Change official guidance on coming off antidepressants, urges Royal College
Author: Caroline White
Clinical guidance on coming off antidepressants needs to be changed to reflect the wide range of experience patients have when they stop taking these drugs, says the Royal College of Psychiatrists in a position statement.
Existing advice from the National Institute for Health and Care Excellence (NICE), which was last published in 2009 and is currently being updated, suggests most people should be able to come off antidepressants over four weeks.
But not everyone is able to do this, insists the College, which has called for the change after listening to the experiences of patients and clinicians, including GPs.
It is becoming increasingly clear that some patients have more severe symptoms that can last much longer, it says. This may affect those who have been prescribed antidepressants over a long period and who have stopped their use too quickly.
Greater focus is needed on how to help patients when withdrawing from antidepressants, and more research is needed to quantify how many people have problems when stopping these drugs, says the College.
While antidepressants are a vital, potentially life-saving treatment option for those with more severe depression, their use needs to be carefully managed, it emphasises.
This includes clinicians discussing the potential pros and cons of treatment with patients, regular reviews of their use, and effective withdrawal management.
Among the recommendations in the position statement, the College says that NICE should make its guidance “clear, evidence-based and pharmacologically informed to help guide gradual withdrawal from antidepressant use.”
Other recommendations include the introduction of a routine monitoring system to provide comprehensive data on when and why patients are prescribed antidepressants, and adequate resourcing to ensure clinicians, particularly GPs, have sufficient time and capacity to regularly review antidepressant use and provide support for, and monitor, withdrawal.
The College says that all doctors should be given training on best practice for prescribing and managing antidepressant use, and that adequate support services for patients affected by more severe and prolonged antidepressant withdrawal, should be provided.
The NHS’s flagship talking therapies programme should be expanded so that they are always available when appropriate as a complement, or alternative, to antidepressants, it says.
And it calls for high-quality research into finding out which antidepressants are likely to work best for which individuals as well as the pros and cons of long-term use.
President Wendy Burn, president of the Royal College of Psychiatrists, commented: “We know that NICE is working on updating its guidelines and want to see them more in keeping with what we’re hearing from some patients – and GPs – about the range of experiences of coming off antidepressants.
"As psychiatrists, we are duty-bound to take on board the concerns of patients who've experienced more severe and long-lasting adverse effects of withdrawal from these medications.
“Antidepressants can be very effective for treating moderate to severe depression, particularly in combination with talking therapies, and what we want is guidance that best supports their use.”
NICE published updated draft guidance on antidepressant withdrawal last year and this is currently out to consultation. This says that when coming off antidepressants the dose should be reduced slowly “at a rate proportionate to the duration of treatment. For example, this could be over some months if the person has been taking antidepressant medication for several years”.