Social Audit Ltd

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Dear Keith,

Further to your commitment to consult widely with relevant bodies in relation to issues discussed in my paper, The Antidepressant Web, please could you arrange for me to be sent a list of all individuals and organisations the MCA has consulted to date.

Please would you also send me any representative example of the letter the MCA sent to the bodies consulted, indicating alternatively whether the MCA solicited views on any particular points, and whether or not it sent copies or extracts of my paper to those from whom opinions were sought?

I would be grateful if you could let me know in addition whether the MCA has offered to treat any replies to these enquiries in confidence and, if not, whether I might, in due course, have copies of them.

On a different tack, I would like to refer you to a paper which may throw some light on the MCA's view that the risk of withdrawal reactions from SSRIs is so low as to be "undetectable except through spontaneous reporting where drug exposure is high". The paper was presented at a closed symposium 'SSRI Discontinuation Events' held December 17, 1996 in Phoenix, Ariz., sponsored by Eli Lilly and Company, and the abstract reads as follows:

"Background: While the incidence of discontinuation events in controlled studies of serotonin re-uptake inhibitors ranges between 34.5% and 86%, only a small number of discontinuation reactions are reported to national data bases of spontaneously reported adverse drug reactions. It was hypothesized that the disparity was due to lack of knowledge amongst physicians about the potential for antidepressant discontinuation reactions. Method: Therefore, a questionnaire was mailed to 100 psychiatrists and 100 general practitioners (GPs) in northeast England to assess the knowledge base and to validate this assumption. Results: Fifty psychiatrists (50%) and 53 GPs (53%) responded to the questionnaire. Of the respondents, 36 (72%) of the psychiatrists and 16 (30%) of the GPs were aware that patients may experience antidepressant discontinuation events; 33 (66%) psychiatrists and 22 (42%) GPs had had experience with patients who had discontinuation symptoms; and 10 (20%) psychiatrists and 9 (17%) GPs said they always caution patients about the possibility of discontinuation events. Conclusion: According, to the results of the survey, a sizable minority of physicians denied being confidently aware of the existence of antidepressant withdrawal symptoms. Education about discontinuation reactions, including the hallmark features, symptoms, and course. is needed for both psychiatrists and family practice physicians." (A.H. Young, A Currie, Physicians' knowledge of antidepressant withdrawal effects: a survey, J Clin Psychiatry, 1997, 58 (suppl 7), 28-30.)

In the light of previous correspondence, I would be interested to know when Dr Price first became aware of these findings. They will also be relevant to Dr Wood in the light of my still pending request that the main MCA/CSM publication on this issue (in Br. J. Clin. Pharmacol., 1996, 42, 757-763) be withdrawn.,

Please treat these as formal requests under the Agency's Code on Access to Information.

Yours sincerely,

Charles Medawar

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