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Are we getting good enough advice about antidepressants?

Last year, Prof John Read and Dr James Davies published a paper in the scientific journal ‘Addiction’ reviewing the withdrawal effects of antidepressants and suggesting these are worse than most people have been informed.

They raise concerns that symptoms of withdrawal are both more common, affecting nearly half of people trying to come off them, and last much longer, up to 4-6 weeks ( rather than the one or two suggested in the government guidelines ). They are also concerned that the symptoms of withdrawal people experience when trying to stop taking the medication may be mistaken for a relapse of their illness, causing them to go back onto the medication without good reason. Finally, they argue that the withdrawal symptoms are so severe that the clinical guidelines around their use should be revised.

Antidepressant medications are being used more and more, rising by 170% since 2000. As many as 16% of the UK population were prescribed antidepressants last year and half of all users have been taking them for more than 2 years. Looking further, 36% have been on antidepressants for more than 5 years and 26% expect to stay on them for life. Alarmingly, 65% had never had a discussion with the person who prescribed them about coming off and, perhaps in a connected way, 45% of those who had stopped the drugs had done so without consulting their doctor. Indeed, about 1 / 3 people taking antidepressants for more than 2 years have no clinical indications for taking them.

Depression is a horrible problem to have to suffer with and, if antidepressants are providing effective treatment, it may well be worth tolerating some side effects and withdrawal symptoms. The main problem is that it seems as though these downsides and side effects are being understated and people may not be being given full and accurate information about them. Nearly half of people experiencing withdrawal effects describe them as ‘severe’, and it is not uncommon for people to continue experiencing withdrawals for several months. This is quite different from the current guidelines which describe ‘discontinuation symptoms’ as ‘mild and self-limiting, resolving over 1-2 weeks’.

All of this is not to say that people should stop medications they are finding helpful or that others shouldn’t explore medications as a good treatment option but it does sound like the advice and management around medication needs a lot more care and attention. Firstly, people need more detailed advice about the difficulties they might experience when they try and stop their medication and secondly their cases need regularly reviewing to see if, when and how they might consider stopping.

Finally, it should be emphasised that although we are discussing some of the side effects of medications, many still find them extremely helpful. Also, there are a number of new medications for depression showing great promise so the outlook for sufferers will only improve in the coming years and maybe even months. We shall report on some of these new treatments in articles very soon.

References:

“A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based?”:

https://www.sciencedirect.com/science/article/pii/S0306460318308347

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