Correspondence with Profs Wendy Burn and David Baldwin, RCPsych

In the interests of transparency, I have decided to reproduce all correspondence between myself and Profs Wendy Burn and David Baldwin since the publication of their letter to the Times newspaper on 25 February 2018.  The letter itself is reproduced here.

A letter in the Times: ‘Pills for depression’

It was written in response to the following letter.

Sir, Further to your report “More people should get pills to beat depression” (Feb 22), the research by Andrea Cipriani et al has generated much excitement, with the Royal College of Psychiatrists claiming that it “finally put to bed the controversy on antidepressants”.

The study actually supports what is already known: namely that the differences between placebo and antidepressants are so minor that they are clinically insignificant. Furthermore, the trials covered only short-term usage (eight weeks). But about 50 per cent of patients have been taking antidepressants for more than two years, and the study tells us nothing about their effects over the long term. In fact, there is no evidence that long-term use has any benefits. Lastly, the study does not address the damage caused by long-term prescribing, including the financial burden to the NHS and the disabling withdrawal effects that these drugs cause in many patients, which often last for many years.

Antidepressants are prescribed to about 10 per cent of the UK population and even existing guidelines do not support their use by at least one third of these patients. This study will unfortunately do nothing to reduce this level of unnecessary prescribing and the consequent harms.

Dr James Davies; Dr Joanna Moncrieff; Professor Peter Kinderman; Viscount Hinchingbrooke, Council for Evidence-based Psychiatry

 

My blog yesterday described my most recent correspondence with Prof Wendy Burn.   Marion Brown has kindly appended her email to Prof Burn in the comments section.

https://nevertrustadoctor.wordpress.com/2018/06/08/wendy-burn-president-of-rcpsych-offered-to-meet-offer-now-withdrawn/

Earlier correspondence is outlined below.  I will leave readers to draw their own conclusions.  I have not received a response to my email of 2 March 2018.

Please note that in email of 1 March reproduced below, Prof Burn was very keen to talk about my difficulties with Nitrazepam, whilst ignoring the fact that I was also prescribed antidepressants for 35 years, latterly Venlafaxine.  I tapered off this drug in 2014-15.

“Thanks for getting in touch. I am sorry you have had such a difficult time. As you know nitrazepam is highly addictive, I never prescribe it.  I attach two papers from Professor Baldwin.”

My most recent letter from consultant psychiatrist also fails to mention my 35 years history on antidepressants and the fact that I have recently tapered off Venlafaxine.  There is a pattern emerging here.

26 February

Dear Professor Baldwin

Following your letter published in The Times yesterday and engagement with Dr Wendy Burn on Twitter, I have written the email below which I hope you will read.  I would be very interested to know the evidence for the statement in your letter about withdrawal symptoms resolving within two weeks for most patients.

Kind regards

(email to Wendy Burn below)

26 February 2018

Good afternoon Fiona and thank you for sending me he message. You might want to read the attached papers, which look at discontinuation symptoms both after abrupt discontinuation and after tapered withdrawal. Best wishes

Papers appended. (contact me if you wish copies of these papers).

David S Baldwin, Stuart A Montgomery, Rico Nil, Malcolm Lader.  Discontinuation symptoms in depression and anxiety disorders  International Journal of Neuropsychopharmacology (2007, 10, 73–84)

David S Baldwin, James A Cooper, Anna K T Huusom, Ian Hindmarch.  A double-blind, randomized, parallel-group, flexible-dose study to evaluate the tolerability, efficacy and effects of treatment discontinuation with escitalopram and paroxetine in patients with major depressive disorder.  International Clinical Psychopharmacology 2006, 21:159–169

 

26 February 2018

Dear Dr Burn

Thank you for engaging with myself and others on Twitter regarding antidepressant withdrawal.  As you know members of the online prescribed dependent and withdrawal community are extremely concerned about the lack of knowledge, information, support and services for those attempting to withdraw from antidepressants.  We have been liaising with the BMA and the APPG on Prescribed Drug Dependence for several years and were pleased to see the announcement of a year long review by Public Health England. Campaigners have submitted petitions to the Scottish Parliament and the Welsh Assembly seeding help, support and information for the many patients who are badly affected by antidepressants and other drugs of dependence.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651

https://www.assembly.wales/en/gethome/e-petitions/Pages/petitiondetail.aspx?PetitionID=1235

The leaflet on this subject on RCPsych website does not warn patients how very difficult and protracted withdrawal can actually be.    Members of the online community are extremely surprised that this should be the case.

https://www.rcpsych.ac.uk/healthadvice/treatmentsandwellbeing/antidepressants/comingoffantidepressants.aspx

The survey results presented gives no information about how long the respondents had been on the drugs.  As you know, patients have been kept on these drugs for many years, even decades.  Therefore it is unrealistic to expect patients to taper off in a short time.  I have looked at the NICE Guidelines on tapering and the advice is based on short term studies only.  The advice giving to prescribing doctors is therefore not fit for purpose.  Dr John Mitchell, adviser to Scottish Government, quoted the survey on your website at the last meeting of the Petitions Committee.  He too seemed unaware of the immense problems being caused to many patients by antidepressant withdrawal, dependence and iatrogenic harm.

I was extremely disappointed to read the letter in The Times written by Prof David Baldwin and yourself.

https://www.thetimes.co.uk/article/86afb2fc-18c7-11e8-a427-78e8af199a96

The letter stated that withdrawal symptoms resolve within two weeks for the vast majority of patients.  This is not consistent with the information in the above leaflet nor is it the experience of the very many patients who are congregating online in the prescribed dependent and withdrawal community.   I would like to know why this statement was made and on what evidence it was based.  Perhaps you could let me know so that I can share with online patient community.  We believe that it is extremely important that patients are properly informed about the very difficult process that withdrawal can be, particularly as more and more patients are being kept on antidepressants for longer periods.

You will be aware of the current research being conducted at the University of Southampton by Prof Tony Kendrick.

https://www.southampton.ac.uk/news/2016/07/antidepressent-study-kendrick.page

I would like to know why this programme of research has been started if withdrawal from antidepressants is so very easy for the vast majority of patients.  The recently reported study in the Netherlands was a failure due to the use of the Dutch Guidelines on tapering which proved to be too fast.  The research team is now running a second clinical trial using slower tapering methods. You will see that members of the online community have responded to this paper in the e-letters section.

http://bjgpopen.org/content/early/2017/11/14/bjgpopen17X101265

The survey of patients in the online community by Dr James Davies of Roehampton University suggests a very different picture of withdrawal than that suggested in the RCPsych leaflet and the letter in the The Times.   The Rxisk website covers the issue of protracted withdrawal and acknowledges how difficult it can be.

https://rxisk.org/complex-withdrawal-model/

I have personally withdrawn from Nitrazepam and Venlafaxine after being prescribed the former for almost 40 years and a variety of antidepressants for a similar time period.  Due to no appropriate advice on tapering I am now disabled and housebound after ending 3.5 years of horrendous torture and being confined to bed for the most part. I now encounter patients online equally badly affected when withdrawing from antidepressants alone.  I have clearly sustained a brain injury.  Presumably those who suffer for many years after antidepressant withdrawal have also experienced some sort of damage.  It is extremely important that patients are given accurate and evidence-based advice on this subject and they should not be misled into thinking withdrawal is a trivial matter.  After all, many of our prescribing doctors do not believe us when we describe our horrendous symptoms and the information being provided by RCPsych simply reinforces this sort of disbelief.  The letter to The Times has also made the situation worse.

I sincerely hope that the RCPsych can work constructively with patients and with prescribing doctors so that all can have accurate information to work with and ensure patients are not put at undue risk as a result of misleading advice and information.

Kind regards

Fiona French

 

1 March 2018

Dear Fiona

Thanks for getting in touch. I am sorry you have had such a difficult time. As you know nitrazepam is highly addictive, I never prescribe it.  I attach two papers from Professor Baldwin.

The leaflet was time- expired and as you say missing important details. It was based on a self-selecting survey and was never intended to stand alongside peer reviewed research which is what we now base our leaflets on.

This is an important area and we will produce a revised information leaflet with input from patients and, of course, the Royal College of GPs who see so many patients with mental health needs. I am happy to include someone who has had difficulty in stopping antidepressants in the production of the leaflet.

Best wishes

Wendy

 

2 March 2018

Dear Wendy

Thank you for your response.  It is well known of course that benzodiazepines are highly addictive and difficult to withdraw from but as I am finding out patients in the online dependent and withdrawal community are just as badly affected by SSRI antidepressants, including Venlafaxine, which I was also prescribed for about 15 years.  I include two videos of the sort of suffering I encounter every day online as a result of antidepressant withdrawal.

https://www.youtube.com/watch?v=XL7bUlsQr7c

https://www.youtube.com/watch?v=yn7IZyZcX80&t=30s

Thank you for the two papers which Prof Baldwin also sent to me.  I note that they are short term studies of patients which does not reflect the realities of what is happening to patients who take them for longer.

The survey results reported in your leaflet clearly showed that withdrawal symptoms lasted for some months for many patients.  That is indeed evidence and I can see no reason for the leaflet having been withdrawn.  Is that your normal practice, to withdraw leaflets during the revision process?  Having some additional information such as length of time on the drugs would of course have been very useful.  There is of course no other evidence of withdrawal symptoms apart from the accounts of patients who experience them.

The online patient community is happy to collaborate on the production of a new leaflet.  I am happy to be the contact person for that collaboration and I can liaise with anyone who cares to liaise with me on the subject.   There is a wealth of knowledge and experience of antidepressant withdrawal in the online community.  After all, we deal with nothing else.  We have engaged very successfully with the BMA, the APPG-PDD and other interested parties.

Kind regards

Fiona French

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2 Responses to Correspondence with Profs Wendy Burn and David Baldwin, RCPsych

  1. Snow-Leavis says:

    Dear Fiona,
    In the same spirit of transparency, here are my communications with Profs Wendy Burn and David Baldwin on their letter to the Times.

    Kind wishes Peter

    ———————-

    Sent: 26 February 201
    To: Professor David Baldwin
    Cc: Professor Wendy Burn
    Subject: Your letter to the Times 24 February 2018

    Bridge of Allan,
    Scotland.

    26 February 2018

    Dear Professor Baldwin,
    I am an NHS Psychiatrist for older adults working in Scotland.

    I noticed your letter in the Times (see below). Would you mind if I asked you a few questions about this as I am interested to learn more about the evidence-base for long term prescribing of antidepressants.

    I am interested in this as in Scotland we now have 1 in 7 adults on antidepressants and the majority are taking them either long term or indefinitely. Professor Ian C Reid, my friend and colleague, who is sadly no longer with us, used to describe this prescribing as “conservative”. Would you agree with Ian Reid, and can you provide the evidence, both in quantitative and qualitative terms, that supports such long term or indefinite prescribing? I am not aware of evidence that has established that 1 in 7 Scots live with chronic or recurrent major depressive disorder. I would be grateful if you could help me with this uncertainty of mine about available evidence.

    Petitions have been raised in Scotland and in Wales in relation to antidepressant drug dependency and withdrawal. A large volume of evidence of experience has been submitted and I would suggest to you and Professor Wendy Burn that it is worth reading. I am sure that you will both agree that evidence comes in words and numbers, though neither can be said to fully represent experience:

    Scottish petition: http://www.parliament.scot/GettingInvolved/Petitions/PE01651

    Welsh petition: https://www.assembly.wales/en/gethome/e-petitions/Pages/petitiondetail.aspx?PetitionID=1235

    I would therefore also be grateful if you could share the references that support your conclusions in your Times letter on the potential for antidepressants to cause withdrawal syndromes.

    Kindest wishes,

    Dr Peter J Gordon GMC 3468861
    Writing in my own time

    —————————-
    From: Professor Wendy Burn
    Sent: 28 February 2018 09:02
    Subject: Re: A letter for Dr John Crichton, Chair, Royal College of Psychiatrists in Scotland

    Hi
    Thanks for copying this to me. I haven’t checked Professor Baldwin’s email address, as you can imagine I get hundreds of emails each day!

    The letter has provoked many emails and much correspondence on Twitter, some of it very rude and hurtful.

    If you send the email again I will forward to Professor Baldwin.
    Best wishes

    Wendy
    Professor Wendy Burn

    ———-

    Sent: 28 February
    To: ‘Professor Wendy Burn
    Subject: RE: A letter for Dr John Crichton, Chair, Royal College of Psychiatrists in Scotland

    That is kind Wendy,
    Thank you very much for responding.

    This is the e-mail. I would be most grateful if you might send on to Professor Baldwin.

    We have a snowy white-out here in Bridge of Allan! I live near Stirling castle. I have not been able to get into work this morning, nor has my wife who is a GP.

    Aye Peter

    —————–

    From: Baldwin D.S.
    Sent: 26 February 2018 09:41
    Subject: RE: Your letter to the Times 24 February 2018

    Good morning Peter and thank you for the message and queries. Yes, Ian Reid is greatly missed.

    I believe the best evidence to support long-term antidepressant prescribing (up to 2 years) comes from meta-analyses such as that reported by Geddes in 2003. The evidence for prescribing beyond 2years is limited but the papers by Kupfer and colleagues describe beneficial effects up to 5 years.

    As regards symptoms occurring after stopping antidepressants I described such symptoms with paroxetine and escitalopram (and the differences between the drugs) and have also described those symptoms with venlafaxine.

    I will look at the web-links to the two petitions.

    best wishes from a cold but sunny Southampton

    David

    David Baldwin
    Professor of Psychiatry and Head of Mental Health Group, University of Southampton Faculty of Medicine. Honorary Professor of Psychiatry, University of Cape Town, South Africa. Visiting Professor, Shandong Mental Health Centre, China. University Department of Psychiatry, Academic Centre, College Keep, 4-12 Terminus Terrace, Southampton SO14 3DT
    Interested in psychopharmacology? Visit BAP at http://www.bap.org.uk

    ——————————————-
    Sent: 28 February 2018
    To: Professor David Baldwin
    Cc: Professor Wendy Burn
    Subject: Your letter to the Times 24 February 2018

    Dear David,
    Just to say your e-mail has been received. I am very grateful to you. And thank you Wendy.

    Aye Peter

    Like

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