A review has been launched on antidepressants reportedly linked to suicide after the death of Royal Family member Thomas Kingston.
Senior coroner Katy Skerrett raised concerns last week over whether there is ‘adequate communication’ regarding the risks of suicide with the drugs sertraline and citalopram – and if such risks had been communicated to patients taking them.
Mr Kingston, whose marriage to Lady Gabriella at Windsor Castle in 2019 was attended by the late Queen, took his own life after being prescribed the drugs for anxiety by a Buckingham Palace doctor.
The drugs – known as SSRIs (selective serotonin reuptake inhibitor) – are the NHS’s first-choice medicine for anxiety and depression, which are currently being prescribed to more than four million people.
In a prevention of future deaths report, Ms Skerrett questioned whether the current guidance to ‘persist’ with the drugs is ‘appropriate’ in circumstances when the individual is suffering ‘adverse side effects’.
It was revealed by the Times earlier this week that there are 40 PFD reports which reference the use of either citalopram or sertraline by the deceased person.
A range of concerns have been identified in these reports. These include the failure to alert patients to the potential side-effects, breaches of prescribing guidelines, not reviewing patients and not keeping records of patients’ behavioural changes while on the medication.
At an inquest into the death of Samuel Morgan in South Wales, coroner Colin Phillips suggested citalopram should come with a US-style ‘black box’ warning, as it ‘would have a more immediate impact’.
It was heard that the 25-year-old from Swansea had been on citalopram for seven days before he took his own life in January 2020.
Mr Phillips reported: ‘Whilst the precise effect of this medication (citalopram) on Sam is unknown, it is clear that Sam had never self-harmed previously and his actions were completely out of character.
‘The simple and clear message in this specific case would be that there is an increased risk of suicidal thinking in young adults.’
Coroners highlight measures which could slash the death toll in Prevention of Future Deaths (PFD) reports and alert public bodies when they fear that there is ‘a risk that future deaths could occur unless action is taken’.
Whilst the recipients – which are usually ministers and their departments, NHS trusts, prisons or regulators – must respond in writing, they are not required to take concrete steps to address the concerns identified in these reports.
Mr Phillips’ suggestions were rejected by the Medicines and Healthcare Products Regulatory Agency (MHRA), who said the warnings in their patient information leaflets had been reviewed and tested.
But the MHRA has now opened a review into sertraline and citalopram and said it originally set up an expert working group in 2022.
It therefore denied this review was prompted by Mr Kingston’s case, instead claiming it had taken time to assemble the 20-member panel.
The regulator did confirm that it had received Ms Skerrett’s PDF report and was ‘carefully considering’ its response.
Dr Alison Cave, chief safety officer at the MHRA, told The Times: ‘Following concerns raised by patients and families about how the risk of suicidal behaviours is communicated in the patient leaflets, we have established a new independent expert group to advise the Commission on Human Medicines, which provides expert advice to government ministers.’
It was also revealed that thousands of deaths could be prevented every year if public bodies took action over concerns highlighted at inquests.
According to the Office for National Statistics, almost 82,000 deaths in 2022 were recorded in England and Wales as ‘preventable’.
This meant they could have been avoided ‘through effective public health and primary prevention interventions’.
Despite his symptoms, Mr Kingston ‘had not expressed any suicidal ideation’ an Ms Skerrett said his ‘intent remains unclear’ as he was suffering from ‘adverse effects of medications he had recently been prescribed’.
The businessman was visiting his parents in Kemble, in the Cotswold district of Gloucestershire, for the weekend when he decided to take his own life.
After having lunch with them, on February 25, he began to load his car and prepared to return to London.
Ms Skerrett said that between approximately 5pm to 6pm, Mr Kingston ‘removed a shotgun from his vehicle which he had recently borrowed from his father for a shoot’.
‘He then accessed an annex attached to his parent’s property,’ she continued.
‘Within a locked bathroom he self-inflicted a gunshot to the head, and sustained injuries incompatible with life.’
The former negotiator was subsequently found by his father and was later pronounced dead at 6:54pm by police, who confirmed there were no suspicious circumstances surrounding his death.
The coroner added: ‘Mr Kingston took his own life using a shotgun which caused a severe traumatic wound to the head.
‘Intent remains unclear as the deceased was suffering from adverse effects of medications he had recently been prescribed.’
An inquest heard he had ‘recently been experiencing anxiety’ but had ‘not expressed any suicidal ideation’.
It was reported that Mr Kingston had initially been given sertraline, a drug used to treat depression and zopiclone, a sleeping tablet, after complaining of trouble sleeping following stress at work.
Reports said both were prescribed by a GP at the Royal Mews Surgery, a practice at Buckingham Palace which is used by royal household staff.
Mr Kingston returned to the surgery, saying they were not making him feel better. His doctor then moved him from sertraline to citalopram, a similar drug.
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