Nex Benedict's death ruled a suicide

What comes next?

This post will be very short. The Advocate has an article up about the medical examiner’s report. It reports that Nex’s death was ruled a suicide and that combined diphenhydramine (Benadryl) and fluoxetine (Prozac) toxicity was the direct cause of death. A brief glance at pharmaceutical warnings didn’t reveal risk of death for this interaction. Instead it says this:

Using diphenhydrAMINE together with FLUoxetine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

This does not mean that death is not a possible outcome given enough of these drugs in one’s system. I am neither a doctor nor a pharmacologist. I will be following up with other sources and hope to have more information later.

That said, suicides are caused by bullying, and that sort of causation is beyond the purview of a coroner. Nex had been subject to bullying for quite some time — not from the three girls involved in the assault in the bathroom, Nex says in the interview that they don’t know each other — and I know well that that takes a toll on a person.

If you are experiencing suicidal thoughts or another form of mental health crisis and you don’t already have the help you need to manage them, consider visiting https://988lifeline.org or calling 988. You should feel free to do this if you think someone you know is in this situation. It can be hard to ask for help, so volunteering yourself can be a good thing, and the 988 resource can help you figure out how best to broach the subject.

Be good to each other in the comments, eh?

---

ETA: There’s one documented case in PubMed of this drug combination in a person who died. The case stresses that this was a “massive” overdose of prozac/fluoxetine and that such overdoses can, on their own, cause death (though this is rare). Benadryl overdose can also cause death on its own, and there was exactly one documented case in PubMed about that as well.

I have questions out to medical experts on these things and will let you know when I have more answers, but from my almost entirely uninformed perspective, it seems like it would be less likely to be “combined toxicity” and more that a lethal dose of one (or both) medications was present, with the other drug not helping the situation.

---

Here’s a general PubMed article on fluoxetine overdose. Remembering that every case is different and that we are not medical experts, it’s still interesting to note that the symptoms of uncomplicated fluoxetine overdose (meaning fluoxetine alone without alcohol or other medications present) were generally minor and temporary.

Of the 87 cases where fluoxetine was ingested alone, 67 patients were adults and 20 were children. Symptoms that were seen in the adult group included: tachycardia (15/67), drowsiness (14/67), tremor (five/67), vomiting (four/67), or nausea (four/67). Thirty patients did not develop symptoms. Twelve of the adult overdose patients had total fluoxetine levels ranging from 232 to 1390 ng/mL. The authors conclude that symptoms that develop after an acute overdose of fluoxetine appear minor and of short duration. Aggressive supportive care is the only intervention necessary.

Again, not sure what that means. Perhaps it means the complicating presence of Benadryl really is clinically important. Just because I can only find one other death with these two substances, and that one had lethal levels of fluoxetine alone, does not automatically mean that the Benadryl was irrelevant. It could just be that death from Prozac overdose is rare, and so it’s even more rare to see a Prozac death with Benadryl present. The fact that there aren’t warnings about combined fatal toxicity could just be an artifact of very few people intentionally overdosing on Prozac so we don’t have all the information we need to release a public warning about it.

Of course, that again raises questions about why the medical examiner would note “combined toxicity,” but who knows at this point.