Hundreds of deaths have been linked to powerful antidepressants, figures show.
None of the fatalities, however, are proven to have been caused by SSRIs, a category of drugs including sertraline and fluoxetine. Many may have been caused by existing illnesses and conditions.
But given how extremely common SSRIs are, experts warn the figure – stored by the Medicines and Healthcare products Regulatory Agency (MHRA) – might be the tip of the iceberg.
Officials tasked with policing the safety of medications given to Britons have received 1,127 SSRI ‘reports with a fatal outcome’ since the late 1980s.
Although the MHRA says this number is actually more like 1,102, as some cases have multiple SSRIs listed as suspected drugs – meaning they are counted twice.
Nine were among kids under ten. All of these cases involved suspected side effects during or following exposure in pregnancy.
Psychiatrists insist the benefits of SSRIs, also used to treat anxiety, OCD, bulimia and premature ejaculation, are ‘clear’ and far outweigh any potential risks.
Millions take the drugs safely and have done for years, doctors say. And the MHRA, which trawls through the latest reports, has yet to raise any alarm.
The NHS states you shouldn’t suddenly stop taking the drugs ‘even if you feel better’ because they can cause crippling withdrawal symptoms.
Yet some experts question the safety of the pills, which can batter patients with nasty side effects. The NHS warns a loss of libido, diarrhoea and dizziness are ‘common’ – and says ‘some people have suicidal thoughts and a desire to self-harm’ when they first take SSRIs.
Holes have also been poked in the science behind how the drugs supposedly work, with uptake having spiralled in recent years in a trend critics have described as ‘medicalising misery’.
The Daily Mail analysed reports given to the MHRA’s Yellow Card scheme – a database set-up in the wake of the 1960s thalidomide scandal.
It allows doctors, pharmacists and patients themselves to report adverse reactions thought to be caused by drugs used in Britain.
This can lead to them being reviewed, having warnings stuck on labels or being taken off the market completely.
Every drug approved for use in Britain has to go through rigorous safety trials before being made available to the public but some issues can slip under the radar, such as the rare blood clots triggered by AstraZeneca’s Covid vaccine.
We looked at seven commonly prescribed SSRIs:
- sertraline (Lustral)
- citalopram (Cipramil)
- escitalopram (Cipralex)
- fluoxetine (Prozac or Oxactin)
- paroxetine (Seroxat)
- fluvoxamine (Faverin)
- vortioxetine (Brintellix)
NHS statistics show that these SSRIs were prescribed 47million times in 2023 – the equivalent of around 1.5 every second.
Side effect reports have risen in line with soaring prescriptions.
Professor Joanna Moncrieff, a psychiatrist at University College London and lauded author, said the figures are a reminder that the widespread use of antidepressants is not risk free.
Some people, she warned, ‘pay a high price’ for taking them.
Professor Moncrieff added: ‘Antidepressants can be risky for many reasons and these statistics underestimate the deaths in which antidepressants play a role, but are not registered as a cause of death.
‘We know, for example, that they increase the risk of cardiovascular disease and of having falls and fractures in the elderly, all of which may lead to death, but are unlikely to be attributed to antidepressants.’
Professor Moncrieff, who has written several books on the controversial topic, thinks some of the side effects of SSRIs, such as persistent sexual dysfunction, can make people so desperate they become suicidal.
She added: ‘In rare cases they induce suicidal thoughts and behaviour, especially in younger people, and they can cause death directly if people overdose on them (especially in combination with other drugs).’
As anyone can use the Yellow Card system – patients as well as their medics – a reaction being linked to a vaccine or drug is not proof it was responsible.
The MHRA highlights that some reactions may simply be coincidence.
Yet there are long-standing concerns that the scheme picks up only a fraction of side effects that may be caused by drugs. According to some estimates, just one in ten serious reactions is reported to the scheme.
Doctors and pharmacists blame time constraints, and can be put off by having to take patients’ word for possible side effects, rather than being able to see them for themselves.
The analysis comes as experts are increasingly questioning the long-term safety of SSRIs.
UCL academics, led by Professor Moncrieff, have previously debunked the main theory explaining how the drugs supposedly work.
Selective serotonin reuptake inhibitors were originally understood to work by correcting abnormally low levels of serotonin – the ‘feel-good’ chemical.
But a major review of the evidence, published in 2022, ruled there was ‘no convincing evidence’ that depression was caused by an imbalance. It did not prove that SSRIs don’t help – only that the science of how they work was deeply flawed because their exact mechanics remains shrouded in mystery.
Other studies have suggested SSRIs might not work any better than a placebo.
Professor Moncrieff is among the voices to have urged people to ‘think very hard before they go anywhere near’ the drugs because of their side effects.
Lesser troublesome SSRI issues include dry mouth, indigestion, diarrhoea, nausea and headaches.
In rarer cases, patients can be left hallucinating and unable to urinate. The NHS warns ‘some people have suicidal thoughts and a desire to self-harm when they first take SSRIs’.
One of the main concerns has been their libido crushing side-effects, with some users reporting being transformed into ‘sexless’ zombies even years after they stopped taking the mind-altering pills.
That particular issue was thrust into the spotlight in 2023 by the Scottish singer Lewis Capaldi. In a bare-all Netflix documentary, he spoke about taking it to help treat his anxiety and grimly commented on the knock-on effect it had on his sexual health. ‘They’re not really doing anything except I can’t get a f****** hard-on to save my life’, he said.
Their libido-dampening effects are so powerful that the drugs have even been trialled on sex offenders in the past to help curb their urges.
The Royal College of Psychiatrists has said the original idea that antidepressants ‘correct a chemical imbalance in the brain’ is an oversimplification.
But the theory is still taught by some medical schools and psychiatric textbooks.
Singer Lewis Capaldi has been honest about his struggle with side effects from antidepressants, describing problems with sexual dysfunction
Professor Joanna Moncrieff, a psychiatrist at University College London and lauded author, said people ‘pay a high price’ for taking antidepressants
Psychiatrists urge patients concerned about side effects, or potential consequences, of antidepressants to talk to their medical professional about their options.
Dr Cathy Wield, who wrote about her experiences with SSRIs in her book Unshackled Mind, believes health chiefs need to further investigate the side effects of the drugs.
She said: ‘Even though I was a doctor, I was also a patient who did not know the facts behind SSRIs when I was first prescribed fluoxetine.
‘I was not made aware of the potential for unpredictable and serious side effects and was greatly alarmed when I developed suicidal thoughts.
‘The government should understand that encouraging more and more prescriptions of drugs such as SSRIs cannot address the underlying causes of unhappiness within our communities.’
Dr Wield, a specialist in emergency medicine, added: ‘SSRIs have been reported by patients and their families to have caused serious side effects including, suicidal thoughts where none existed before.
‘In some cases, patients have tragically gone on to complete suicide, and their families are convinced that this has been directly due to the SSRI.
‘It is, therefore, imperative that the MHRA listen to patients, and review the data on these drugs before any more lives are lost.’
Earlier this year, one of the UK’s most eminent GPs warned thousands of Brits were mistaking the ‘normal stresses of life’ for mental health problems – and incorrectly diagnosing themselves with psychiatric conditions.
Dame Clare Gerada, former president of the Royal College of General Practitioners, told the Daily Mail in January that Britain has a ‘problem’ with people ‘seeking labels to explain their worries’.
A spokesperson for the Royal College of Psychiatrists said: ‘Depression is common and affects over 10million people per year in the UK.
Sertraline (branded as Zoloft) is one of the most common SSRIs handed out in the UK. There have been 257 Yellow Card reports of the drug that resulted in fatal outcome
‘It can be a very serious mental illness. It can devastate people’s lives and lead to preventable deaths, yet it is a readily treatable condition. The evidence is clear, the risks of depression far outweigh the risks associated with treating depression.
‘Antidepressants can significantly benefit people with more severe depression and help them recover.
‘As with all medications, some people will experience side effects. These medications should be prescribed after a thorough discussion with patients, and their use regularly reviewed.’
The MHRA states it always evaluates new evidence as it becomes available and has conducted multiple reviews on SSRIs.
It argues that any risks from taking medication, including antidepressants, in pregnancy need to be balanced against the risk of becoming more unwell without treatment.
Dr Alison Cave, MHRA chief safety officer, told the Daily Mail that the safety of patients is always ‘our top priority’.
She said: ‘SSRIs are used by millions of people and are considered effective and safe for treating moderate or severe depression and other conditions in the majority of individuals.
‘However, no medicine is without risk and SSRIs have the potential to cause side effects which are described in the patient information leaflet supplied with the medicine.
‘As with all medicines, the MHRA continuously monitors the safety of SSRIs to ensure that the benefits continue to outweigh the risks, and we take action where appropriate to minimise risks.
‘It is very important to note that a report with a fatal outcome does not necessarily mean that it was caused by the medicine, only that the reporter has a suspicion it may have been.
‘We advise anyone who has concerns about suspected side effects related to SSRIs to talk to their doctor and to report via our Yellow Card scheme.’
The MHRA says the number of reports can be hard to calculate because some cases have multiple SSRIs listed as suspect drugs.
Where a case contains more than one drug, it will show in each individual iDAP, meaning if you count the total figures per drug, the case will be counted multiple times in the total final figure.