Dear Keith,

This time last year, I wrote to ask if the MCA/CSM would consider withdrawing or correcting the MCA/CSM paper on SSRI withdrawal reactions (Price et al., 1996), and I'm now writing to ask again if you will consider this. The evidence that this paper seriously underestimated the problem is now overwhelming.

In addition to the five studies referred to in my 10 June letter to Professor Rawlins, there is now evidence from a recently-published, well-controlled prospective study of the effects of withdrawal from sertraline and paroxetine (Rosenbaum, Fava et al, 1998) which should leave no one in doubt that the MCA/CSM's estimate is badly wrong. I am in the process of reviewing this paper on our website. I hope you will take account also of future instalments, which will discuss the nature of the risks involved in withdrawing from fluoxetine.

I look forward to hearing from you, perhaps also with news of the status of the review of the dependence risk with SSRIs that you told me you started a year ago.

Yours sincerely,

Charles Medawar

J S Price, P C Waller, S M Wood, A V P Mackay, A comparison of the post-marketing safety of four selective serotonin re-uptake inhibitors including the investigation of symptoms occurring on withdrawal, Br J Clin Pharmacol, 1996, 42, 757-763.

J F Rosenbaum, M Fava, S L Hoog, R C Ascroft, W B Krebs: Selective Serotonin Reuptake Inhibitor Discontinuation Syndrome: A Randomised Clinical Trial, Biol Psychiatry, 1998, 44, 77-87.

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