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

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25 September 2024

Dear Dr Gordon

Thank you for your email dated 16 June on antidepressant prescribing. Please accept my apologies for the delayed reply, I receive a huge amount of correspondence, and the last few months has been particularly busy for me with clinical and College commitments.

I am sorry to hear about the experiences you, and those you are writing on behalf of, have had with stopping antidepressants.

This is a matter the College has taken a lead role in raising awareness about over recent years. I therefore disagree with your view that the psychiatric profession and College has a defensive culture, does not prioritise patient safety and chooses to spin evidence about this issue.

We recognised the need for a greater focus on safely stopping antidepressants in our 2019 position statement, and as you note, subsequently published a patient resource to provide information about the risk of withdrawal and how to reduce or avoid these symptoms. This is the first of its kind to be produced by a professional medical organisation in the UK or internationally and has recently been updated. There are also many examples of College statements and public comments which highlight the importance of gradually stopping antidepressants.

You specifically raise concerns about the study published in the Lancet on 5 June by Henssler et al, the subsequent Guardian article by Professor Pariante, and mine and others’ public responses to these. I think it is important to reflect on how the academic uncertainty and debate about the incidence of antidepressant withdrawal has led to significant media and public discourse over the last few years. This has at times lacked balance, risks undermining the important role of antidepressants as a recommended treatment option and may instil a sense of fear about their use. These are concerns the College rightly challenges and that is why I chose to highlight the research study and Guardian article. That does not imply a change in position of the College but is a recognition that there remains an uncertainty about the incidence of antidepressant withdrawal.

I also do not agree it is misleading to have publicly highlighted the research on the basis that there are criticisms of the study methodology, which is a normal occurrence with the publication of new research, particularly in areas where there is a lack of high-quality data. It is of note that in response to the 2019 study on antidepressant withdrawal by Davies and Read – which concluded that the incidence of withdrawal is significantly higher than that found in the research by Henssler et al, and which has also faced criticism of its methodology – the College publicly commented on this recognising that for many people the withdrawal effects can be severe, particularly when antidepressants are stopped abruptly.

You ask in your email that the College makes a statement on how it will support individuals who have been prescribed antidepressants. The 2019 College position statement I mentioned previously already recommends a range of actions to promote optimal use and management of antidepressants and calls for support services for patients affected by more severe and prolonged antidepressant withdrawal, modelled on existing best practice.

Finally, you also suggested the College could address language used by members in relation to individuals sharing their personal experiences. I assume this relates to social media use, for which we do not have a remit to monitor or regulate individual College members activity. We have, however, a social media policy which provides guidance on this matter, and I can assure you that I expect those speaking on behalf of the College, who are currently in an elected or appointed role, to do so in a respectful manner, in line with our College values.

Finally, I am sure that we all agree that the incidence and prevalence of depression across the world, and the inadequate provision of the range of treatment options that we know are effective, is an area we should be focusing on. I hope that you support this view.

Thank you again for taking the time to write to me.

Yours sincerely
Dr Lade Smith

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This is a reply to the letter of the 25 September 2024 sent by the President of the Royal College of Psychiatrists:

To: Dr Lade Smith, CBE, President of the Royal College of Psychiatrists
From: Dr Peter Scott-Gordon
Subject: Thank you for your reply

26 September 2024

Dear Dr Smith,

Thank you for your reply to our letter on patient safety in relation to antidepressant prescribing.

We understand how busy you will be as President of a Royal College. However, despite polite reminders to you as President of the Royal College of Psychiatrists, you only finally replied after we copied-in a number of individuals who have a role in protecting patient safety [included in this e-mail].

We made clear in our letter to you that 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”.

In relation to harms emerging beyond short-term EBM studies on antidepressants, it is less than the whole truth for you to state that “the College has taken a lead role in raising awareness about [these issues] over recent years”. It might be closer to the truth to say that the College, to protect its credibility, has continued to ignore/dismiss/disbelieve such lived experience for at least 3 decades. There can of course be arguments about numbers involved. But to ‘ignore’ lived experience is surely stigma.

In your reply, which one would naturally assume had input from the RCPsych Communications team and Head of Policy and Campaigns, there is careful, perhaps deliberate avoidance to acknowledge, let alone explain, why you chose [as President] to promote on social media a most misleading opinion piece in the Guardian by a career-long paid opinion leader. The overall tone of the Guardian piece suggested there is “little to be concerned of here . . . it is time to move on”. In your reply to us you have continued to develop this suggestion.

1 in 4 of our population are now taking an antidepressant. This is mass prescribing. A significant percentage of this 1 in 4 have been taking an antidepressant beyond an evidenced-based period. Your reply avoided commenting on whether this very large group requires an antidepressant for recurrent major depressive disorder. Your reply avoided giving balanced recognition of those who find that they cannot stop antidepressants even when they have NO craving for them. Instead, you ended your letter with:

“Finally, I am sure that we all agree that the incidence and prevalence of depression across the world, and the inadequate provision of the range of treatment options that we know are effective, is an area we should be focusing on. I hope that you support this view.”

My determined wish is to reduce suffering. This is the focus of all those who signed this letter. Our primary focus.

Kind wishes
Dr Peter Scott-Gordon