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NICE Recommends Supporting Adults Who Want to Quit Antidepressants

Editor's note: Due to NICE updating the figures for the percentage of people who completed an IAPT treatment course, we have updated the figures below.

The National Institute for Health and Care Excellence (NICE) says that adults with depression who want to quit antidepressants should be given support on how to do it safely over time.

Around 1 in 6 (17%) adults aged 16 years and over in Great Britain experienced some form of depression in summer 2021, with the rate higher than before the coronavirus pandemic, when 1 in 10 adults experienced some form of depression, according to the Office for National Statistics (ONS). In addition, data from NHS Business Services Authority highlighted there were an estimated 21.4 million antidepressant drugs items prescribed between July and September 2022.

New draft NICE quality standards for mental health - which set out priority areas for quality improvement for the care of adults with depression - include a statement to help adults who want to come off antidepressants permanently.

Reducing the dose of an antidepressant in stages over time - known as ‘tapering’ - helps to reduce withdrawal effects and long-term dependence on the medication.

NICE said that adults with depression who want to stop taking antidepressants should have the dose of their medication "reduced in stages" to reduce the likelihood and severity of withdrawal symptoms.

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."

Dr Adrian James, president of the Royal College of Psychiatrists, told Medscape News UK: "We know that antidepressants can save lives, and most people will not need to take them for more than 6 to 12 months, but when a patient does come off antidepressants, they may experience both physical and mental withdrawal symptoms which is why it is usually best to stop them slowly. These new guidelines are a positive step forward which will help countless people come off antidepressants across the UK safely."

Doctor-Patient Agreement Warranted

Whilst the independent advisory committee emphasised that primary care and mental health professionals should "follow the NICE guideline recommendations on stopping antidepressant medication", it added that an "agreement" should be made with the patient about "whether it is right for them to stop taking the medication" and if so, the speed and duration of withdrawal from it.

"It should be stressed there is no one-size fits all approach to coming off antidepressants," cautioned Dr Chrisp. "The way it should be done has to be down to the individual and their healthcare professional, to agree a way which it can work and only when side-effects can be safely managed."

Any withdrawal symptoms need to have been resolved, or to be tolerable, before making the next dose reduction the NICE committee said.

"In many cases people experience withdrawal symptoms, and the length in 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," said Dr Chrisp.

Culturally Appropriate Routes to Mental Health Care Encouraged

The committee has also made other new quality statements, one of which was that adults with depression from minority ethnic family backgrounds were supported to access mental health services.

The statement highlights that adults from minority ethnic family backgrounds are disproportionately less likely to access mental health services than the general population. "They may be among those who face stigma due to being treated for a mental health condition, and face difficulty in accessing some or all mental health services," the authors pointed out.

According to NICE, data has shown that only over half (57%) of people from mixed, Black, or Asian family backgrounds completed a course of treatment for depression compared with just over 3 in 5 (64%) people from a White family background.

"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 Improving Access to Psychological Therapies (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."

NICE suggested that adults are given a choice of methods to access mental health services and that services are delivered in a way that is culturally appropriate, alongside information about routes to treatment that is also culturally appropriate and available in a language that can be understood.

The other new quality statements from NICE were that adults who may have depression have a comprehensive assessment, and that adults with a new episode of depression discuss the full range of treatment options with their healthcare professional. NICE also updated its quality statement that adults with depression who are at a higher risk of relapse are offered relapse prevention interventions.

Reacting to the new guidelines, Stephen Buckley, head of information at Mind, told Medscape News UK: "We're pleased to see that NICE have adopted a quality standard for the care of adults with depression. Improvement in this area is all the more important as more people have been struggling with their mental health and the number of people prescribed antidepressants in England has risen."

Prof Allan Young, director, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, told the Science Media Centre: "It makes complete sense that the guidelines for treating depression in adults - which were published in June last year- are followed. These are not new recommendations for the way depression is treated but a document which describes key areas of care which NICE thinks can be improved on. Whether it can be delivered given the current state of the NHS is another question."

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