Royal College of Psychiatrists’ Suicide Note

This blog post by Dr. David Healey contains a reply to Dr. Adrian James (President of the Royal College of Psychiatrists) concerning antidepressants and suicide. It begins:

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.’ …

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 can read more from here.

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