RCPsych President responds to newspaper coverage on antidepressants

24 April 2023

 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

For further information, please contact:

Email: press@rcpsych.ac.uk Twitter: @rcpsych

Out-of-hours contact number: 07860 755896

Response to Dr James

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.

The authors of the paper underpinning the media coverage took care to get the wording right. They note that in the case of suicides in people taking antidepressants, the antidepressants were clearly not working. They do not say caused the suicide.  The press, equally, are not wrong to link antidepressants to suicide.

I reviewed the paper by John Read and colleagues for Ethical Human Psychology and Psychiatry.  I noted the care they took 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.

Footnote

This post follows up on last weeks post – Will Medical Insurers Stop Killing People.  The article sent to Adrian James was linked in there.

The Daily Mail and Daily Telegraph articles to which Dr James was responding are linked here.

 

The post Royal College of Psychiatrists’ Suicide Note first appeared on Dr. David Healy.