Dr Adrian James, President of the Royal College of Psychiatrists, has written to national newspapers responding to recent articles erroneously linking antidepressants to suicide. Here is the full text of the letter.
“I was disappointed to read your article, which has potential to unjustifiably worry readers who are taking anti-depressant medication or know someone who is.
“The study cited in your article found some individuals who died by suicide were taking antidepressants at the time. This is mere association. It does not demonstrate a causal link. It is a fundamental principle of science that correlation does not equate to causation. To suggest otherwise is simply wrong.
“The overwhelming body of medical evidence tells us antidepressants help to reduce the symptoms of and improve the quality of life for adults with moderate and severe depression, as well as anxiety and other mental illnesses.
“While antidepressants can control symptoms, they do not necessarily treat the underlying cause of the depression or eradicate it. For this reason, antidepressants are recommended to be prescribed alongside talking therapies for treatment of depression.
“Ultimately, the choice of treatment should always be a shared decision between patient and doctor, based on clinical need, medical evidence and the preferences of the patient.”
Dr Adrian James President of the Royal College of Psychiatrists
Dr Adrian James President of the Royal College of Psychiatrists
April 25, 2023.
RCPsych President responds to newspaper coverage on antidepressants
Dear Dr James
Your press release risks harming patients and their families more than the article you criticize.
John Read, the author of the paper underpinning the media coverage took care to get the wording right. He notes that in the case of suicides in people taking antidepressants, the antidepressants were clearly not working. He does not say caused the suicide. The press, equally, are not wrong to link antidepressants to suicide.
I reviewed the paper by John Read for Ethical Human Psychology and Psychiatry. I noted the care taken not to go beyond the data and how this was likely to mislead doctors, and the public. I offered Don Marks, the journal editor, an option to publish my review alongside the Read article, which might better inform readers. He accepted. I attach the companion piece to the Read article here.
I imagine you are not aware of the points laid out. If you are aware and have done nothing, I am shocked. In brief, at inquests, doctors do not claim an antidepressant caused a suicide primarily because the doctors are advised by Defense Unions not to blame the drug. This is a business matter. Rather than support a doctor to help a family at a time of great distress, and support him to advance public safety, Defense Unions seek to avoid further costs.
In Samuel Morgan’s case, whose citalopram-induced suicide is Scenario 2 in the paper, the doctor was advised by his Defense Union not to talk to me. He remained silent at the inquest. When a concerned coroner made a Regulation 28 Report, MHRA responded that the doctor had not implicated the drug and therefore they could do nothing.
This is the reason a paper on inquests appears to only produce correlations. Unfortunately, the system is literally a stitch up. It should be your job and the job of the President of the Royal College of General Practitioners to know about and do something about this.
The evidence that antidepressants can cause suicide is unequivocal. I am copying Tania and Ian Morgan, Samuel’s parents, in on this letter. I invite you to tell them, there is no evidence that citalopram killed their son.
You mislead when you say antidepressants treat moderate to severe depression. Older tricyclics can indeed treat melancholia, which comes with a high risk of suicide. Most people, however, will think you are referring to SSRI and related antidepressants. There is no evidence that these drugs are of benefit in moderate to severe depression or that they reduce the risk of suicide in those treated with them.
This is not to say these drugs cannot be of benefit, but the public need an honest appraisal of their role and potential hazards. I can see a role for you and the College to ensure the use of these hazardous drugs is made as safe as possible; you should not be increasing, as you are now, along with the Defense Unions, the chances of a family ending up bereaved as a result of a treatment induced suicide.
In talks on these issues, I commonly use a press release by the American Psychiatric Association from 2004 who were lobbying hard against warnings on antidepressants. Their press release stated that:
The American Psychiatric Association believes that Antidepressants save lives.
I tell listeners that this is a suicide note. If the drugs work wonderfully well and are free of hazards, doctors will be out of business. The APA should have said:
The American Psychiatric Association believes that Psychiatrists save lives.
If you join forces with RCGP, you might say Doctors save lives.
From now on, I will include your press release alongside APA’s as an example of a professional suicide note.
I am also copying Dan Johnson from Alberta into this letter. Dan faces an inquest on his 15 year old son Dexter, whose suicide was induced by Prozac. Dan drew my attention to your press release, worried that your press release would work against him and Dexter.
I am also copying in Yoko Motohama and Vincent Schmitt from France, whose 16 year old son Romain’s suicide was caused by paroxetine. Romain’s case is Scenario 1 in the attached article.
Both sets of parents are trying to raise the profile of a very real and horrific hazard, in order that other parents do not have to go through what they have been through.
I can only hope your press release will illustrate to the public what they and the Morgans are up against.
I regard this letter as open, and will post it online.
Yours sincerely
David Healy MD FRCPsych
Ian and Tania Morgan, Dan Johnson, Yoko Motohama, Vincent Schmitt, John Read, Don Marks.
RCPsych responds to BBC Panorama programme on antidepressants
Following the broadcast of Panorama’s ‘The Antidepressant Story’, the Royal College of Psychiatrists has issued the following response:
“Depression is a serious and potentially life-threatening condition that is treatable, usually involving a combination of self-help, psychological therapies and medications.
“Treatment options will depend on a patient’s type of depression, how long it has lasted, and whether they have experienced depression in the past.
“Antidepressants are a clinically recommended treatment, and they are effective at reducing the symptoms of moderate to severe depression, particularly when used in combination with talking therapies. Patients should discuss their treatment options with a qualified practitioner, including their benefits, risks and side effects, to ensure there is informed consent.
“Medicine continuously evolves, as does our knowledge of treating mental illness, as a result, the College updates its guidance, and ensures it is made accessible to healthcare professionals, stakeholders and partners with lived experience, when new evidence comes to light. Over the last 30 years our understanding of how different types of antidepressants work and the variation in side effects has grown considerably.
“We know that on average, most patients will benefit from the use of antidepressants, but some do report mixed or negative experiences. This is why their use should be carefully monitored and regularly reviewed. This is particularly important when stopping antidepressants. Antidepressants usually need to be taken for at least six months after your symptoms have gone away.
“Long-term use of antidepressants should only be considered for people that have recurrent depression and repeated, severe relapses after stopping antidepressants. For those patients, the beneficial effects of continuous use of antidepressants are more likely to balance the potential risks. However, this should be reviewed regularly, and multiple attempts should be made to stop taking these medications after prolonged periods of established wellbeing.
“Most people will be able to stop taking antidepressants without significant difficulty by reducing the dose (known as ‘tapering’) over a few weeks or months. Some people can experience withdrawal symptoms that last longer and may be more severe, particularly when the medication is stopped suddenly.
“As the body of evidence of withdrawal symptoms has improved, the College has pushed for changes to clinical guidance, to have a greater focus on safely managing withdrawal. This has increasingly been reflected in NICE guidance over the last few years. We also published a patient resource in 2020 to help support people to have discussions with their doctor when they are thinking about stopping antidepressants. We believe this was the first of its kind published by a professional medical organisation.
“Ultimately, the use of antidepressants, should always be a shared decision between a patient and their doctor based on clinical need and the preferences of the patient.
“We would advise all those thinking of stopping their antidepressants to talk to their doctor first, as these medications should not be stopped abruptly.”
The families who say pills for depression led their children to take their lives: A new report highlights a link between antidepressants and suicide. Now, grieving parents and experts are calling for clearer warnings about potential risks
Dr Shubulade Smith CBE (President) Dr Adrian James (Previous president)
Dr Josanne Holloway Meera Nair PROFESSOR SUBODH DAVE PROFESSOR RAFEY FARUQUI RICHARD WILSON Dr Gertrude Seneviratne Dr JOHN CRICHTON SALLY SPENSLEY KAREN TURNER CINDY LESLIE John Charles Gunn
Antidep Effects 