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21st June 2023
Patients are being urged not to suddenly stop taking antidepressants after seeing headlines warning that people may be taking them for too long.
A BBC Panorama programme reported NHS figures that about two million people have been taking them for five years.
The investigation also raised questions about evidence for their long-term use and that this may increase the risk of withdrawal symptoms when people try to stop.
It follows a study last year in which researchers said patients should not be told that depression is a chemical imbalance in the brain because there was ‘no convincing evidence’ that depression is caused by serotonin abnormalities.
The team at University College London (UCL) said although antidepressants can work for patients, it is not clear how they work, and patients needed to be aware of that when making decisions about treatment.
But the debate came to the fore once more this week when a group of researchers wrote a piece in the journal Molecular Psychiatry warning that the conclusion in the UCL research had been overstated and there had been selective reporting of data.
Professor Tony Kendrick, professor of primary care at the University of Southampton, said he had spoken to Panorama about the soon-to-be-published results from the REDUCE trial of a programme of support for those coming off long term antidepressants, but it had not been included.
‘The preliminary findings have shown a good proportion of people can come off long-term antidepressants with tapering advice provided by their GPs, and that internet and telephone support from a psychological wellbeing practitioner may help protect them from depressive and withdrawal symptoms,’ he said.
More detail from the three-year study involving 131 practices and 330 patients will be reported soon but it was shown to be cost effective, he added.
Responding to the Panorama investigation, RCGP chair Professor Kamila Hawthorne said when prescribed appropriately, evidence shows that antidepressants can be an effective treatment for many patients suffering from mental health conditions such as depression and anxiety.
Where alternative options may be helpful to medication, access can be patchy and slow, she noted.
But, she added: ‘Wherever possible we don’t want patients to have to rely on medication long term, and most patients don’t want that either.
‘If it is appropriate for patients to continue with antidepressants, we will schedule ongoing medication reviews to explore whether there are opportunities to reduce dosages, or stop taking medication altogether.
‘If a patient wants to stop taking antidepressants or reduce their dose, it is important that they speak to their GP, or prescribing clinician, in the first instance, and not simply stop taking their medication, as this could be very uncomfortable, and potentially dangerous, due to withdrawal effects.’
The Royal College of Psychiatrists said use of antidepressants should be carefully monitored and reviewed regularly.
‘Most people will be able to stop taking antidepressants without significant difficulty by reducing the dose (known as ‘tapering’) over a few weeks or months.
‘Some people can experience withdrawal symptoms that last longer and may be more severe, particularly when the medication is stopped suddenly.’
The College said NICE guidance in recent years has reflected the body of evidence on withdrawal symptoms with a greater focus on how to manage that safely.
‘Ultimately, the use of antidepressants, should always be a shared decision between a patient and their doctor based on clinical need and the preferences of the patient.
‘We would advise all those thinking of stopping their antidepressants to talk to their doctor first, as these medications should not be stopped abruptly.’