Patients are still not being warned how difficult it can be to come off antidepressants, say psychiatrists campaigning for a reduction in the needless use of the drugs.
Yet the withdrawal symptoms are frequently mistaken for a relapse in the condition for which the drugs were prescribed and, as a result, patients end up being put back on them. The psychiatrists are now calling for prescribing guidelines to be updated urgently.
Under current NICE guidance, unchanged since 2004, withdrawal symptoms from antidepressants are described as ‘usually mild and self-limiting over about one week’. But both research and patients’ experience suggest otherwise, with severe symptoms including nausea, insomnia, anxiety and panic attacks that can last for weeks — or longer.
Fact: Under current NICE guidance, unchanged since 2004, withdrawal symptoms from antidepressants are described as ‘usually mild and self-limiting over about one week
Major research, published by the Mail in October, confirmed that the frequency, severity and duration of reactions to antidepressant withdrawal was ‘more widespread, severe and long-lasting’ than doctors had been led to believe, with nearly half of patients suffering severe symptoms (that’s 1.8 million in Britain).
Now, in a letter published today in The BMJ, 14 of the world’s leading experts on antidepressant withdrawal are calling on NICE and the Royal College of Psychiatrists to review their guidelines urgently ‘to bring them in line with the scientific evidence base’.
They say it’s ‘concerning’ that, despite overwhelming evidence that millions of patients battle to come off antidepressants for months or even years, two recent surveys show only a tiny proportion recall being told anything about withdrawal effects, dependence, or potential difficulties coming off the drug
‘The guidelines are misleading doctors about the extent to which withdrawal is an issue and this is causing devastating problems for many people,’ says Dr James Davies, a reader in medical anthropology and mental health at the University of Roehampton, and one of the letter signatories.
A review by Dr Davies, published last year in the journal Addictive Behaviors, looked at 14 studies and found that half of patients experience withdrawal when trying to stop or reduce their antidepressants; nearly half described their withdrawal as severe.
WHAT IS DEPRESSION?
While it is normal to feel down from time to time, people with depression may feel persistently unhappy for weeks or months on end.
Depression can affect anyone at any age and is fairly common – approximately one in ten people are likely to experience it at some point in their life.
Depression is a genuine health condition which people cannot just ignore or ‘snap out of it’.
Symptoms and effects vary, but can include constantly feeling upset or hopeless, or losing interest in things you used to enjoy.
It can also cause physical symptoms such as problems sleeping, tiredness, having a low appetite or sex drive, and even feeling physical pain.
In extreme cases it can lead to suicidal thoughts.
Traumatic events can trigger it, and people with a family history may be more at risk.
It is important to see a doctor if you think you or someone you know has depression, as it can be managed with lifestyle changes, therapy or medication.
Source: NHS Choices
Dr Davies says the faulty guidance explains why, although the number of people being prescribed the drugs for the first time is slowly falling, millions are being kept on them for years. He says: ‘So what happens to a person who turns up at their GP surgery four weeks after stopping a drug, still experiencing withdrawal effects?
‘We fear those symptoms will be misdiagnosed as a return of their condition, and that doctors simply put them back on the antidepressants, leading to long-term use.’
The letter’s signatories cite evidence of the physical and emotional consequences of long-term antidepressant use, which range from weight gain and a worsening of depression, to an increased risk of dementia and even death.
NICE is reviewing its guidelines on the diagnosis and management of depression. It is also developing separate guidelines on the ‘safe prescribing and withdrawal management of prescribed drugs’. A spokesman said it was ‘too early to confirm’ antidepressants would be included, though ‘we’d envisage they would be’.
But even if they are, consultation has yet to begin and ‘this means we could be waiting for three or four more years before these necessary guideline changes are made,’ says Dr Davies.
Last week, the Royal College of Psychiatrists revealed to Good Health that it has completed a year-long ‘assessment of the current evidence about antidepressants and our views on how to promote optimal use and management’. It will be published soon.
Professor Wendy Burn, president of the college, adds: ‘We need high-quality research to improve our understanding of withdrawal problems so these can be minimised. For many people with more severe depression, antidepressants are an effective treatment.’