This News feature was published in the BMJ on the 13 January 2025. It can be read in full below.
Several rapid responses to this News feature have been published and can be read here.
I have submitted the following rapid response and hope that the BMJ will publish it:
Dr Peter Scott-Gordon
Retired NHS psychiatrist
20 January 2025
Dear Editor
Suicide and prescribed SSRIs: missed opportunities
In order to prevent future deaths it is vital that collective action is taken. National Suicide Prevention strategies [1], Royal Colleges, NICE, MHRA, medical journals and mental health charities need to work together to ensure prescribers and patients are fully aware that suicidality and impulsivity can arise when starting, changing or stopping SSRI antidepressants.
Baroness Cumberlege began the ‘First Do No harm’ report by stating “We have found that the healthcare system is disjointed, siloed, unresponsive and defensive” [2]
The First Do No harm review was published in 2020. Yet, to my knowledge, there have been very few formal responses from within the healthcare system to this review. Indeed, in asking about this, I have found that many healthcare professionals have responded: “Cumberlege what?”
Drug induced akathisia has long been recognised [3]. Lives could be saved if there were structured and regular formal education about this issue along with the provision of services as suggested by Dr Peter Selley [4]. Yet, a recent ‘Practice Pointer’ Assessment and management of self-harm and suicide risk in young people, published by the BMJ, omitted to mention consideration of drug induced akathisia as a risk factor [5].
In Scotland, nearly 1 in 4 adults are taking prescribed antidepressants, and most commonly beyond the period of treatment recommended in national guidelines. In 2021, my wife wrote to the British Journal of General Practice about antidepressant prescribing [6]. She said “This is important now” and continued “there are large numbers of people who need help in coming off their medications”, concluding “General practice, and the RCGP in particular needs to resist the urge to defensiveness, learn the lessons of experience and show leadership in addressing this problem.”
Collective action is required now. Missed opportunities mean that avoidable deaths will continue to happen.
References:
[1] Hjelmeland, H., Jaworski, K., Knizek, B. and Marsh, I. 2019. Problematic advice from suicide prevention experts. Ethical Human Psychology and Psychiatry. 20 (2), pp. 79-85. https://doi.org/10.1891/1559-4343.20.2.79
[2] First Do No Harm -The report of the IMMDS Review, Baroness Cumberlege, July 2020 https://www.immdsreview.org.uk/Report.html
[3] Clinical Review Lesson of the week: Akathisia: overlooked at a cost, June 2002, : BMJ 2002;324:1506 https://www.bmj.com/content/324/7352/1506
[4] Rapid response by Dr Peter Selley, 19 January 2025, https://www.bmj.com/content/388/bmj.r67/rr-3
[5] Practice Pointer: Assessment and management of self-harm and suicide risk in young people, August 2024, BMJ 2024;386:e073515, https://www.bmj.com/content/386/bmj-2022-073515
[6] Antidepressant withdrawal, BJGP letter, Dr Sian F Gordon, 7 March 2021 https://bjgp.org/content/71/703/76/tab-e-letters
Full text of the News Feature Coroner questions advice on risk of suicide with SSRIs after death of financier:
