When Thomas Kingston, a financier and former diplomat took his own life at his parents' Cotswold estate on 25 February 2024, the nation was forced to confront a startling question: are the risks of SSRIs being communicated clearly enough?
The tragedy unfolded at the Kingston family home in Gloucestershire, England, and a coroner's inquest held in January 2025 concluded that the self‑inflicted gunshot wound occurred while he was "suffering adverse effects of medication he had recently been prescribed." The inquest ruled the act was impulsive, not a pre‑planned suicide, underscoring how quickly side‑effects can destabilise a patient.
Background and Coroner Findings
Thomas had been married since May 2019 to Lady Gabriella Windsor, daughter of Prince and Princess Michael of Kent. The couple lived a high‑profile life, attending royal events and managing demanding financial roles. By early 2024, work‑related stress and sleeplessness pushed Thomas to seek medical help at the Royal Mews Surgery, a clinic that serves members of the royal household.
During the inquest, the coroner described the medication episode as "an impulsive act in the context of adverse reactions to the prescribed medications" and noted that Thomas had packed his bags to return to London the very day he died, suggesting he had no settled intention to end his life.
Prescription Timeline and Adverse Reactions
In January 2024, Thomas received a prescription for sertraline, a common SSRI, and zopiclone, a sleep aid, from his GP at Royal Mews Surgery. After just four days he stopped sertraline, reporting that mornings left him "sleepy and low" and that he felt "woozy and overheated" during the day.
When he returned to the clinic in February, the doctor switched him to citalopram, another SSRI. Thomas halted that medication after two doses for the same reasons. Toxicology after his death showed only trace caffeine and a small amount of zopiclone; therapeutic levels of citalopram were absent.
These rapid discontinuations are not unusual. Lingling Wang, a former senior consultant at a London bank, told The Independent that a year on the same drugs left her with severe suicidal thoughts, describing her life as "finished" after the medication took hold.
Family's Campaign for Reform
Martin Kingston, 72, and his wife Jill Kingston, 69, have turned their grief into advocacy. Appearing on BBC Radio 4’s Today programme, Martin urged that "more people should be told explicitly the potential side effects of SSRIs and what can happen if they stop taking them." Jill added that a "spouse, parent, or close friend" should be present when the risk‑acknowledgment form is signed.
Their proposal calls for a mandatory, signed document that outlines both initiation and discontinuation risks, including a direct warning that "in rare cases, antidepressants can increase suicidal thoughts or behaviour." They argue this would create a clear record between doctor and patient, ensuring that no one slips through the cracks.
Data from the Medicines and Healthcare products Regulatory Agency (MHRA) supports their concerns. Over the past decade, there have been nearly 200 alerts to the MHRA linked specifically to deaths involving citalopram and sertraline, according to analysis by The Independent.
Broader Debate Over Antidepressant Safety
Labour MP Dr. Simon Opher, who represents Stroud, has echoed the Kingston family’s worries, labeling the over‑prescription of antidepressants a "public health crisis". He points to the UK’s prescribing guidelines, which acknowledge that "most people will only experience a few mild side effects" but often downplay the severity of suicide‑related warnings.
Critics say the current Patient Information Leaflet (PIL) layout stacks risk information under a generic heading, making it easy for patients to miss the crucial line about suicidal ideation. The Kingstons argue that a signed acknowledgment would force clinicians to discuss this openly, rather than leaving it buried in fine print.
What Changes Could Look Like
- Introduction of a standardized "Antidepressant Risk Acknowledgment Form" signed by patient (or a designated support person) before the first prescription.
- Mandatory training for GPs on discussing discontinuation syndrome and suicide risk.
- Electronic flagging in NHS records when a patient is switched between SSRIs, prompting a follow‑up appointment within 48 hours.
- Public reporting of adverse‑event alerts by the MHRA in a more searchable format.
If adopted, these steps could give patients a clearer picture of what to expect, potentially reducing impulsive reactions during the vulnerable early weeks of treatment.
Frequently Asked Questions
How would a signed acknowledgment form change the prescribing process?
The form would require clinicians to verbally explain both the benefits and the serious risks of SSRIs, including the possibility of suicidal thoughts. By having a patient—or a trusted support person—sign, it creates a documented conversation that can be referred to if side‑effects emerge, encouraging more frequent follow‑ups.
What evidence links SSRIs to increased suicide risk?
Clinical trials and post‑marketing surveillance have identified a small but significant rise in suicidal ideation among adolescents and certain adult sub‑groups during the first weeks of treatment. The MHRA’s 200‑plus alerts over ten years, many involving sertraline and citalopram, illustrate that the risk, while rare, is real and sometimes fatal.
Who would be responsible for ensuring the form is completed?
Primary responsibility would lie with the prescribing GP or psychiatrist. However, the new protocol could also involve practice nurses and pharmacists, who would verify that the signed document is on file before dispensing the medication.
Could this approach deter doctors from prescribing antidepressants?
Some clinicians worry about added paperwork, but most agree that better patient education outweighs the inconvenience. In fact, clearer communication may reduce unnecessary prescriptions by ensuring patients only start an SSRI after thorough evaluation.
What timeline is being suggested for implementing these reforms?
The Kingston campaign hopes to see a draft policy presented to the Department of Health by early 2026, with a pilot program in selected NHS trusts by the end of 2026. Full nationwide adoption could follow after evaluation of pilot outcomes.
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