Do antidepressants make you suicidal?
It would be easy to blame the pills for Thomas Kingston's death - but it wouldn't be right.
With age, we’re granted the gift of self knowledge; precious insight that prevents us from saying yes to stuff we know we can’t do/don’t want to, like a day out at the ice skating, or doing a second tequila shot.
In this vein, I have made a crucial discovery over the last few months: I am, without a shadow of a doubt, a Prozac girly.
Regular readers of my mental health chronicles might remember that I’ve had my ups and downs with SSRIs – the most common form of antidepressants prescribed these days.
I’ve been on Prozac several times throughout my 33 years to treat anxiety and had pretty uneventful experiences (and significant benefit) until three years a go, when it turned me into a panicked, quivering shell for the first month of taking it. But it passed, and I soon felt better. Much better. So good in fact that I came off them after six months – I didn’t need them any longer, I concluded.
The problem is that mental illnesses like generalised anxiety disorder don’t often go away. And so, predictably, I managed only six months drug-free before my brain smacked me with a freight train of horrifying fears that wouldn’t evaporate with heavy breathing exercises.
I decided to try a new type of SSRI that I’d heard was especially good for anxiety: escitalopram. Long story short; I went marginally mad for the first few months before calming down somewhat, but not enough. The drug triggered a strange and unsettling sense of detachment from myself, my thoughts, my surroundings, that didn’t seem to be worth the marginal benefit.
So, back on Prozac I went. That was three months a go and, so far, so good. About six weeks in I felt the constant urgency in my brain relax, and the lifelong search for the next scary thing stopped. Until last week.
The harrowing death of 45 year-old Thomas Kingston – a financier who was married to King Charles’ second cousin – was once again thrust into the spotlight, after his parents appeared on The Today Programme calling for greater awareness of the risks of antidepressants.
Kingston was, according to his family, a well-adjusted and mentally well man, who was prescribed two different types of SSRI medication to help him deal with a bout of work-related anxiety. He seemed in good spirits on the day he shot himself in the head in February last year.
A subsequent Prevention of Future Deaths report, written by coroner Katy Skerrett, stated that the deceased was ‘suffering from adverse effects of medications he had recently been prescribed’ when he took his own life.
Invested parties took to Twitter to voice their anti-antidepressant sentiment, telling of ‘intense urges to jump off a balcony’ that they experienced on the drugs.
Meanwhile, news outlets followed the story with further antidepressant ‘warnings’, such as: ‘More than 100 alerts were made in a decade to the UK’s medicines regulator over deaths linked to the antidepressants which Thomas Kingston was taking before he killed himself.’
After the bombardment of said stories in the afternoon, I listened to the interview with Kingston’s parents on the way home from work, and found my attention gravitating towards my own state of mind.
Kingston had never expressed suicidal intent before his death, it was said, and had enjoyed a delightful lunch and afternoon walk with his beloved parents before committing the most unimaginably violent act of self-destruction. It was completely out of the blue. Out of character.
Could I be at risk of the same fate? The pills have made me feel like a slightly less predictable version of myself, after all. Maybe I do still harbour a sense of detachment and perhaps this could leave me open to behaviours I’d never before considered. We all get the ‘what if I jumped in front of this train’ impulse - but to what extent do I actually want to do it? How does one know?
I was suddenly back in the headspace I was six months before, recalling the unbearable anxiety that made me dread making up the next day in the same prison of terror. I remembered all the innocuous things that freaked me out back then, replaying the twisted logic. Suddenly there I was, knees jittering on the tube, heart pounding out of my chest, halfway to convincing myself I ought to admit myself to a psychiatric hospital.
The anxiety continued for a couple of days, until I was distracted enough for it to disintegrate. The experience reminded me of the impossible complexity of this subject – and the very frightening risks of communicating the potential complications badly, or at least without the full picture.
My point is two fold. First, Thomas Kingston’s death was by no means clear-cut, and I will explain why in a moment. Secondly, scary messages about vital drugs that 8.7million people in the UK take, which are often life-saving, can do serious damage. Of course it’s important the public knows about the risks of popular medication. But only if they are based on hard facts.
Firstly, high-quality studies involving hundreds of thousands of patients have shown that, on the whole, SSRI antidepressants prevent suicide. Some research has found a very slight increased risk of self-harm and suicidal completion/ideation in adolescent boys – but only with certain types of SSRIs. Generally speaking, the pills help about half of those who take them.
Another thing to note is that, on the whole, studies on the efficacy of antidepressants that are quoted have looked at the effect on depression – not anxiety, which was suffered by Mr Kingston, and about one in 10 of the population.
A recent review published by Canadian researchers on benefits for generalised anxiety disorder, involving more than 12,000 people, found that SSRIs were 41 per cent more effective than a sugar pill. Importantly, there was no difference in dropout rate between the groups, or the incidence of agitation while on the meds.
Kingston’s case is more complex than some headlines would have you believe. Firstly, there were several drugs involved, with switches between medications seemingly taking place over a relatively short period of time.
I didn’t attend the inquest, so it is difficult to ascertain exactly which medication he was prescribed, and in what order. But reports state that he was first given the SSRI sertraline, along with the sleeping tablet zopiclone (which GPs tell me are rarely prescribed these days due to their addictive quality). A while later he retuned to the GP and said the pills were making him feel very anxious. He was switched to another SSRI, citalopram, and the sedative diazepam. It was reported that, in the days before his death, he had ‘not long’ stopped taking the antidepressants.
It is well known within medical circles that stopping an SSRI suddenly is risky. Guidance written for GPs – and patient information leaflets – warn never to go cold turkey, advising a gradual ‘tapering’ off the medication. Mr Kingston’s method of stopping the medication is not clear. The length of the initial period of sertraline is also unclear from reports; it is well known that all SSRIs can make you feel worse for the first few months, before you feel an improvement.
Clearly, with four different mind-altering medications in his system, Mr Kingston should have been monitored a lot more closely. Arguably, as has previously been suggested, all patients who begin a prescription should be. In my experience, the first few weeks can be brutal. But crucially, in most cases, patients get better.
I strongly disagree with the primary demand made by Mr Kingston’s parents – the introduction of a consent form listing possible side effects including suicide, which everyone who takes an SSRI should sign.
The most pressing problem with antidepressant prescription in the UK is that not enough people who stand to benefit are taking them. One 2023 study found that around a quarter of all British adults have undiagnosed anxiety or depression. That means nearly five million could be suffering in silence, forgoing treatment that could vastly improve their lives. In short, we don’t need another reason to scare people off antidepressants.
There’s also the risk of the nocebo effect, which I fell victim too. Several trials have found that, if patients expect to suffer a certain side effect after taking antidepressants, they are more likely to report it. Studies consistently see that those in the placebo group report the same side effects as people in the antidepressant group, even if they’re not taking the pill.
A 2019 Australian study illustrates this perfectly. The researchers looked at patients’ experiences of taking the antidepressant venlafaxine following (false) news reports that the latest formulation of the medication was less effective and causing side effects. They found a significant increase in patients’ reports of the exact side effects – including suicidal thoughts - mentioned in the scaremongering stories in the months after the furore. The investigators also noted a jump in the number of patients who said they thought the pills were no longer effective.
People with mental health problems are uniquely vulnerable to media messaging. The disturbed brain latches on to sabotage, in any form available – especially those that hinder recovery.
My final point is one that didn’t go down very well on Twitter. Still, I think it’s necessary. I was fascinated by the speed at which commentators honed in on antidepressants as the demon in this story, neglecting the actual and direct cause of death: a shotgun wound to the head. None of the outrage was reserved for the legislation that allows people in this country to own a lethal weapon.
The jury is still out on whether or not antidepressants cause fatalities. The same cannot be said for firearms, as far as I know.