A letter in the Times: ‘Pills for depression’

On the 25th February 2018 the following letter was published in the Times. It was written by Professor David Baldwin, Chair of the Psychopharmacology Committee, and Professor Wendy Burn, the President of the Royal College of Psychiatrists:

On the 26th February I wrote to Professor Baldwin:

Dear Professor Baldwin,
I am an NHS Psychiatrist for older adults working in Scotland.

I noticed your letter in the Times. Would you mind if I asked you a few questions about this as I am interested to learn more about the evidence-base for long term prescribing of antidepressants.

I am interested in this as in Scotland we now have 1 in 7 adults on antidepressants and the majority are taking them either long term or indefinitely. Professor Ian C Reid, my friend and colleague, who is sadly no longer with us, used to describe this prescribing as “conservative”. Would you agree with Ian Reid, and can you provide the evidence, both in quantitative and qualitative terms, that supports such long term or indefinite prescribing? I am not aware of evidence that has established that 1 in 7 Scots live with chronic or recurrent major depressive disorder. I would be grateful if you could help me with this uncertainty of mine about available evidence.

Petitions have been raised in Scotland and in Wales in relation to antidepressant drug dependency and withdrawal. A large volume of evidence of experience has been submitted and I would suggest to you and Professor Wendy Burn that it is worth reading. I am sure that you will both agree that evidence comes in words and numbers, though neither can be said to fully represent experience:

Scottish petition

Welsh petition:

I would therefore also be grateful if you could share the references that support your conclusions in your Times letter on the potential for antidepressants to cause withdrawal syndromes.

Kind wishes,

Dr Peter J Gordon GMC 3468861
Writing in my own time

Professor Baldwin kindly replied that day, stating that “the best evidence to support long-term antidepressant prescribing (up to 2 years) comes from meta-analyses such as that reported by Geddes in 2003. The evidence for prescribing beyond 2years is limited but the papers by Kupfer and colleagues describe beneficial effects up to 5 years.”

Professor Baldwin went on to state “as regards symptoms occurring after stopping antidepressants I described such symptoms with paroxetine and escitalopram (and the differences between the drugs) and have also described those symptoms with venlafaxine.”

Today, 28th February 2018, the following open letter was sent by Professor John Read on behalf of  a number of co-authors:

Dear Professors Burn and Baldwin,
On 24.2.2018 The Times published a letter signed by you, in your capacities as President, and Chair of the Psychopharmacology Committee, of the Royal College of Psychiatrists (RCP). In that letter you made the following claim: ‘We know that in the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment’

We believe that statement is not evidence-based, is incorrect and has misled the public on an important matter of public safety.

Although more research may be needed before any definitive statements on this issue can be made we note that even the RCP’s own survey of over 800 antidepressant users, reported in the RCP document ‘Coming Off Antidepressants’, found that withdrawal symptoms were experienced by the majority (63%) and ‘…. generally lasted for up to 6 weeks’ … and that ‘A quarter of our group reported anxiety lasting more than 12 weeks’.

We further note, however, that within 48 hours of making your misleading statement in The Times you removed the ‘Coming Off Antidepressants’ document from your RCP website. One interpretation of this action, and the timing thereof, is that you wanted to prevent the public from seeing evidence that contradicts your claim in the Times.

We are considering lodging a formal complaint with the appropriate professional body about your misleading the public on a matter of public safety. We would first, however, like to give you the opportunity to publicly retract, explain and apologise for the statement, in The Times and on the RCP website. Alternatively please provide us with the research studies on which you based the statement that ‘in the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment’.

We will await your response for one week before deciding whether to lodge the aforementioned complaint.

Please note that, as this is an urgent matter of public safety, we are making the concerns expressed in this letter public. We may also make public your response.

Yours sincerely

Dr John Read
Professor of Clinical Psychology
University of East London

On behalf of:

Dr Steven Coles (Clinical Psychology) Nottinghamshire Healthcare NHS Foundation Trust
Dr James Davies (Medical Anthropology) University of Roehampton
Dr Pieter Groot (Psychiatry) University of Maastricht
Professor Peter Kinderman (Clinical Psychology) University of Liverpool
Dr Hugh Middleton (Psychiatry) University of Nottingham
Professor Jim van Os (Psychiatry) University of Maastricht
Professor David Pilgrim (Clinical Psychology) University of Southampton
Professor John Read (Clinical Psychology) University of East London
Professor Sami Timimi (Psychiatry) Lincolnshire Partnership NHS Foundation Trust

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