National Institute for Health and Clinical Excellence (NICE)
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Adults with depression who want to quit antidepressants should be given support on how to do it safely over time, says NICE

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, NICE has said.

A new draft quality standard, which sets out priority areas for quality improvement for the care of adults with depression, includes a statement to help adults who want to come off the medication permanently.

The independent advisory committee, which includes experts in treating adults with depression, has recommended the staged withdrawal of antidepressants.

The committee said primary care and mental health professionals should follow the NICE guideline recommendations on stopping antidepressant medication, including agreeing with their patient whether it is right for them to stop taking the medication and if so, the speed and duration of withdrawal from it.

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.

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

According to data from NHS Business Services Authority, there were an estimated 21.4 million antidepressant drugs items prescribed between July to September 2022. The Office of National Statistics said around one in six (17%) adults aged 16 years and over in Great Britain experienced some form of depression in summer 2021. The rate remains higher than before the coronavirus pandemic (July 2019 to March 2020), where 10% of adults experienced some form of depression.

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.

“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.

“But it should be stressed there is 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. Our guideline on depression signposts to information produced by the Royal College of Psychiatrists which can offer practical advice to help people safely come off this medication.”

The committee has also recommended adults with depression from minority ethnic family backgrounds are supported to access mental health services.

This follows data which shows just 57% of people from mixed, Black, Black British, Asian or Asian British family backgrounds completed a course of treatment for depression compared with 64% of people from a white family background.

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.

NICE has 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 culturally appropriate and available in in a language that they can understand.

Dr Chrisp added: “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 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.

“I hope that our statement will help ensure adults with depression from minority ethnic family backgrounds are supported to access mental health services and tackle this avoidable health inequality issue.”

A consultation on the five statements has now begun and feedback can be made via until Tuesday 14 February 2023.

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