A coroner has issued a warning about the effects of antidepressants prescribed by a Buckingham Palace doctor to the son-in-law of Prince and Princess Michael of Kent before his suicide.
Thomas Kingston, 45, whose marriage to Lady Gabriella at Windsor Castle in 2019 was attended by the late Queen, killed himself last February after “suffering adverse effects of medication he had recently been prescribed”, an inquest found last month.
On Friday the coroner, Katy Skerrett, warned the medication used could lead to more deaths without a change in guidance and labelling about the risks.
The inquest at Gloucestershire coroner’s court heard that after complaining of poor sleep and stress at work as a financier, Kingston had initially been given the antidepressant sertraline and zopiclone, a sleeping tablet, by a GP at the Royal Mews surgery, a practice at Buckingham Palace used by royal household staff.
Kingston returned to the surgery saying they were not making him feel better and his doctor moved him from sertraline to citalopram, a similar drug in a type known as selective serotonin reuptake inhibitors (SSRIs).
In the days leading up to his death, Kingston had stopped taking medication and toxicology tests showed caffeine and small amounts of zopiclone in his system.
In a prevention of future deaths report, Skerrett questioned whether there was adequate communication of the risks of suicide associated with such medication.
She also raised concerns about whether the current guidance to persist with SSRI medications, or switch to an alternative SSRI medication, was appropriate when no benefit had been achieved.
Skerrett said this was especially concerning when “adverse side effects are being experienced”.
The report was sent to the National Institute for Health and Care Excellence (Nice), the Medicines and Healthcare Products Regulatory Agency and the Royal College of General Practitioners, who have 56 days to respond.
The coroner’s concerns echo those of Kingston’s widow, Lady Gabriella, who warned about the effects of the drugs during the inquest. In a statement read out by Skerrett, she said: “I believe anyone taking pills such as these needs to be made more aware of the side effects to prevent any future deaths.
“If this could happen to Tom, this could happen to anyone.”
Recording a narrative conclusion, Skerrett said Kingston took his own life while “suffering adverse effects of medication he had recently been prescribed”.
The inquest heard that the antidepressants prescribed to Kingston by his doctor were in accordance with Nice guidelines.
Giving evidence to the inquest, Dr David Healy, a psychiatric medical expert, said zopiclone could also cause anxiety while sertraline and citalopram were both SSRIs, and essentially the same.
Healy said Kingston’s complaints that sertraline was continuing to make him anxious was a sign SSRIs “did not suit him” and he should not have been prescribed the same thing again.
He said the guidelines and labels for SSRIs were not clear enough about the risks of going on the drugs in the first place or what the effect could be when moving from one to another.
“We need a much more explicit statement saying that these drugs can cause people to commit suicide who wouldn’t have otherwise,” he said.
Nice recommends a staged withdrawal of antidepressants, known as tapering, to reduce withdrawal effects and long-term dependence on the medication.
A spokesperson for Nice said: “Nice can confirm we have received the coroner’s prevention of future deaths report in relation to Thomas Kingston. We will consider the issues raised by the report and respond to the coroner directly.
“We follow an established process when making sure our published guidelines are current and accurate and take a proactive approach to responding to events (with an assessment of priority) that may impact on our recommendations.”
• In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@samaritans.org or jo@samaritans.ie. In the US, you can call or text the National Suicide Prevention Lifeline on 988, chat on 988lifeline.org, or text HOME to 741741 to connect with a crisis counselor. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org
