A timeline of missed opportunities

This film presents a timeline from 2002 to 2019 in relation to England’s National Suicide Prevention Strategy.

The film presents missed opportunities, in particular the potential role of prescribed medications as risk factors for suicide.

Music credits: [all made free to share under common license by Dexter Britain]
(1) ‘Perfect I am Not’
(2) ‘From Truth’
(3) ‘Chasing Time’

Film credits:
(1) ‘A message from Professor Louis Appleby’ for Zero Suicide Alliance (April 2017)
(2) ‘Remember Amy’ a Presentation by Beverley Thorpe for (AD4E) A disorder for everyone (July 2019)

Thanks to Millie Kieve for kindly agreeing to let me use the recording of her January 2004 phone call to Manchester Coroners Office.

Thanks to Marion Brown and Beverley Thorpe for their help with this film

This film is for all those affected by suicide.

A definition of Akathisia: “presents people with a tortuous fight to stay alive. It is so uncomfortable, distressing & under-recognised by the medical profession that people often turn to ‘suicide as their only option. They literally think they are losing their minds.”

AKATHISIA:

Are you or someone you know suddenly unable to stop moving or agitated?

If so, and you recently started, stopped or changed the dosage of a medication, you may be suffering from akathisia. This disorder is also characterized by inner restlessness, anxiety, agitation, impulsivity, aggressiveness, insomnia, irritability, and hostility. Akathisia can lead to violence/suicide.

Akathisiais a disorder, induced as a side effect of medications (including SSRIs and antipsychotics), which can cause a person to experience such intense inner restlessness that the sufferer is driven to violence and/or suicide. It has been said, ‘Death can be a welcome result.’ For reasons related to the strong political and lobbying power of pharmaceutical companies, akathisia is rarely explained as a possible side effect of medications, and medical professionals and the general public know very little of the existence of this disorder.” (MISSD)


House of Commons, Suicide Prevention Report, 2016-2017

Anti DepAware archive

Mille and the Tsar, AntiDepAware, 9 Nov 2019

A Word to the Coroner, AntiDepAware, November 15 2019

Problematic Advice From Suicide Prevention Experts, Ethical Human Psychology and Psychiatry, Volume 20, Number 2, 2018. By Heidi Hjelmeland, Katrina Jaworski, Birthe L. Knizek, and Ian Marsh

Centre for Suicide Prevention, Manchester

Working with the government, by Professor Louis Appleby, British Journal of Psychiatry, Volume 193, Issue 3September 2008 , p. 191

RSM Health Matters, Podcast, Episode 1: Antidepressants, Antibiotics and The Gender Pay Gap, April 2018, Professor Sir Simon Wessely and Professor Clare Gerada

Do Antidepressants Save Lives? A Comment On The 2016 Interim Report On Suicide Prevention By The House Of Commons Health Select Committee, by Professor Carmine Pariante, Huffpost, 6 Feb 2017

‘Mental health drug epidemic for children in Scotland’, Herald, by Helen McArdle, 27 October 2019

Suicide risk and the SSRIs, by Wessely S, Kerwin R, JAMA. 2004 Jul 21;292(3):379-81.
[Note: Professor Sir Simon Wessely has made available his extensive publications, though unfortunately he has not included this publication]

Treatment Emergent Violence To Self And Others; A Literature Review of Neuropsychiatric Adverse Reactions For Antidepressant And Neuroleptic Psychiatric Drugs And General Medications. By Clarke C, Evans J, Brogan K. Adv Mind Body Med. 2019 Winter;33(1):4-21.

Letter to the Editor: Newer-Generation Antidepressants and Suicide Risk in Randomized Controlled Trials: A Re-Analysis of the FDA Database. Hengartner M.P., Plöderl M. Psychother Psychosom 2019;88:247–248

Research News: SSRIs double the risk of suicide and violence in healthy adults. BMJ 2016; Ingrid Torjesen, BMJ 2016;355:i5504

20 Replies to “A timeline of missed opportunities”

  1. From: Dr Peter J Gordon
    To:
    (1) Professor Louis Appleby,
    (2) Professor Sir Simon Wessely,
    (3) Professor Wendy Burn
    (4) Mr Paul Rees
    Subject: Suicide prevention: a timeline

    Friday 17th January 2020.
    Time sent: 14.43
    With a request for delivery and read receipt.

    National Suicide Prevention Strategy: a timeline of missed opportunities https://holeousia.com/2020/01/15/a-timeline-of-missed-opportunities/

    This film presents a timeline from 2002 to 2019 in relation to England’s National Suicide Prevention Strategy.

    The film presents missed opportunities, in particular the potential role of prescribed medications as risk factors for suicide.

  2. To:
    (1) Professor Louis Appleby, Lead for the National Suicide Prevention Strategy for England
    (2) Professor Rory O’Connor, Co-Chair of the Academic Advisory Group to the Scottish Government’s Suicide Prevention Leadership Group.
    (3) Nadine Dorries, MP, Parliamentary Under-Secretary of State for Health and Social Care
    (4) Jeremy Hunt, MP
    (5) Professor Sir Simon Wessely, President of the Royal Society of Medicine
    (6) Paul Rees, CEO of the Royal College of Psychiatrists
    (7) Professor John Crichton, Chair of the Scottish Division of the Royal College of Psychiatrists
    (8) Clare Haughey, MSP, Minister for Mental Health, Scottish Government
    (9) Nicola Sturgeon, MSP, First Minister for Scotland
    (10) Scottish Government, DGHSC@gov.scot

    Subject: Suicide prevention

    From: Dr Peter J Gordon (retired NHS Psychiatrist)

    Tuesday 11th February 2020

    Dear Professor Rory O’Connor, Professor Appleby, Sir Simon Wessely, Professor Wendy Burn, Professor John Crichton and Paul Rees,

    SUICIDE PREVENTION
    The following short film, made by me, has been widely viewed since I published it almost a month ago: A timeline of missed opportunities.

    I shared the link to this film with Profs Appleby, Wessely, Burn, and Mr Rees the CEO of the Royal College of Psychiatrists, on the 17th January 2020 [with a request for delivery and read receipt.] I have had no reply whatsoever.

    Professor Appleby said on the last day of 2019 “My greatest wish for the year ahead is about young people, whose suicide rate has risen over the past decade. That we offer them a more hopeful future. That people in power listen. That their voices will matter.”

    It would be concerning to consider that legal advice might be inhibiting the “open dialogue” that the current President of the Royal College of Psychiatrists has said that she seeks.

    I would be grateful for a substantive, constructive, and meaningful reply from you as leads on Suicide Prevention to the opportunities raised in this short film.

    A timeline of missed opportunities:

    Yours sincerely,
    Peter J Gordon

  3. From: Department of Health and Social Care [mailto:DoNotReply@dhsc.gov.uk]
    Sent: 28 February 2020 13:05
    To: Dr Peter J Gordon
    Subject: Your recent correspondence

    Our ref: DE-1204751

    Dear Dr Gordon,
    Thank you for your correspondence of 11 February to Paul Rees and Professors O’Connor, Appleby, Wessely, Burn and Crichton regarding suicide prevention. Your email has been forwarded to the Health and Social Care Department and I have been asked to reply.

    I appreciate your concerns.
    Every suicide is a tragedy which has a devastating and enduring impact on families and communities.

    That is why, in January 2019, the Government published the first Cross-Government Suicide Prevention Workplan, which sets out an ambitious programme across national and local government and the NHS. It will see every local authority, mental health trust and prison in the country implementing suicide prevention policies.

    We have made further investment of £1.8m to support the Samaritans helpline and £2m for the Zero Suicide Alliance, which aims to achieve zero suicides across the NHS and in local communities by improved suicide awareness and prevention training and developing a better culture of learning from deaths by suicide across the NHS.

    The NHS Long Term Plan reaffirms the NHS’s commitment to make suicide prevention a priority over the next decade. This will see investment in all areas of the country by 2023/24 to support local suicide prevention plans and establish suicide bereavement support services.

    The Government’s aim is to put mental health services on an equal footing with physical health services so that people with mental health problems can access the most appropriate treatment and support when they need it.

    The Government has made much progress since the publication of the Five Year Forward View for Mental Health in 2016. For example, through its Improving Access to Psychological Therapies (IAPT) programme, more people than ever before are getting help with common conditions like anxiety and depression. However, the Government realises that there is still much to do.

    The NHS Long Term Plan represents the largest expansion of mental health services in a generation. It renews the Government’s commitment to increase investment in mental health services faster than the overall NHS budget for each of the next five years. Mental health will receive a growing share of the NHS budget, worth at least £2.3billion more in real terms per year by 2023/24. The Plan also includes a new commitment that funding for children’s and young people’s mental health services will grow faster than both overall NHS funding and total mental health spending.

    Amongst other things, the NHS Long Term Plan will see:

    • IAPT services for adults and older adults with common mental health problems expanded to provide access for an additional 380,000 people per year;

    • new models of integrated primary and community mental health care, which will provide greater choice and support for 370,000 adults and older adults with severe mental illness;

    • services for people experiencing a mental health crisis expanded, with an increase in alternative forms of provision for those in crisis and NHS 111 being used as the single, universal point of access;

    • mental health transport vehicles introduced and ambulance service staff trained and equipped to respond effectively to people experiencing a mental health crisis;

    • mental health liaison services available in all acute hospital A&E departments;

    • an additional 24,000 women per year with moderate to severe perinatal mental health difficulties and a personality disorder diagnosis having access to evidence-based care;

    • at least 345,000 more children and young people aged 0-25 able to access support through NHS-funded mental health services and school- or college-based mental health support teams; and

    • new support for young adults, with tailored services extending beyond 18-25, ending the current ‘cliff edge’ of support and helping thousands more tackle any mental ill-health issues that can arise during the transition to adulthood.

    I hope this reassures you that improving mental health services remains a priority for this Government and the NHS.

    Yours sincerely,
    Anthony Moses

    Ministerial Correspondence and Public Enquiries
    Department of Health and Social Care

    Please do not reply to this email. To contact the Department of Health and Social Care, please visit the Contact DHSC section on GOV.UK

  4. OPEN LETTER TO UK GOVERNMENT DEPARTMENTS OF HEALTH & SOCIAL CARE & ALL THOSE RESPONSIBLE FOR PUBLIC HEALTH & SAFETY
    ENGLAND, SCOTLAND, N IRELAND & WALES

    3 March 2020

    UK NATIONAL SUICIDE PREVENTION STRATEGY: SSRIs/SNRIs and AKATHISIA risks

    We write to express extreme alarm at the way our concerns – expressed over more than a decade to a considerable number of individuals and groups, representing various committees, specialities, institutions and departments in the UK – have been, and are being, apparently quashed.

    Current ‘expert’ advice on suicide prevention, which is now accepted government policy, is that SSRI/SNRI drugs are prescribed to any patient who indicates they may be feeling suicidal or have suicidal thoughts. Our concern is that SSRI/SNRI drugs can themselves cause such suicidal thoughts/impulses – and also a very serious adverse drug reaction called AKATHISIA, the symptoms of which are so unbearable that they can lead people to end their own lives. This fact is not recognised by governments, the NHS or the public, and is not mentioned in the national ‘Suicide Prevention Strategy’, despite our efforts to draw this important issue to the attention of responsible individuals and departments. Many people ARE INDEED dying avoidable deaths by iatrogenic suicide – when suffering known and/or extreme and unrecognised adverse prescribed drug effects.

    Our efforts have been extensive, and most recently resulted in the online publication of a short film compiled by Peter Gordon, retired NHS psychiatrist, with input from several contributors: ‘A Timeline of Missed Opportunities’. This has already been widely shared on Social Media.

    https://holeousia.com/2020/01/15/a-timeline-of-missed-opportunities/

    Please watch this short film – and also read the Replies/Comments section (found at the foot of the blogpost) where further correspondence has been added, including a letter dated 28 Feb 2020 from the UK Department of Health and Social Care (Ref: DE-1204751).

    We are sharing this open letter on social media and with the press as we consider this to be a very serious matter indeed – where the lives of countless people are being knowingly and recklessly put at risk by national ‘Suicide Prevention Strategy’ and ‘Policy’. The public – and indeed prescribers – are being cruelly misled.

    We ask specifically that the KNOWN RISKS of SSRI/SNRI drugs in particular (and indeed other medications which can cause akathisia) be fully recognised NOW – and action taken by Governments, cascaded to EDUCATE all prescribers, healthcare professionals and the public on how to avoid or mitigate these risks.

    Examples of our appeals can be found in this collection of letters published by the BMJ a few months ago. https://www.bmj.com/content/366/bmj.l5102/rapid-responses

    Signed
    Marion Brown, Beverley Thorpe Thomson, Peter Gordon, Millie Kieve, Jo Watson, John Read, Peter Gotzsche, Catherine Clarke, Janette Robb, Stevie Lewis, James Moore, Bob Fiddaman, Dierdre Doherty, Kristina Gehrki, Fiona French, Alyne Duthie

  5. We thank the Helensburgh Advertiser, Scotland, for publishing our Open Letter (our concerns about the National Suicide Prevention Strategy sent to UK Governments 3 March 2020 – see above ‘reply’), in print and online, on 5 March 2020.

  6. Reply received from Department of Health and Social Care 1 April 2020

    Our ref: DE-1208072

    Dear Mrs Brown,

    Thank you for your correspondence of 3 March about suicide.

    I appreciate your concerns and I can assure you the Government takes suicide prevention very seriously. The NHS Long Term Plan reaffirms the NHS’ commitment to make suicide prevention a priority over the next decade. This is supported by commitments to implement a new Safety Improvement Programme across mental health trusts and rolling out suicide bereavement services in every area of the country by 2023/24.

    The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for ensuring that medicines, healthcare products and medical equipment meet appropriate standards of safety, quality, performance and effectiveness and are supported by clear and detailed product information which contains the relevant information to use the approved medicines as safely as possible.

    All medicines have the potential to cause side effects in some patients and product information is therefore made available to patients and doctors to inform them of the risks and benefits associated with a particular treatment. The product information is kept up to date during the lifecycle of the product and consists of the summary of product characteristics (for prescribers) and the patient information leaflet (for patients). The product information can be accessed on the Medicines and Healthcare products Regulatory Agency website at https://products.mhra.gov.uk/ and the patient information leaflet is supplied with each package of medicine.

    It is not government policy that SSRI/SNRI drugs are prescribed to any patient who indicates they may be feeling suicidal or have suicidal thoughts. This remains a matter for the healthcare professionals responsible for an individual’s care.

    There are clear warnings in the product information for selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) regarding the risk of suicide and suicidal behaviour, particularly when these medicines are taken by children, adolescents or young adults.

    The product information for SSRIs and SNRIs also includes a warning about the risk of akathisia which highlights that those who experience symptoms of akathisia should speak to their doctor and healthcare professionals are warned that increasing the dose may be detrimental.

    The risk of suicide and suicidal behaviours associated with these medicines has been kept under close review by MHRA with advice from its independent advisory committees. The warnings have been updated as needed following various United Kingdom and European reviews. The current product information is considered to reflect the available data regarding the risks of suicide, suicidal behaviour and akathisia.

    Healthcare professionals in the United Kingdom have been informed about the risk of suicidal behaviour associated with SSRIs and SNRIs via articles in the MHRA’s bulletin Drug Safety Update in April 2008 and December 2014, more information can be found at https://www.gov.uk/drug-safety-update/antidepressants-suicidal-thoughts-and-behaviour.In addition, guidance was published on the MHRA webpage in December 2014 at https://www.gov.uk/government/publications/ssris-and-snris-use-and-safety/selective-serotonin-reuptake-inhibitors-ssris-and-serotonin-and-noradrenaline-reuptake-inhibitors-snris-use-and-safety.

    The British National Formulary (BNF) states ‘the use of antidepressants has been linked with suicidal thoughts and behaviour; children, young adults, and patients with a history of suicidal behaviour are particularly at risk. Where necessary patients should be monitored for suicidal behaviour, self-harm, or hostility, particularly at the beginning of treatment or if the dose is changed’.

    Also, the National Institute for Health and Care Excellence (NICE) has produced a clinical guideline on ‘depression in adults: recognition and management’ that explains when prescribing antidepressants, potential side effects should be discussed with the patient and that:
    ‘A person with depression started on antidepressants who is considered to present an increased suicide risk or is younger than 30 years (because of the potential increased prevalence of suicidal thoughts in the early stages of antidepressant treatment for this group) should normally be seen after 1 week and frequently thereafter as appropriate until the risk is no longer considered clinically important.’ This can be found at https://www.nice.org.uk/guidance/cg90/chapter/1-Guidance#step-3-persistent-subthreshold-depressive-symptoms-or-mild-to-moderate-depression-with-inadequate

    NICE published a key therapeutic topic in March 2019 and a key point of this states an option for local implementation is to “monitor people who are prescribed antidepressants for an increased risk of suicide.” More information can be found at https://www.nice.org.uk/advice/ktt24/chapter/Key-points

    I hope this reply is helpful.

    Yours sincerely,

    Tamilore Bamidele
    Ministerial Correspondence and Public Enquiries
    Department of Health and Social Care

    ————————————————————————————————————————-

    Please do not reply to this email. To contact the Department of Health and Social Care, please visit the Contact DHSC section on GOV.UK

    1. This reply from the Department of Health and Social Care of the 1st April 2020 would appear to follow a standard template for patient concerns. I do not know about others but I am not reassured by what is offered for the reasons set out in the ‘Missed Opportunities Timeline’. These opportunities have NOT been taken up by National Suicide Prevention networks and indeed there has been NO reply from any of the national leads for suicide prevention. This is telling. The letter from the Department of Health and Social Care completely FAILS to address this stonewall: a stonewall that has prevented, and continues to prevent, any meaningful engagement. As such, more lives risk being harmed or lost.

      These are my initial thoughts. I would be interested to hear what other folk think.

      aye Peter Gordon

  7. Reply received 2 April 2020 from Scottish Government

    Our Reference: 202000019423

    02 April 2020

    Dear Marion Brown,

    Thank you for your email of 3 March to Scottish Ministers containing an open letter regarding the prescription of SSRIs/SNRIs and Akathisia risks. Your email was passed on to me to respond on behalf of Scottish Ministers as I work in the Mental Health Directorate in the Scottish Government.

    The Scottish Government has worked hard to reduce the stigma faced by people with mental health problems. As this stigma declines we would expect more patients to seek help from their GPs for problems such as depression. People with mental illness should expect the same standard of care as people with physical illness and should receive medication if they need it. We are also committed to improving access to alternatives, such as psychological therapies, that increase choice and best accommodate patient preference. However, medicine and psychological therapy are commonly used together to achieve better outcomes.

    Where medication is prescribed, this is a clinical decision, which should be discussed within the context of an individual’s long term recovery, and all prescribing should be in line with clinical guidelines and evidence-based practice. Medication should be reviewed regularly to achieve the best possible health outcomes and on-going support should be provided to patients who are prescribed medicines.

    The Scottish Government is currently preparing a position paper on the use of anti-depressants and this will be discussed by the Short Life Working Group on prescribed medicines which have the potential to cause addiction and withdrawal.

    Yours sincerely
    Craig Wilson
    AMH : Public Mental Health and Suicide Prevention

  8. This article was published by HSJ on 17 April 2020:

    It states:
    An “unprecedented” national suicide prevention plan has been launched by a government advisory group amid concerns suicides could increase during the covid-19 pandemic, HSJ can reveal.
    The government’s national suicide prevention advisory group has developed the plan to address risks covid-19 could present to vulnerable people.
    Chair of the group and the national adviser to the government on suicide prevention, Louis Appleby, told HSJ the plan was centred on getting far quicker access to data on suicides and self-harm episodes, which is the strongest indicator of suicide risk.

    https://www.hsj.co.uk/coronavirus/unprecedented-plan-to-prevent-suicides-during-covid-19-crisis/7027431.article

  9. I share here an email I sent to Professor Appleby on 21 April 2020:

    Dear Professor Appleby

    Further to [earlier] emails, I see that there is an article 17 April 2020 in HSJ “Unprecedented plan to prevent suicides during Covid-19 crisis’, by Rebecca Thomas, in which you are quoted, as Chair of the new group and the national adviser to the government on suicide prevention, saying “This is a serious attempt, in some senses an unprecedented attempt, to prevent a crisis turning into a mental health crisis”.
    https://www.hsj.co.uk/coronavirus/unprecedented-plan-to-prevent-suicides-during-covid-19-crisis/7027431.article

    I take it that you are aware of the Open Letter that was sent to the 4 UK Government departments of Health and Social care on 3 March 2020 – attached.
    This Open Letter, and the replies that have been received have been posted in the ‘Replies’ section of the mid-January 2020 ‘Timeline of missed opportunities’ post: https://holeousia.com/2020/01/15/a-timeline-of-missed-opportunities/
    This has all been shared very widely on social media and with the Press and has attracted a great deal of public attention.

    I do hope that this ‘Unprecedented plan’ will indeed prove to be a new ‘unprecedented opportunity’ – now in 2020 – to ensure that the suicide risks posed by antidepressants (and indeed other medications) – are fully addressed, and public and prescriber education about the dangers of akathisia (and other adverse drug effects) is urgently put in place. ASAP. Every Life Matters.

    Yours sincerely

    Marion Brown

  10. I have today submitted – on behalf of the group of us who wrote the 3 March2020 ‘Open Letter’ – a response to the reply we received from the UK Department of Health and social Care on 1 April 2020:

    TO: Ministerial Correspondence and Public Enquiries
    UK Department of Health and Social Care 1 May 2020

    Your Ref: DE-1208072

    Thank you for your letter of 1 April 2020, in response to our Open letter of 3 March.
    “UK NATIONAL SUICIDE PREVENTION STRATEGY: SSRIs/SNRIs and AKATHISIA risks”

    Your response [see in Replies above] does indeed contain links that would indicate that the significant suicide risks of SSRI & SNRI antidepressants are recognised by MHRA, NICE and BNF, and that prescribers are cognisant of these – in the context of ‘treatment for depression’. Even so, in the ‘treatment for depression’ context the suicide risks are effectively ‘played down’, claiming that ‘benefits outweigh risks’, which tends to be what prescribers ‘hear’. Busy and overwhelmed GP prescribers are effectively unable to ‘monitor closely’ for ensuing suicidality those patients (of any age) who they start on antidepressants, and at times of dose &/or medication changes.

    The facts (known suicide risks of antidepressants – including risks of medication-induced akathisia) are nevertheless completely omitted from the National Suicide Prevention Strategy. This is a very serious and significant omission – and is what we are red-flagging.

    Please see this: https://www.researchgate.net/publication/331536346_Problematic_Advice_From_Suicide_Prevention_Experts
    Based on a 10-year systematic review of suicide prevention strategies, “29 suicide prevention experts from 17 European countries” recommend 4 allegedly evidence-based strategies to be included in national suicide prevention programs. One of the recommended strategies is pharmacological treatment of depression. This recommendation is problematic for several reasons. First, it is based on a biased selection and interpretation of available evidence. Second, the authors have failed to take into consideration the widespread corruption in the research on antidepressants. Third, the many and serious side effects of antidepressants are not considered. Thus, the recommendation may have deleterious consequences for countless numbers of people, and, in fact, contribute to an increase in the suicide rate rather than a decrease.

    Please ensure that this is matter is properly addressed at this time when the National Suicide Prevention Strategy is being revisited in the context of the Covid-19 Pandemic, as reported in HSJ 23 April 2020, and also topic of Lancet Article 21 April 2020.
    https://www.hsj.co.uk/coronavirus/unprecedented-plan-to-prevent-suicides-during-covid-19-crisis/7027431.article
    https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30171-1/fulltext

    Thank you
    Marion Brown, Stevie Lewis, Beverley Thorpe Thomson, Millie Kieve, Catherine Clarke, Peter Gordon, Jo Watson, John Read, Peter Gotszche, Janette Robb, James Moore, Bob Fiddaman, Dierdre Doherty, Kristina Gehrki, Fiona French, Alyne Duthie

    1. PLEASE NOTE:
      The Ministerial Correspondence and Public Enquiries has not replied to the above communication of the 1st May 2020.

      1. Auto-acknowledgement of receipt was logged on the day it was sent 1 May 2020.

        “This is an acknowledgement – please do not reply to this email.
        Thank you for contacting the Department of Health and Social Care.
        A copy of your query can be found below:

        URGENT RESPONSE:
        Your Ref DE-1208072
        UK NATIONAL SUICIDE PREVENTION STRATEGY: SSRIs/SNRIs and AKATHISIA risks
        These risks are very serious.
        People’s lives are being put at risk. RIGHT NOW
        UPDATE RE: COVID-19”

  11. For the record … below is text of follow-up letter sent on 2 May 2020 in response to Scottish Government:

    TO: Scottish Government. Public Mental Health and Suicide Prevention
    2 May 2020
    Your Ref: 202000019423
    Thank you for your letter of 2 April 2020, in response to our Open letter of 3 March.
    “UK NATIONAL SUICIDE PREVENTION STRATEGY: SSRIs/SNRIs and AKATHISIA risks”
    Your Scottish Government response [previously posted’]in ‘replies] refers to the prescribing of antidepressants in the context of ‘treatment for depression’ – and refers to a ‘position paper’, currently in preparation, on the ‘Use of anti-depressants’. We are well aware that, in the ‘treatment for depression’ context – and in the current ‘evidence-based’ Guidance (NICE, BNF etc.) – the known suicide risks of SSRI/SNRI antidepressants are ‘played down’, claiming that ‘benefits outweigh risks’, which tends to be what prescribers ‘hear’. Busy and overwhelmed GP prescribers are effectively unable to ‘monitor closely’ for ensuing suicidality those patients (of any age) who they start on antidepressants, and at times of dose &/or medication changes.
    The facts (known suicide risks of antidepressants – including risks of medication-induced akathisia) are nevertheless completely omitted from the National Suicide Prevention Strategy. This is a very serious and significant omission – and is what we are red-flagging.
    Please see this: https://www.researchgate.net/publication/331536346_Problematic_Advice_From_Suicide_Prevention_Experts
    Based on a 10-year systematic review of suicide prevention strategies, “29 suicide prevention experts from 17 European countries” recommend 4 allegedly evidence-based strategies to be included in national suicide prevention programs. One of the recommended strategies is pharmacological treatment of depression. This recommendation is problematic for several reasons. First, it is based on a biased selection and interpretation of available evidence. Second, the authors have failed to take into consideration the widespread corruption in the research on antidepressants. Third, the many and serious side effects of antidepressants are not considered. Thus, the recommendation may have deleterious consequences for countless numbers of people, and, in fact, contribute to an increase in the suicide rate rather than a decrease.

    Please ensure that this is matter is properly addressed at this time when the National Suicide Prevention Strategy is being revisited in the context of the Covid-19 Pandemic, as reported in HSJ 23 April 2020, and also topic of Lancet Article 21 April 2020.
    https://www.hsj.co.uk/coronavirus/unprecedented-plan-to-prevent-suicides-during-covid-19-crisis/7027431.article
    https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30171-1/fulltext

    Thank you
    Marion Brown (mmarionbriown@gmail.com)
    Stevie Lewis, Beverley Thorpe Thomson, Millie Kieve, Catherine Clarke, Peter Gordon, Jo Watson, John Read, Peter Gotszche, Janette Robb, James Moore, Bob Fiddaman, Dierdre Doherty, Kristina Gehrki, Fiona French, Alyne Duthie

  12. Received 11 May 2020 from Department of Health Northern Ireland http://www.health-ni.gov.uk :

    Dear Ms Brown,

    SSRIs/SNRIs AND AKATHISIA RISKS
    Your correspondence of 3 March 2020 refers regarding the above, which I note has also been forwarded to other health and social care Departments within the UK. I apologise for the delay in replying but the Department has been focused on responding to the Covid-19 pandemic.
    As you will be aware, the Medicines and Healthcare products Regulatory Agency (MHRA) regulates medicines for all of the UK and is the government agency with responsibility for ensuring that medicines and medical devices work and are acceptably safe.
    Similarly, you will be fully aware that the safety of all medicines, including Sertraline and other SSRIs, is continuously monitored in a process known as pharmacovigilance which seeks to identify unrecognised adverse effects or changes in the patterns of adverse effects and inform action to support safer use.
    The Department of Health in Northern Ireland is guided by the advice of the MHRA and, at this time, it is my understanding that there are no plans to review the use of Sertraline or other SSRIs. I would stress, however, that Sertraline and other SSRIs are subject to ongoing pharmacovigilance and the MHRA collects data from all spontaneous reporting and provides interactive Drug Analysis Profiles (iDAPs) on their Yellow Card website https://yellowcard.mhra.gov.uk/iDAP/
    Under the circumstances, you may wish to raise your concerns directly with the MHRA and I would suggest that the most appropriate contact would be Director of Vigilance and Risk Management of Medicines, MHRA, 10 South Colonnade, Canary Wharf, London, E14 4PU.
    In Northern Ireland, the Department of Health has formal links with NICE whereby NICE clinical guidelines are locally reviewed for applicability to Northern Ireland and, where appropriate, are endorsed for implementation in Health and Social Care (HSC).
    This link ensures that Northern Ireland has access to up-to-date, independent, professional, evidence based guidance on the value of health care interventions. I can advise that the current NICE guideline on the treatment and management of depression in adults is currently being updated. Further information about the update can be requested by contacting NICE at DepressionInAdultsUpdate@nice.org.uk.

    Yours sincerely,

    Mrs Cathy Harrison
    Chief Pharmaceutical Officer

  13. TO: Mrs Cathy Harrison
    Chief Pharmaceutical Officer
    Department of Health, Northern Ireland

    12 May 2020

    Dear Mrs Harrison

    Your Ref: TOF-1259-2020

    Thank you for your letter of 11 May2020, in response to our Open letter of 3 March.
    “UK NATIONAL SUICIDE PREVENTION STRATEGY: SSRIs/SNRIs and AKATHISIA risks”

    Your response does indeed indicate that the regulation, safety and significant risks of SSRI & SNRI antidepressants are recognised and monitored by MHRA, via pharmacovigilance – and that NICE clinical guidelines are endorsed where appropriate in Northern Ireland. You imply that prescribers are cognisant of these risks – in the context of ‘treatment for depression’. Even so, in the ‘treatment for depression’ context the suicide risks are effectively ‘played down’, claiming that ‘benefits outweigh risks’, which tends to be what prescribers ‘hear’. Busy and overwhelmed GP prescribers are effectively unable to ‘monitor closely’ for ensuing suicidality those patients (of any age) who they start on antidepressants, and at times of dose &/or medication changes.

    Your response omits the main thrust of our Open Letter of 3 March: that these facts (the known suicide risks of antidepressants – including risks of medication-induced akathisia) are completely omitted from the National Suicide Prevention Strategy. This is a very serious and significant omission – and is what we are red-flagging.

    Please see this: https://www.researchgate.net/publication/331536346_Problematic_Advice_From_Suicide_Prevention_Experts
    Based on a 10-year systematic review of suicide prevention strategies, “29 suicide prevention experts from 17 European countries” recommend 4 allegedly evidence-based strategies to be included in national suicide prevention programs. One of the recommended strategies is pharmacological treatment of depression. This recommendation is problematic for several reasons. First, it is based on a biased selection and interpretation of available evidence. Second, the authors have failed to take into consideration the widespread corruption in the research on antidepressants. Third, the many and serious side effects of antidepressants are not considered. Thus, the recommendation may have deleterious consequences for countless numbers of people, and, in fact, contribute to an increase in the suicide rate rather than a decrease.

    Please ensure that this is matter is properly and urgently addressed at this time when the National Suicide Prevention Strategy is being revisited in the context of the Covid-19 Pandemic, as reported in HSJ 23 April 2020, and also topic of Lancet Article 21 April 2020.
    https://www.hsj.co.uk/coronavirus/unprecedented-plan-to-prevent-suicides-during-covid-19-crisis/7027431.article
    https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30171-1/fulltext

    Thank you
    Marion Brown, Stevie Lewis, Beverley Thorpe Thomson, Millie Kieve, Catherine Clarke, Peter Gordon, Jo Watson, John Read, Peter Gotszche, Janette Robb, James Moore, Bob Fiddaman, Dierdre Doherty, Kristina Gehrki, Fiona French, Alyne Duthie

  14. Received from Scottish Government
    Directorate for Mental Health
    20 May 2020:

    Our Reference: 202000034583 Your Reference: 202000019423

    20 May 2020

    Dear Marion Brown,

    Thank you for sharing this information. I have highlighted your concerns to the Chair of Scotland’s National Suicide Prevention Leadership Group (NSPLG). The NSPLG will be considering the impact of Coronavirus in their future strategy and will be using relevant research including the Lancet paper you mentioned alongside the experiences of the group to form decisions.

    Your work/evidence will also be considered as part of the development of the Quality Prescribing Guidance for Antidepressants which will be produced as an output of the Short Life Working Group into Prescription Medicine Dependence and Withdrawal.

    Yours sincerely

    Craig Wilson AMH : Public Mental Health and Suicide Prevention

  15. From: Peter J. Gordon
    Sent: 20 May 2020

    Subject: ‘A Timeline of Missed Opportunities’

    Dear Marion,
    Thank you for sharing this response from the Scottish Government [20 May 2020].

    All correspondence on this subject can be read here: https://holeousia.com/2020/01/15/a-timeline-of-missed-opportunities/

    As National Leads on Suicide Prevention, Professor Louis Appleby, and Professor Rory O’Connor, have been invited to directly reply to https://holeousia.com/2020/01/15/a-timeline-of-missed-opportunities/ but have chosen not to do so.

    I will add this e-mail [without any identifying details] to https://holeousia.com/2020/01/15/a-timeline-of-missed-opportunities/

    Aye Peter

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