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Antidepressants ‘should be reduced in stages’ to avoid withdrawal symptoms | Mental health


GPs whose patients want to stop taking antidepressants should reduce the dose of their medication in stages to lower the risk and severity of withdrawal symptoms, the medicines watchdog has said.

About one in six (16%) adult Britons experience moderate to severe depression, according to the Office for National Statistics. In England alone, 21.4m antidepressant drugs were prescribed between July and September 2022, according to the NHS Business Services Authority.

A new draft quality standard for the care of adults with depression from the National Institute for Health and Care Excellence (Nice) – the first update in 11 years – includes specific guidance to help adults come off antidepressant medication permanently.

Nice’s independent advisory committee, which includes experts in treating adults with depression, recommends the staged withdrawal of antidepressants in patients who want to stop taking the drugs.

A staggered reduction of medicine, known as tapering, helps to reduce withdrawal effects and long-term dependence on the medication, according to Nice.

The committee said primary care and mental health professionals should follow the Nice guideline recommendations on stopping antidepressant medication, including agreeing with their patient whether it is right for them to stop taking the medication and, if so, the speed and duration of withdrawal from it.

Any withdrawal symptoms need to have been resolved, or to be tolerable, before making the next dose reduction, according to Nice’s panel of experts.

Prof Allan Young, the director of the Centre for Affective Disorders at King’s College London, said: “These are not new recommendations for the way depression is treated but a document which describes key areas of care which Nice thinks can be improved on.”

Dr Paul Chrisp, the director of the centre for guidelines at Nice, said: “There are millions of people taking antidepressants. If an individual decides they want to stop taking this medication, they should be helped by their GP or mental health team to do that in the safest and most appropriate way.

“In many cases people experience withdrawal symptoms, and the length in time it takes them to safely come off these drugs can vary, which is why our committee’s useful and usable statement for a staged withdrawal over time from these drugs is to be welcomed.

“But it should be stressed there is no one-size-fits-all approach to coming off antidepressants. The way it should be done has to be down to the individual and their healthcare professional, to agree a way which it can work and only when side-effects can be safely managed.”

Lucy Schonegevel, of the charity Rethink Mental Illness, said: “Antidepressant medications can alleviate the debilitating symptoms of several mental health conditions, helping to improve someone’s quality of life.

“But there may come a point in an individual’s recovery when they feel ready to stop their medication, and we welcome this guidance underlining how important it is for medical professionals to support people to reduce their dosage slowly at a pace appropriate for them.”



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