Guidelines on deprescribing antidepressants are due to be launched in Sunderland, which has one of the highest antidepressant prescribing rates in the country.
The guidelines, which are based on advice published by the Royal College of Psychiatrists, the Maudsley Hospital in London, and the New South Wales Therapeutic Advisory Group, aim to help prescribers overcome barriers that can prevent healthcare professionals deprescribing antidepressants.
“Unlike opioids, antidepressants have a good evidence base and are entirely appropriate in lots of circumstances,” said Ewan Maule, head of medicines optimisation at Sunderland Clinical Commissioning Group (CCG), which has published the guidance.
“The problem is they just don’t get reviewed and discontinued often enough. And often, the decision to prescribe is not necessarily linked in with other support around the patient’s social circumstances.
“We wanted to make sure … that discontinuation was a more obvious part of the pathway.”
The guidelines have been co-authored by individuals in primary and secondary care and will be tied in with the GP incentive scheme to optimise uptake.
“We think it’s really important … firstly to get secondary care to engage in the process of deprescribing, because quite often they’re initiating these [medicines], but to also give the authority to primary care to say it’s OK to deprescribe something that’s been started in secondary care.
“Quite often that’s a barrier [to deprescribing]; GPs don’t want to touch it because it [was prescribed by] a specialist.”
The guidelines state that, in patients prescribed high doses for longer periods, a more gradual reduction plan may be more appropriate, and that certain antidepressants with a higher risk of withdrawal symptoms require a more cautious reduction. They also include prompts for referral to social prescribers and low mood plans, as well as other ongoing management approaches to support patients after they have stopped taking their antidepressants.
“We’ve tried to localise it a fair bit — for example, we’ve got references in there to refer on to social prescribers, how to find social prescribers and that being a part of the conversation with the patient,” Maule explained.
The guidelines also highlight the key warning signs and symptoms that may indicate a need to pause or stop the tapering process; and there is a section on deprescribing in learning disability and autism, in recognition of the additional challenges associated with this patient group.
Sunderland CCG is planning to publish a number of deprescribing guidelines and their impact will be evaluated over the coming year.
Researchers find more evidence is needed on antidepressant withdrawal
In April 2021, a Cochrane review concluded that there was an ‘urgent shortage’ of evidence around safe withdrawal from antidepressants.
The authors said that, owing to the small number of studies focused on approaches to discontinuing long-term antidepressants, they could not make any firm conclusions about effects and safety of the approaches studied to date.
They added that research into the deprescribing of long-term antidepressants was urgently needed — particularly in primary care — to determine the safest and most effective approach.
The review follows the publication of guidelines by the Royal College of Psychiatrists in September 2020, which recommend tapering antidepressants over a period of months or a year, depending on the dose and how long the individual has been taking them.