The antidepressants which contributed to the death of Royal Family member Thomas Kingston have reportedly featured in 40 coroners’ reports aimed at averting future deaths.
Mr Kingston, whose marriage to Lady Gabriella at Windsor Castle in 2019 was attended by the late Queen, died by suicide after he shot himself in February last year.
An inquest into his death last month was told the 45-year-old took his own life after being prescribed the drugs sertraline and citalopram 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, being prescribed to more than four million people.
In a prevention of future deaths report, Senior coroner Katy Skerrett raised concerns over whether there is ‘adequate communication’ regarding the risks of suicide with such pills.
Returning a verdict of suicide, she also questioned whether the current guidance to ‘persist’ with the drugs is ‘appropriate’ in circumstances when the individual is suffering ‘adverse side effects’.
She is the latest coroner to highlight concerns about SSRIs. According to The Times, 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.
Thomas Kingston (left), the husband of Lady Gabriella Windsor (right), took his life following an adverse effect to prescribed medication, an inquest heard
Queen Camilla, King Charles III, Lady Gabriella Windsor and Thomas Kingston watch the racing from the Royal Box as they attend day 5 of Royal Ascot 2023
It comes as 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’.
Coroners highlight measures which could slash that 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 by coroners.
In January 2020, Samuel Morgan, 25, from Swansea, committed suicide and it was found he had been taking citalopram seven days before his death.
At an inquest into his death in South Wales, coroner Colin Phillips suggested citalopram should come with US-style ‘black box’ warning, as it ‘would have a more immediate impact’.
He 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.
Thomas Kingston (left) pictured marrying Lady Gabriella Windsor at St George’s Chapel on May 18 2019
Mr Kingston (pictured), was visiting his parents in Kemble, in the Cotswold district of Gloucestershire, for the weekend when he decided to take his own life
‘The simple and clear message in this specific case would be that there is an increased risk of suicidal thinking in young adults.’
His 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.
In June 2021, Joshua Asprey, 19, from East Sussex, began taking sertraline 18 days before he committed suicide.
An inquest in to his death in 2023 heard a GP had increased the dosage three days before Asprey took his own life and ‘did not discuss any risk of suicidal ideation associated with commencing or increasing the dose of sertraline’.
Michael Spencer, assistant coroner for East Sussex, expressed concerns that the medicines guidebook, the British National Formulary, ‘does not identify suicidal ideation as a risk of prescribing sertraline’.
A coroner in Cambridgeshire also expressed concerns about the way a GP, on the advice of a nurse, had prescribed citalopram to Edward Mallen, 18, two weeks before he took his life.
The MHRA told The Times it kept SSRIs under constant review and added: ‘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.’
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’.
Mr Kingston watched the racing alongside Queen Camilla from the Royal Box at Ascot in June 2023
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.’
Lady Gabriella and Thomas Kingston had official photos taken on their wedding day – here with the late Queen and Prince Philip sat to the right of them
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.
It was reported that in the days leading up to his death, he had not long stopped taking anti-depressants to treat his symptoms.
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