A coroner has issued a warning about the effects of medication used to treat depression after the husband of Prince and Princess Michael of Kent’s daughter took his own life. Thomas Kingston, a 45-year-old financier, died from a shotgun wound and a gun was found near his body on February 25 last year at his parents’ home in the Cotswolds.
A coroner concluded Mr Kingston took his own life and was “suffering adverse effects of medication he had recently been prescribed”. He married Lady Gabriella, 43, at Windsor Castle in 2019, with Queen Elizabeth II and the late Duke of Edinburgh among the guests.
The inquest into his death at Gloucestershire Coroner’s Court last year was told he had initially been given sertraline, a drug used to treat mental health problems, and zopiclone, a sleeping tablet, by a GP at the Royal Mews Surgery, a practice at Buckingham Palace used by royal household staff, after complaining of trouble sleeping following stress at work.
Mr Kingston returned to the surgery saying they were not making him feel better and his doctor moved him from sertraline to citalopram, a similar drug. In the days leading up to his death, Mr Kingston had stopped taking medication and toxicology tests showed caffeine and small amounts of zopiclone in his system.
Katy Skerrett, senior coroner for Gloucestershire, has said action must be taken over the risk of suicide to patients prescribed the drugs. In a prevention of future deaths report, the coroner questioned whether there is adequate communication of the risks of suicide associated with such medication.
She also raised concerns about whether the current guidance to persist with selective serotonin reuptake inhibitor (SSRI) medications, or switch to an alternative SSRI medication is appropriate, when no benefit has been achieved, “especially when any adverse side effects are being experienced”.
The report was sent to the National Institute for Health and Care Excellence, the Medicines and Healthcare Products Regulatory Agency and the Royal College of General Practitioners, who have 56 days to respond.
The coroner’s concerns echo those of Mr Kingston’s wife, Lady Gabriella, who warned about the effects of the drugs during the inquest. In a statement read out by Ms Skerrett, she said: “(Work) was certainly a challenge for him over the years but I highly doubt it would have led him to take his own life, and it seemed much improved.
“If anything had been troubling him, I’m positive that he would have shared that he was struggling severely. The fact that he took his life at the home of his beloved parents suggests the decision was the result of a sudden impulse.”
She said she believed his death was “likely provoked” by an adverse reaction to the medication he had begun, and subsequently stopped taking, in the weeks leading up to his death.
“The lack of any evidence of inclination, it seems highly likely to me that he had an adverse reaction to the pills that led him to take his life,” Lady Gabriella said.
“I believe anyone taking pills such as these need to be made more aware of the side effects to prevent any future deaths. If this could happen to Tom, this could happen to anyone.”
Recording a narrative conclusion, Ms Skerrett said: “Mr Kingston took his own life using a shotgun which caused a severe traumatic wound to the head. The evidence of his wife, family and business partner all supports his lack of suicidal intent. He was suffering adverse effects of medication he had recently been prescribed.”
Giving evidence to the inquest, Dr David Healy, a psychiatric medical expert, said zopiclone could also cause anxiety while sertraline and citalopram were both SSRIs, and essentially the same.
Dr Healy said Mr Kingston’s complaints that sertraline was continuing to make him anxious was a sign SSRIs “did not suit him” and he should not have been prescribed the same thing again.
He said the guidelines and labels for SSRIs were not clear enough about going on the drugs in the first place or what the effect could be when moving from one to another.
“We need a much more explicit statement saying that these drugs can cause people to commit suicide who wouldn’t have otherwise,” he said.