Patient safety: a letter to the President of the Royal College of Psychiatrists

16th June 2024

To: Dr Lade Smith, CBE, President of the Royal College of Psychiatrists
Copied to: Dr Trudi Seneviratne, Registrar, Royal College of Psychiatrists, Professor Subodh Dave, Dean, Royal College of Psychiatrists, Sonia Walter, Chief Executive Officer, Royal College of Psychiatrists, Corinne Bishop, Director of Strategic Communications, Royal College of Psychiatrists, Elen Cook, Interim Director of Professional Standards

Dear Dr Lade Smith,

I am writing on behalf of a group of people who have suffered life changing harm from antidepressants.

It took 30 years of patient harm and campaigning for the significant public health issue of antidepressant withdrawal to be recognised in the UK – culminating in new guidance from the Royal College of Psychiatrists in 2019.

Concerns about inappropriate antidepressant prescribing and withdrawal risks are now embedded in the latest NHS Medicines Optimisation Objectives.

Last week a piece appeared in the Guardian, fronted by Professor Carmine Pariante, a career-long paid opinion leader, claiming that new research showed antidepressant withdrawal was not nearly as significant as previously thought – and these drugs were safe because they are ‘non-addictive’.

A number of academics, such as Professor Tony Kendrick, Professor of Primary Care at Southampton University, were critical of the withdrawal figures quoted and recalculated them to about one in three patients, close to previous estimates.

Professor Pariante’s assertion that antidepressants are luckily found to be ‘non-addictive’ is, frankly, manipulative. Antidepressants have never been conceptualised as ‘addictive’. This ‘non-addictive’ descriptor is being used to imply drug safety in a highly dangerous way; to the general public ‘non-addictive means ‘easy to quit’, which for 1/3 of patients antidepressants are not.

We have suffered life changing harm from antidepressants – some of us have been personally disabled for life, some of us have had our children or husbands killed by the adverse effects they induce.

The unvalidated Guardian piece has done nothing but intensify our distress. It has also made us fearful that others may suffer the same fate, due to disinformation. I understand that on the same day that the Guardian piece was published, as President of the Royal College of Psychiatrists you said on social media “this is a MUST read” (sic). This misleading assessment will have reached your numerous followers, many of whom will be practising psychiatrists.

We wrote this letter (below) expressing our deep concerns to the Guardian: so far they have chosen not to publish it.

Letter, as sent to the Guardian, 11 June 2024:

We write as a group of individuals adversely affected, directly or indirectly, by prescribed antidepressants. These harms include dependence, withdrawal and other side effects: a significant public health issue. We want to express the further harm caused by Professor Pariante’s opinion piece published on Saturday 8th June.

We are not researchers and leave others to detail the limitations of the meta-analysis to which he refers. But even a non-specialist reading indicates the research does not support his emphatic claims. The word ‘addiction’ never appears in the research, nor is it an issue associated with antidepressants. However Professor Pariante’s repeated use of ‘addiction’ suggests to the general public that antidepressants are easy to halt. This is untrue for an estimated one third of patients. Academics should, as should manufacturers, be meticulous in their use of language.

Yet again, we are being failed by psychiatry. The Guardian piece has been supported by establishment psychiatrists with limited research analysis. We understand a wish to avoid people with severe depression being fearful of treatments: however we know they are far outnumbered by patients without severe depression. Prescriptions continue to increase. The profession is not being fully honest, and we feel repeatedly belittled by the imbalance of power. The recommendations of the Hillsborough enquiry and recent evidence given to the Post Office Horizon enquiry are direct parallels.

Psychiatry often congratulates itself for ‘tackling stigma’. Yet it chooses to ‘spin’ evidence in a way that continually undermines the voices of those who have experience of being harmed by prescribed medications.

We want to minimise the potential for the same harms to disable increasing numbers of patients. We must have further research that specifically looks at dependence and withdrawal as well as less common but potentially very serious issues like akathisia and irreversible sexual dysfunction (PSSD). The Maudsley Deprescribing Guidelines (2024) state “physical dependence is a predictable physiological response to chronic use of psychotropic medication”. When it comes to patient safety psychiatry needs to be more truthful about risks.

Your uncritical support of Professor Pariante’s opinion piece has only served to convince us further that the College does not prioritise patient safety. Despite all the College’s assurances regarding reducing stigma it does nothing to address a harmful imbalance of power. This defensive culture risks repeating the patient safety scandals of the past, of which Valproate is only one example. We seek your reassurance that the College recognises that this defensiveness must change. The lack of response by the College to the Cumberlege Report does not make us optimistic that this reassurance will be forthcoming. However, we have some hope that you, as current President, can lead the College to a place where patient safety is given its rightful priority. For now, we would ask that the College makes a detailed and specific statement on how it will practically support individuals who have been harmed by taking antidepressants as prescribed. In terms of culture, the College could start by addressing the use of denigratory language by its members in relation to those who are doing their best to offer learning from the experience of taking antidepressants, particularly in the longer term.

We look forward to your response.
Yours sincerely,

Peter Scott-Gordon, Alyne Duthie, Nicolas Destors, Yoko Motohama, Vincent Schmitt,  Marion Brown, Cathy Wield, Daniel Demers, Ian Morgan, Tania Morgan, Dan L. Johnson, Legai Lara, Hélène Périsse, Aurore Lesellier, Armony Venereux, Mannoni Giusiana, Mannoni Gilles, Kumi Chauveau, Christophe Chauveau