Thank you for your letter of 3^rd February.

As you know, I had lunch with Malcolm Lader last week. He had a copy of your letter at that time, but mine hadn't arrived, so I had not appreciated that you now seek to distance the Royal College from his views. Because you sent me his paper, I had assumed you were generally in agreement with them.

I don't think Malcolm Lader and I much disagreed on the question of what risks might arise, and he is clearly disappointed with the efficacy of SSRIs. He confirmed his view that the risks are outweighed by the considerable benefits to some patients. I can readily accept this as the judgement of a distinguished clinician, treating a highly selected group of patients, if not as a proper basis for any national drug policy or campaign. Nothing we discussed would cause me to budge more than a diplomatic inch or two on any question raised in my paper about the conduct of the Defeat Depression Campaign by the RCPsychs.

I take your point about not wanting to continue this correspondence, and I wouldn't want you feel dragged into anything. I regret that we are still miles apart, but appreciate that you now accept that there is at least some possibility of a substantial problem. I interpret, "this does not seem very likely", as something of an advance on the hitherto categorical and most authoritative denials of any risk of dependence at all. 

I hope you, in turn, appreciate that my main concern - which your letters have never really addressed - is that the failure to recognise the significance of withdrawal reactions has led to potentially dangerous assumptions being made about the long-term effectiveness of antidepressants.

I have four further points:

1. I do not doubt the College meant well in planning the Defeat Depression Campaign. Any argument between us would be about the extent to which meaning well meant doing good.

2. I accept in part your points about dates of knowledge and lack of evidence of harm. However, as you recognise the unswerving tendency of history to repeat itself (in relation to psychotropic drug prescribing), I imagine you might at least privately appreciate why I wondered why College policies and pronouncements were based on lack of evidence of harm, instead of a common-sense assessment of risk.

3. I was grateful to you for spelling out the process and timing involved in developing guidelines for ICD-10. I think this clarifies and improves on the account in my paper and I shall hyperlink your comments to the relevant section of text.

4. I also could have done better in an earlier letter to you. In my letter of 2nd December, I wrongly represented one of the findings in the 1994 study by Gregor et al. Please delete the words "for all 460" at the end of paragraph two on page three. Only 38/460 patients completed the nine treatment periods on sertraline, and their stating dose is not stated. This doesn't affect the analysis in my paper, but I regret the error.

Notwithstanding your professed lack of concern about the present situation, I hope you and your colleagues will continue to take an interest in these issues. I am sure you should and hope you will drop in on our new website, from time to time - to be launched on a pilot basis, I hope before the end of the month.

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	Correspondence: matters arising