Adults with depression who are stopping their antidepressants should have the dose reduced in stages, according to one of several new measures included in a draft quality standard published by the National Institute for Health and Care Excellence (NICE).
The draft standard, which is expected to be published in June 2023, also states that adults with depression from minority ethnic family backgrounds should be supported to access mental health services, in light of data suggesting that this cohort are “disproportionately” less likely to access these specialist services than the general population.
The new quality standard, which is a complete update to the existing standard published in March 2011, covers the clinical assessment and management of depression in adults aged 18 years and over, and describes high-quality care in priority areas for improvement.
The draft document says that reducing the dose of antidepressant medication in stages over time, a process known as tapering, helps to “reduce withdrawal effects and long-term dependence on antidepressants where their continued use is not indicated”.
“The decision to stop antidepressant medication, including speed and duration of withdrawal, should be taken after discussion and agreement between the adult and their healthcare professional,” it says.
“Any withdrawal symptoms need to have been resolved or be tolerable before making the next dose reduction.”
Paul Chrisp, director of the Centre for Guidelines at NICE, said that if an individual on antidepressants decides they want to stop taking their 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 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.”
However, he stressed that there was “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 a way which it can work and only when side effects can be safely managed.”
Danny Kruger, chair of the All-Party Parliamentary Group (APPG) for prescribed drug dependence, welcomed the recognition of the need for tapering antidepressants in the new quality standard.
“Prescribers should also be referred to the Royal College of Psychiatry’s information resource, ‘Stopping antidepressants’, which includes examples of tapering plans,” he added.
The NICE committee also highlighted that 57% of mixed, black, black British, Asian or Asian British people completed a course of treatment for depression, compared with 64% of white people.
As a result, the draft standard now states that adults with depression from minority ethnic backgrounds should be supported to access mental health services, as many face stigma and, as a result, difficulty accessing some or all of these services.
“By monitoring and comparing rates of access to mental health services among adults with depression by ethnicity, approaches to promoting and improving access to mental health services can be identified,” the statement adds.
Ciara Ni Dhubhlaing, immediate past president of the College of Mental Health Pharmacy, said she was “disheartened” to see the figures relating to access to Improving Access to Psychological Therapies (IAPT), now referred to as NHS Talking Therapies.
“Involving their healthcare team is essential for a patient considering a reduction or discontinuation of medication,” she said.
“As well as providing advice on pharmacokinetics, pharmacists may have a particular role in advising on availability of dosage forms to safely facilitate slow withdrawal where required.
“Empowering patients to make informed decisions on what is right for them is important as there are many online forums which can cause significant, and often unwarranted, anxiety about the risks of antidepressant withdrawal.”
In April 2022, NICE was criticised by the APPG for prescribed drug dependence for failing to take into account the experience of thousands of patients in the advice it gave on tapering the dose when discontinuing certain medicines. The APPG said that the guidance provided no information on how slowly to taper, how frequently to reduce doses and by how much.
The draft quality standard is out for consultation until 14 February 2023. The final quality standard is expected to be published in June 2023.