Dr. Simon Opher MP: Tragic suicide of Prince Michael of Kent’s son-in-law highlights potential serious risks of antidepressants

The tragic suicide of Prince Michael of Kent’s son-in-law has highlighted the potential serious risks of antidepressants. While these drugs can undoubtedly help some people, they can also cause harm to others.

At the inquest into Thomas Kingston, Lady Gabriella’s husband, the coroner blamed the adverse effects of prescribed medication – the SSRI antidepressants citalopram and sertraline – and said she was preparing a report on the prevention of future deaths to be sent to medical bodies.

Lady Gabriella said that “anyone taking pills like these needs to be made more aware of the side effects to prevent future deaths”.

For more than two decades, the medical profession and regulatory bodies have been aware of the risk of suicidal ideation and actual suicide associated with SSRI antidepressants, as well as other debilitating and distressing side effects, including PSSD (Post-SSRI sexual dysfunction) and akathisia (an uncontrollable movement disorder).

Hundreds of ‘Yellow Card Alerts’ have been reported to the MHRA (the medicines regulator) about SSRIs leading to suicidal thoughts and self-harm, with more than 150 deaths linked to citalopram and sertraline since 2014.

This is probably only a fraction of likely events.

The principle of informed consent requires the doctor to discuss the potential benefits and harms of medicines with their patient. Detailed guidelines from NICE (The National Institute of Health and Care Excellence) for doctors prescribing anti-depression medication also include the need for a management plan. This is particularly important given the difficulty many patients face in coming off the medication.

However, it appears that a significant number of doctors do not do this.

A Public Health England review of antidepressants and other drugs that can cause addiction found in 2019 that patients believed there was a lack of information about the risks of drugs and that doctors did not recognize or recognize withdrawal symptoms. They also said they were not offered any non-medical treatment options.

As a general practitioner for 31 years, my subspecialty was mental health. Like many other doctors, I found that about one in three patients described feeling anxious or depressed, often with sleep problems.

With constraints on doctors’ time, it is not surprising that these patients tend to be diagnosed with mild to moderate depression and prescribed an antidepressant, despite NICE saying that antidepressants should not be routinely offered as first-line treatment for less severe depression.

The number of prescriptions for antidepressants is alarming and continues to rise. Over the past 12 years, antidepressant prescriptions have almost doubled in England, from 47.3 million in 2011 to 89 million in 2023/4.

More than 8.7 million adults, almost one in five, in England are prescribed them annually. Sadly, almost 450,000 children and young people under the age of 18 – almost 4,000 under the age of ten – were prescribed antidepressants in 2022/23.

Rather than mental illness, I found that the underlying problem affecting my patients’ state of mind was often a social or financial problem: loneliness or isolation, layoffs, inadequate housing, debt management, or marital and family problems. Prescribing a pill cannot solve these problems.

Social prescribing, now embedded in NHS policy, has been shown to be effective as a non-medical alternative to pills. Doctors can refer patients to Social Prescribing Liaison Officers for support with a range of practical issues from debt management and benefits to housing or legal issues, as well as signposting them to a range of community services for all ages, from carers to choirs, gardening to walking and talking groups , even help to get online.

After employing an artist in the surgery and referring patients with mild to moderate depression instead of offering anti-depressants, we got a good response.

Exercise is also as effective as pills or talk therapy for many people. A recent review of 218 studies found that taking aerobic exercise, joining a yoga, walking or dance group had a greater impact on mood than CBT (cognitive behavioral therapy) or medication.

The government-funded Prescribing Nature Works project, which offers nature-based activities for people with poor mental health, has shown that participants’ sense of happiness and life worth improved and anxiety levels decreased.

As chairman of the Beyond Pills All Party parliamentary group, which wants a rapid reduction in the prescription of antidepressants, I believe that it is imperative for the medical profession to consider alternatives to antidepressants in the treatment of mild to moderate depression due to the problems , we have seen for many years. , including withdrawal.

We have to think differently than the medical profession normally thinks, and that is a challenge. As clinicians, we must recognize that while antidepressants may be helpful for some patients, at least in the short term, non-medication options are often a better choice for the large cohort who have mild to moderate depression, which is often the result of socioeconomic factors rather than mental illness.

We also need to explain to patients the risks of possible side effects, including those experienced by Thomas Kingston, and offer existing patients services to help them withdraw safely, where appropriate, along with psychosocial support.

For confidential support call Samaritans on 116 123, visit samaritans.org or visit www.thecalmzone.net/get-support