Services for People Withdrawing From Antidepressants

Before and during the Covid pandemic, prescriptions of antidepressants have risen, internationally, year after year, for two decades; in England, by about 5 percent per year. There are now 83.4 million prescriptions of antidepressants in England, to 8.3 million people. This represents nearly one in five adults (19 percent). Rates are even higher for women, older people, and poorer people.

In a previous post I summarised our 2019 research review, which found that just over half (56 percent) of people experience withdrawal effects when trying to reduce or come off antidepressants and that just under half of those people (46 percent) describe the withdrawal symptoms as "severe."

I have also reported on the major changes to national guidelines in the UK, which finally acknowledged the prevalence, severity, and duration of withdrawal, after decades of minimization and denial. We have also seen an important 2019 Public Health England report recommending specialised services and a phone hotline for people withdrawing from dependency-forming prescribed drugs such as benzodiazepines, opiates, and antidepressants, along with training for GPs and psychiatrists about withdrawal symptoms and how to support people to come off gradually and safely.

What matters, of course, is whether those recommendations, already four years old, will ever be implemented. Earlier this month NHS England took us an important step closer to real change when it published a "commissioning framework" entitled Optimising Personalised Care for Adults Prescribed Medicines Associated With Dependence or Withdrawal Symptoms which included many, but not all, of the PHE recommendations.

Almost simultaneously, not entirely by chance, two psychiatrists from University College London (Mark Horowitz and Joanna Moncrieff) and I have published the findings of our survey of 1,276 members of Facebook groups for antidepressant users from 49 countries, entitled "Designing Withdrawal Support Services for Antidepressant Users: Patients’ Views on Existing Services and What They Really Need."

It is the second-largest international survey of antidepressant users ever conducted. It found that the majority (71 percent) experience their prescribing doctor as "unhelpful" when it comes to supporting their efforts to withdraw. Most doctors were uninformed about withdrawal symptoms and therefore denied their existence and/or recommended withdrawal much too quickly.

The services that patients would have found "very useful" but had been unable to access include:

• Smaller doses (e.g., tapering strips, liquid, smaller dose tablets) to ensure gradual reduction.
• A health professional providing a personalised, flexible reduction plan.
• A telephone/online, video/online chat helpline.

Our study concluded: "Our findings indicate, in keeping with previous studies, that clinicians require upskilling in safe tapering of antidepressants and that patients need specialised services to help them stop safely."

These recommendations, by hundreds of patients who have been badly let down by their doctors, precisely echo the recommendations of the comprehensive Public Health England report in 2019. However, the NHS has still not put in place a single specialised withdrawal service, helpline, or training programme for doctors. Meanwhile tens of thousands of people are turning to Facebook groups, all over the world, for support and guidance, to fill the void left by mainstream services.

Co-author Mark Horowitz commented, "Our survey respondents are using Facebook groups because their doctors did not have the skills to help them safely come off these medications. The consequence of this is much unnecessary suffering which can lead to huge impairment – including job loss and relationship stress.

"We urgently need to up-skill doctors and provide them with the tools (like liquid versions of drugs, or tapering strips) and the time to oversee careful tapers. Meanwhile a telephone help line is urgently needed to plug the gap in services that are currently failing patients”.

Examples of patients’ quotes cited in the article:

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• "I was advised I could reduce over a period of 3 days to a week at most!"
• “My doctor told me to go cold turkey.”
• “Psychiatrist had the best intentions, but was completely ignorant and therefore unable to help.”
• “Lost confidence in my GP because he didn’t tell me about side effects.”
• “I think a lot of doctors have no idea! No one explained the withdrawal symptoms to me, no one told me how dependent you become.”
• “I had been on antidepressants on and off for 25 years. When I was struggling with withdrawal, I was only ever offered more antidepressants.”
• “The first prescriber suggested quick withdrawal. The second helped me plan a gradual schedule.”
• “She just wanted me to stop cold turkey. She doesn’t believe in withdrawal.”
• “Told me withdrawal from antidepressants doesn’t exist.”
• “Told me that the symptoms that I knew were side effects were a relapse of the original problems.”
• “Do not prescribe before warning patients about the risk they are about to take if they start Ads.”
• “Don't prescribe antidepressants to everyone in every little crisis.”

Our survey of GPs in England found that they acknowledged their need for training about antidepressant withdrawal symptoms and how to support patients to safely come off these drugs.

Psychotherapist Anne Guy, Secretariat Co-ordinator for the All Party Parliamentary Group for Prescribed Drug Dependence, added, "This timely research highlights what patients need from the NHS to help them stop or reduce their prescription medicines when they’re ready. The research also provides new evidence of the urgent need for a national helpline and website which would offer a crucial source of expert information and support for both patients and clinicians."