Royal College of Psychiatrists Changes its Position on Antidepressant Withdrawal

It has issued a revised policy statement updating its guidance to doctors, and calls upon NICE to update its guidelines as well.  This follows many months of work by CEP and its members, including the publication of research which indicates that antidepressant withdrawal is more widespread, more severe and more long-lasting than suggested by current guidelines.

Specifically, the College is calling for the following changes:

• There should be greater recognition of the potential for severe and long-lasting withdrawal symptoms on and after stopping antidepressants in NICE guidelines and patient information
• NICE should develop clear evidence-based and pharmacologically-informed recommendations to help guide gradual withdrawal from antidepressant use
• The use of antidepressants should always be underpinned by a discussion with the patient about the potential level of benefits and harms, including withdrawal
• Discontinuation of antidepressants should involve the dosage being tapered, which may occur over several months, and at a reduction rate that is tolerable for the patient
• Monitoring is needed to distinguish the features of antidepressant withdrawal from emerging symptoms
• Adequate support services should be commissioned for people affected by severe and prolonged antidepressant withdrawal, modelled on existing best practice
• There should be routine monitoring on when and why patients are prescribed antidepressants
• Training for doctors should be provided on appropriate withdrawal management
• Research is needed into the benefits and harms of long-term antidepressant use

Dr James Davies, co-founder of CEP, says, “We welcome these changes in policy which, if acted upon, will help reduce the harm that is being caused to huge numbers of patients through overprescribing, inadequate doctor training and often disastrous withdrawal management.  CEP calls upon the College to follow through with these demands, and help ensure that NICE guidelines in particular are updated to reflect the latest evidence.  In addition, we look forward to the publication of the Public Health England report on prescribed drug dependence later this year, with the hope that the government will also respond to the urgent need for withdrawal support services, including a 24 hour national helpline.”