The UK is helping people stop antidepressants – but still no tapering advice available in Ireland

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Pharmacists in the UK are being urged to assist people who want to stop antidepressants, with a detailed guidance published in the UK’s Pharmaceutical Journal, the Royal Pharmaceutical Society’s official journal.

This change in practice follows the publication of NICE guidelines in January (NICE guidelines are evidence-based recommendations for health and care in England) indicating that withdrawal effects from antidepressants can be severe and can last “several months”.

Both NICE and the Royal College of Psychiatrists in England recommend that patients are informed of the potential for severe and/or long-lasting withdrawal effects when considering starting an antidepressant.

The article states that:

“There has been a step-change in (NICE) guidance on how to safely stop antidepressants in the past few years… guidelines have since been updated to reflect a new approach, known as hyperbolic tapering. Around half of patients will experience withdrawal effects from antidepressants, with NICE guidelines indicating that withdrawal effects can be severe and can last “several months”. For some patients, antidepressant withdrawal effects can last for years and can be debilitating, leading to job loss, relationship breakdown and even(although rarely) suicide.”

The article highlights the ‘central role’ pharmacists can play in providing advice to GPs and patients about best practice, to help optimise patient care by reducing inappropriate long-term prescribing and avoiding unnecessary harm caused by potentially harmful methods of discontinuation.

Despite it now being widely accepted that withdrawal effects from antidepressants are more common – and can be more severe and long-lasting – than previously understood, no such guidance or advice is currently available in Ireland.

Indeed, there is very little debate or public conversation in Ireland about the widespread prescribing of antidepressants, even though the drugs are no longer meant to be used long term or as a first line treatment for people experiencing what is called ‘mild’’ depression, very often linked to life difficulties/stresses.

The Pharmaceutical Journal article goes on to point out the side effects of antidepressants, stating that adverse (or side) effects are important to consider, as they can impair a patient’s quality of life: 25–80% of patients experience sexual dysfunction and about 50% experience emotional numbing or blunting.

“Memory and concentration issues, tiredness and weight gain are all common with antidepressants. Observational studies have found increased rates of stroke, falls, cardiovascular disease and premature death in antidepressant users compared with non-users, albeit with debate about the degree to which causality should be attributed to antidepressants or the conditions treated. In a survey of psychotherapy patients, patients reported a desire to live without being dependent on a medication, concerns about long-term effects on their health, a lack of efficacy, feeling better, or planning to become pregnant as their main reasons for wishing to stop medication.”

Often, people take antidepressants because they have been led to believe their depression has a biochemical cause, but research shows this belief is not grounded in evidence and believing it can actually worsen outcomes. Research has shown antidepressants are no better than placebo in 85% of people.

These issues demonstrate the need for informed consent at the point of prescribing and the need for a service to help people stop safely when they want to/are ready to.

In Ireland currently, a study to help identify the top priorities for future research about reducing and stopping psychiatric medications is seeking people to take part in two anonymous online surveys to help shape the research agenda about reducing and stopping psychiatric medicines.

The Priorities for Future Research on Reducing and Stopping Psychiatric Medicines (PROTECT) study is being carried out by researchers at Trinity College Dublin.

Additionally, as reported by Mad in Ireland, the World Tapering Org has launched a global petition to make stopping antidepressants and other psych meds/drugs safer.

It is calling for:

– better guidelines for tapering antidepressants and other psych meds/drugs

– providing physicians with practical tools to support patients who are tapering psych meds

– making very low-dosage forms of administration of all psych meds available so that the pace of tapering can be adapted to the needs of each individual patient

 

Editor’s note: this post was originally published by our colleagues at Mad in Ireland, and is reposted with permission here

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1 COMMENT

  1. Thank you Mad in the U.K.,

    It is disheartening to read that Ireland are not open to discuss this. However, Pharmacies and Pharmacists do take an extremely important role in Health Care. In hospitals, on Medical wards, they are present. One is allocated to each Specialty. They check medications, drug charts and when there have been errors, it is the ONLY time, you see green ink written. They over-rule the Consultants. It is part of a SAFETY system. Similarly, in GP Practices there is an Administrative Role called a Prescribing Clerk. GPs do tire and can make mistakes, so it is their job to ensure Prescriptions are correct. Another SAFETY system.

    You do not see this on Psychiatric wards nor in Community Mental Health Team Clinics. Patients will tell a Psychiatrist that the dosage is too high and their side effects. They again are NOT listened to. They can be offered other psychiatric medication to counter-act the Side Effects which results in Poly-drugging. However, any patient can REPORT a medication or medical device on the Medicines and Healthcare Regulatory Agency’s Yellow Card Scheme. It also allows patients a voice. The Yellow Card scheme MONITORS and provides REPORTS such as interactive Drug Analysis Profiles, they also produce STATISTICS which feed into other systems. It is also a SAFETY MEASURE. How many patients know of the Yellow Card Scheme ? Or have been told of it ? Not many, I can tell you. How many patients actually talk and ask their Community Pharmacists questions ? They are pretty knowledgable and I know several on a personal level.

    Kind regards