RCPsych calls on NICE to update its antidepressant withdrawal advice

OFFICIAL guidance on coming off antidepressants needs to reflect the full range of patients’ experiences; the Royal College of Psychiatrists has said.

Existing advice from the National Institute for Health and Care Excellence (NICE) – which provides national guidance to improve health and social care in England – suggests most people should be able to come off antidepressants over four weeks.

However, it is increasingly apparent from the experiences shared by some patients and clinicians, including GPs, that some patients can suffer from more severe symptoms that can last much longer. This may affect those who have been prescribed antidepressants over a long period and who have stopped their use too quickly.

While antidepressants are a vital, potentially life-saving treatment option for those with more severe depression, their use needs to be carefully managed. This includes prescribers discussing the potential benefits and harms with patients, regular reviews of their use and effective withdrawal management.

Today the RCPsych publishes a report on antidepressants and depression and makes a series of recommendations, including that NICE should update its withdrawal guidelines – last issued in 2009 and currently being updated – to make them “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.
  • Adequate resourcing to ensure clinicians, particularly GPs, have sufficient time and capacity to regularly review antidepressant use and provide support for and monitor withdrawal.
  • Training should be provided to all doctors on best practice for prescribing and managing use of antidepressants.
  • Commissioning of adequate support services for patients affected by more severe and prolonged antidepressant withdrawal, modelled on existing best practice.
  • The NHS’s flagship talking therapies programme should be expanded further so that they are always available when appropriate as a complement, or alternative, to antidepressants.
  • A call for high-quality research into issues including which antidepressants are likely to work for which individual; and the benefits and harms of long-term use.

President Wendy Burn, President of the Royal College of Psychiatrists, said: “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.

“While we cannot change that guidance ourselves, we will share our report with NICE and Public Health England (PHE) and hope it will be reflected in updated guidance from them.”

NICE published updated draft guidance on antidepressant withdrawal last year and this is currently being consulted on. It said 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”.