NICE outlines that adults coming off antidepressants should have the dosage reduced in stages to reduce the likelihood and severity of withdrawal symptoms.
A new draft quality standard by the National Institute of Health and Care Excellence (NICE) has noted priority areas for quality improvement for the care of adults with depression, including a statement to help adults who are coming off antidepressants permanently.
The decision to recommend staged withdrawal of antidepressants has come from experts in the depression field and an independent advisory committee. The committee have stated that primary care and mental health professionals should follow NICE guideline recommendations on coming off antidepressants, which includes agreeing with their patients on whether it is the right decision to stop the medication, and the speed and duration of withdrawal.
The current advice about coming off antidepressants
People with depression should always talk to a doctor before coming off antidepressants. It is stated on the NHS website that you should not stop taking antidepressants suddenly, as this could lead to a bad reaction.
Withdrawal symptoms may include restlessness, trouble sleeping, unsteadiness, sweating, stomach problems, and feeling irritable, anxious or confused. Withdrawal symptoms can show themselves within five days of coming off antidepressants and generally last around one or two weeks.
10% of adults experienced some form of depression
According to data from the NHS Business Services Authority, there were an estimated 21.4 million antidepressant drugs prescribed between July to September 2022. The Office of National Statistics said around one in six (17%) adults aged 16 years and over in Great Britain experienced some form of depression in the summer of 2021. The rate remains higher than before the coronavirus pandemic (July 2019 to March 2020), where 10% of adults experienced some form of depression.
Dr Paul Chrisp, 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 of time it takes them to safely come off these drugs can vary, which is why our committee’s useful and useable 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 on a way in which it can work and only when side effects can be safely managed. Our guideline on depression signposts to information produced by the Royal College of Psychiatrists, which can offer practical advice to help people safely come off this medication.”
Better mental health support for ethnic minority patients
The committee also found that 57% of people from mixed Black, Black British, Asian or Asian British family backgrounds completed a course of treatment for depression compared with 64% of people from a white family background.
This highlights that adults with depression from ethnic minority backgrounds are disproportionately less likely to access mental health services than the general population. They may face stigma as a result of being treated for a mental health condition or face difficulty when it comes to accessioning mental health support.
As a result of this finding, NICE has suggested that adults are given a choice of methods to access mental health services and that services should be culturally appropriate and available in multiple languages.
Dr Chrisp added: “It is clear from the data that there is a disproportionate number of adults from a minority ethnic family background who are not completing treatment via IAPT services.
“As a healthcare system, we need to look for innovative ways to help people from these family backgrounds to get the help and support they need which is culturally appropriate to them.
“I hope that our statement will help ensure adults with depression from minority ethnic family backgrounds are supported to access mental health services and tackle this avoidable health inequality issue.”