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A UK study has suggested that almost half of patients taking antidepressants for at least one year could come off the medicines without intensive face-to-face therapy sessions, providing they have GP support and access to online or phone helplines.
The study, published in JAMA Network OPEN on 24 June 2024, used data from 325 adults, recruited from 131 UK GP practices between December 2018 and March 2022.
All participants had been taking antidepressants for more than one year for a first episode of depression, or more than two years for recurrent depression.
Participants were randomised to either receive support (n=178) or no support (n=147).
In the ‘support’ group, patients were given an active review of their medication, access to internet support and offered three phone calls with an NHS Talking Therapies psychological wellbeing practitioner.
All patients in the study were able to consult their GP or nurse practitioner to review their antidepressants, which represented current best practice in the control group, the authors said. They noted that, where necessary, they helped participants with “getting an appointment immediately after baseline assessment, which may take some weeks for a non-urgent problem in UK general practice”.
According to the researchers, more than 40% of patients in the intervention group — who were not at risk of relapse and were otherwise well — were able to stop taking the medication under advice from their GP.
Participants with access to psychological support through online or phone helplines reported better mental wellbeing after discontinuation, as well as lower rates of depression and fewer side effects, compared with the control arm.
However, total rates of antidepressant discontinuation were not statistically significant between the intervention and control groups — 45.5% of patients were able to stop taking the medicine with support, compared with 41.9% of patients without.
Co-author Una Macleod, professor of primary care medicine at Hull York Medical School, said: “The evidence in our study is clear and suggests the UK should establish a national helpline, by phone and online, to help people intending to come off the medication.”
Lead author Tony Kendrick, professor of primary care at the University of Southampton and lead author of the study, said that the approach could “eliminate the risk of serious side effects for patients using antidepressants for long periods who have concerns about withdrawal”.
He added that the findings show many patients withdrawing from antidepressants do not need intense therapy sessions, and that “offering patients internet and psychologist telephone support is also cost-effective for the NHS”.
“Our findings show that support not only improves patient outcomes but also tends to reduce the burden on primary healthcare while people taper off antidepressants.”
Steve Bazire, honorary professor at the University of East Anglia School of Pharmacy, said: “I agree that the [study’s] findings are sound.
“In fact, I commented to The Pharmaceutical Journal on a similar piece of work a few weeks ago, on a meta-analysis that quoted the lower figure of one in seven. I mentioned then two studies carried out by pharmacists where less than 5% of people had problems — none major — stopping antidepressants at an appropriate time and done in a steady way rather than abruptly.
“I personally think those people who believe that 50% of people suffer terrible and long-lasting withdrawal effects from antidepressants have got it wrong.”
The authors acknowledged that two-thirds of practices participating in the research were in areas with below-average levels of deprivation; therefore, the findings “may not be generalisable to more deprived areas”.
“Only 1.9% of participants were from racial and ethnic minority groups compared with 19% of people in the 2021 UK census, and our intervention needs wider testing,” they added.
Read more: ‘Case-based learning — safe withdrawal and tapering of antidepressants‘
