed Private Investigator in the State of California, raises a very important question about this. She writes, "Elisa Lam has a prescription for Quetiapine. The Quetiapine was prescribed by Dr. Sarah E. Scarfe and filled at London Drugs (Canadian Pharmacy), 604-570-0252, Prescription Number: 7153992; Prescribed 01/11/2013. She was issued 30 tablets. There were still 20 in the bottle. RX Directions: 2 Tabs QHS PRN (QHS = Abbreviation for L. quaque hora somni, every bedtime; PRN: Abbreviation meaning “when necessary”).
If there are 10 tablets missing from the bottle, Elisa Lam might have taken them in the 21 days between when they were prescribed (January 11, 2013) and her disappearance (February 1, 2013)."
Why then did her prescribing psychiatrist tell her to take one at bedtime and one "when necessary" This would, in essence, be doubling her dose, would it not?
Fig 2
One has to ask why a 21-year-old woman had been prescribed these four drugs given their major interactions when combined. We can see from the report that her prescriber was Dr. Sarah Scarfe, a Psychiatrist who practices at Student Health Services Psychiatry, University of British Columbia, M334-2211 Wesbrook Mall, Vancouver, Canada.
On top of this, it is alleged that Lam also made posts on her blog referring to her Hypomania and depression. She also made a post where she detailed making an appointment with a doctor to discuss Electroconvulsive Therapy.
According to some prescribers, "bipolar disorder" may include psychotic episodes. However if, indeed, Lam was suffering "bipolar disorder", why would her condition cause psychosis and suicidal thinking? Aren't the drugs she was given supposed to effectively treat such things?
Let's look at the four prescription drugs, three of which, were found in her system (Effexor, Lamictal and Wellbutrin)
Wellbutrin - norepinephrine-dopamine reuptake inhibitor (NDRI) (GlaxoSmithKline)
The website VerywellMind tells us, "Antidepressants, including Wellbutrin, are widely used in managing depression in bipolar disorder. There are concerns when it comes to antidepressants and bipolar disease. One of these concerns is called phase switching, which is a shift in mood from depression to mania. This can be a serious problem because mania can result in impulsive or dangerous behavior."
It is used “off-label” to treat bipolar.
Wellbutrin carries a suicide risk on the patient information leaflet. It also carries a warning of akathisia, a condition which is best described as an 'inner restlessness and turmoil' that can become so overwhelming that death is a welcome result.
Lamictal - Antiepileptic (GlaxoSmithKline)
Lamictal was originally developed as an anticonvulsant to treat seizures and is often used with other medications in the treatment of bipolar.
In 2009, the FDA forced manufacturers of all antiepileptic drugs to include new warnings of possible suicide ideation.
The current Lamictal patient information leaflet carries a suicide warning. Akathisia is also listed as a side-effect.
Seroquel - Antipsychotic - AstraZeneca
Seroquel was approved in 2006 for the treatment of depressive episodes in patients diagnosed with bipolar disorder. It carries a suicide risk warning on the patient information leaflet. People taking Seroquel have a 30% to 40% chance of akathisia.
Seroquel has been the subject of more than 25,000 product liability lawsuits, including one brought by federal prosecutors. The federal litigation and other lawsuits alleged that AstraZeneca (Seroquel's manufacturer) did not disclose certain side effects of the drug, and encouraged doctors to prescribe the drug for treatments not approved by the U.S. Food and Drug Administration (FDA).
Effexor - serotonin-norepinephrine reuptake inhibitor (SNRI) - was introduced by Wyeth Pharmaceuticals in 1993. Since 2009, it has been marketed by Pfizer
Not indicated for bipolar, however, according to Psycom.net, "If you have bipolar disorder and take an SNRI, you may be at risk for triggering a manic episode."
In addition to birth defect lawsuits, other claims have been made for suicidal thoughts, violent behaviours and discontinuation syndrome, or on behalf of deceased loved ones.
Effexor carries a suicide warning on its patient information leaflet. Akathisia is also listed as a side-effect.
Four drugs that carry suicide warnings, four drugs prescribed to this 21-year old woman by a psychiatrist, Dr. Scarfe, who works at a university that caters to young people ages 25 and under. The FDA's black box suicide warning for people age 25 and under was supposedly created to help teens and young adults be better informed about critical adverse drug effects. It is not clear whether Dr. Scarfe ever provided informed consent to Elisa. Many psychiatrists fail to provide informed consent and leave it to chance that a young person such as Elisa, would, somehow, automatically know to carefully read the microscopic fine print in each of the four drug leaflets.
Maybe bipolar disorder was a significant factor in this young woman's suicide or maybe, just maybe, the four drugs found in her system, all of which carry suicide warnings, contributed to her obvious psychosis as depicted in the CCTV footage and previous bizarre behaviour with roommates at the Cecil Hotel in Downtown Los Angeles.
In September 2013, Lam's parents, David and Yinna Lam, filed a wrongful death suit, claiming the hotel failed to "inspect and seek out hazards in the hotel that presented an unreasonable risk of danger to Lam. In 2015, the suit was dismissed.
Maybe they would have had better luck filing suit against Lam's psychiatrist given the four drugs Lam was prescribed, three of which were in her system at the time of her increasingly "odd" behaviours and sudden death.
Bob Fiddaman
Learn more about akathisia here
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