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NICE amends depression guideline highlighting 'severe' and long-lasting withdrawal symptoms

There is a new emphasis on variation in experience of antidepressant medication in the amended guidelines.

Man with depression


Updated guidance from the National Institute for Health and Care Excellence highlights that antidepressant withdrawal symptoms can be “more severe for some patients”

The National Institute for Health and Care Excellence (NICE) has amended its guidelines on depression in adults to highlight that antidepressant withdrawal symptoms may be severe in some patients.

The guidance, which was published in 2009 originally said that antidepressant withdrawal symptoms were usually “mild” and “self-limiting” over the course of a week.

The amendment, dated September 2019, clarifies that there can be “substantial variation in people’s experience” and that symptoms can persist for months or more and be “more severe for some patients”.

It also advises that before stopping antidepressant medication, patients should discuss the decision with their practitioner.

The amendments are in line with a position statement released by the Royal College of Psychiatrists (RCPsych) in May 2019.

Wendy Burn, president of the RCPsych, welcomed the updates to the guidelines.

“Early this year, we called for NICE guidelines to recognise the potential in some people for severe and long-lasting withdrawal symptoms on, and after, stopping antidepressants.

“It is really important that advice for patients and guidelines for clinicians reflect the substantial variation among patient experiences. We are pleased to see that our recommendations are being acted upon.”

NICE delayed the release of a planned full guideline update due in 2018 after a coalition of 14 organisations, including the Royal College of Psychiatrists, British Psychological Society and the charity Mind, said the draft of the updated guideline was underpinned by a flawed methodology, a lack of transparency and several inconsistencies.

They added that, if the guideline was published as it was, it could “seriously impede the care of millions of people in the UK suffering from depression, potentially even causing clinical harm” and demanded a full revision.

NICE agreed to a second four-week consultation, which ended on 12 June 2018. A publication date for the full update is yet to be confirmed.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20207226

Readers' comments (1)

  • This has been known about by patients for many years. Sertraline, citalopram, mertazapine, etc. have all been associated by patients with "electric brain shocks", "chronic diarrhoea", "fatigue", and even "seizures" requiring emergency interventions. Particularly at higher dosages, these drugs have simply replaced one type of problem (with the older medications) with a whole host of new problems. It's staggering that it has taken this long for NICE to take action. My guess is that it will take months for the cultural shift to filter down to GPs. I was submitted to A&E following a seizure two weeks ago, and the medical team were oblivious to the risks, and actually tried to keep me taking the same high dosage. I'm in no doubt that if I had followed their advice, I would have had another seizure. Since coming off them, other than tinnitus and a struggle to concentrate and remember stuff, I feel a lot better.

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