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Depression

NICE guidelines on antidepressant withdrawal in ‘urgent need of correction’, say researchers

Researchers call for guidance to be “urgently” updated after finding that seven out of ten studies providing data on the duration of antidepressant withdrawal symptoms contradict UK and US withdrawal guidelines.

More than half of antidepressant users experience withdrawal, with the majority of these describing their withdrawal as ‘moderate’ or ‘severe’, according to results of a review commissioned by the All-Party Parliamentary Group for Prescribed Drug Dependence[1].

The systematic literature review of 23 relevant studies was carried out by researchers from the University of Roehampton and University of East London, with the aim of ascertaining the incidence, severity and duration of antidepressant withdrawal reactions.

They found that withdrawal incidence rates from 14 of the studies ranged from 27% to 86%, with a weighted average of 56%. Seven of the ten very diverse studies providing data on duration contradicted UK withdrawal guidelines as a significant proportion of people who experienced withdrawal were found to do so for more than two weeks.

Guidance from the National Institute for Health and Care Excellence (NICE) states that withdrawal reactions from antidepressants are “self-limiting” and typically resolve within one to two weeks.

It was also found that it was not uncommon for people to experience withdrawal for several months and beyond — two of the studies reviewed indicated that for 40% of people who withdraw, the effects lasted for at least 6 weeks and for 25% they lasted 12 weeks or more.

The authors of the study, published in Addictive Behaviours on 4 September 2018, recommended that UK and US guidelines on antidepressant withdrawal be “urgently” updated as they are “clearly at variance with the evidence on the incidence, severity and duration of antidepressant withdrawal” and that prescribers should fully inform patients about the possibility of withdrawal effects.

James Davies, lead author of the study, said: “Existing NICE guidelines fail to acknowledge how common withdrawal is and wrongly suggest that it usually resolves within one week.

“This leads many doctors to misdiagnose withdrawal symptoms, often as relapse, resulting in much unnecessary and harmful long-term prescribing.”

 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2018.20205540

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