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National guidance for antidepressant withdrawal too fast for some patients, says RCPsych

The professional body representing psychiatrists in the UK has warned that the guidline for how quickly to ween people off of antidepressants is too quick for some patients, and should be updated to reflect this.

The Royal College of Psychiatrists (RCPsych) wants the national clinical guideline governing withdrawal from antidepressants changed because it says the timescale is too quick for some patients.

The National Institute for Health and Care Excellence’s (NICE) guideline on the recognition and management of depression in adults, , published in 2009, recommends that patients are tapered off their drugs over a period of up to four weeks.

But some psychiatrists are worried that the withdrawal period may be too swift for those who have been taking the medicine for a long time and who may face “severe” withdrawal symptoms for longer periods.

The call for revised timescales from the RCPsych comes in its new position statement on antidepressants and depression published on 29 May 2019.

The RCPsych said it wanted to see a greater focus on how to help patients who are withdrawing from antidepressants.

The statement called on NICE to develop “clear evidence-based and pharmacologically-informed recommendations to help guide gradual withdrawal from antidepressant use”.

It also said it wants to see routine monitoring of when and why patients are prescribed antidepressants, and GPs being allowed the time needed to regularly review medication with patients and offer them support and advice.

Wendy Burn, president of the RCPsych, said: “We know that NICE is working on updating its guidelines and wants 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.”

The position statement comes as NICE is updating the 2009 guidance.

The draft guidance, ‘Depression in adults: treatment and management’, which was out for consultation in 2018, recommends a change to the four-week tapering rule.

The new draft recommendation for coming off antidepressants is that 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,” the guidance said.

Another set of draft guidance is due to be published by NICE and be put out for consultation in October 2019, with the final guidance scheduled for introduction in February 2020.

NICE said it welcomed the position statement from the RCPsych and added: “Ensuring patients can safely discontinue using antidepressants, when they are no longer clinically required, is a topic which requires careful investigation because there is limited high-quality data in this area.

It added that, as part of its work to update the guidance, NICE “has now looked at the most up-to-date evidence on managing the symptoms that can occur when people stop taking their antidepressant medication”.

“We hope the final guideline will allow people with depression to be offered the best treatments and reach joint decisions about their care that reflect their preferences and values.” 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206614

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