The prescribing of antidepressants has been on the rise in recent decades and Australia now has the second-highest use of the drug per capita among OECD countries.
But there’s growing concern about how people are coming off the medication, particularly if they have been on it for a long time, which is often the case.
James Cook University (JCU) lifestyle medicine senior lecturer and doctor Sam Manger said currently, patients were being told to come off the drugs too quickly.
“The old teaching was that you can sort of halve the dose for over a week or two, then halve it again and then stop it,” he said.
“If you go too quickly, you will bring on a raft of quite significant withdrawal effects, which could be very similar to the mental illness itself, like depression or anxiety, a kind of severe agitation, neurological symptoms, or cognitive impacts like brain fog.”
Dr Manger said sometimes people thought their mental health condition had returned and went back on the medication.
It is hoped new guidelines will better inform doctors about the best way for people to come off antidepressant medication. (Reuters: Darren Staples)
He points to new research that shows people need to come off antidepressants far more slowly than what is currently being practised, as outlined by the Maudsley Deprescribing Guidelines book.
Dr Manger and JCU head of psychiatry Carlo Longhitano are integrating these guidelines into the mental health teaching curriculum for medical students and postgraduate lifestyle medicine courses at the university.
The idea is these future doctors will know how to safely deprescribe and reduce any withdrawal side effects.
Dr Longhitano said the training was desperately needed because it was “currently missing from the medical school curriculum and from postgraduate training in psychiatry”.
“I am also ensuring locally trained psychiatrists are aware of this subject, leading to better cooperation between specialists and generalist doctors,” he said.
How to stop safely
Maudsley Deprescribing Guidelines lead author Mark Horowitz will help teach JCU students about the guidelines.
“It’s important people understand when to stop antidepressants; when is the time for people to come off them,” Dr Horowitz said.
“[Also] how to distinguish withdrawal symptoms people have coming off them compared to if it’s a return of their [mental health] condition, and how to do the process safely.”
Dr Horowitz is Australian, but works as a clinical research fellow with the United Kingdom’s National Health Service.
He said the service was further ahead in the field of deprescribing these medications.
Researcher Mark Horowitz says Australia is at least a decade behind the UK when it comes to deprescribing guidelines. (ABC: Andrew Greaves)
For example, one key guideline that is rarely practised in Australia is for patients to take a liquid form of the antidepressant, rather than a pill, because it’s easier to slowly reduce the amount by smaller increments.
Dr Horowitz said Australia was at least a decade behind the UK.
“In the UK they’ve made it a national priority to reduce inappropriate use of antidepressants, they’ve set up clinics to help people stop using these drugs,” he said.
He pointed out that while some clinics had just been set up in Australia, the “colleges have their heads in the sand and aren’t taking this issue seriously”.
“Guidelines haven’t been updated for years; GPs and psychiatrists haven’t been trained in the latest techniques,” he said.
New information for doctors
The Royal Australian College of General Practitioners (RACGP) endorsed the Maudsley Derescribing Guidelines earlier this year, but Dr Horowtiz said most doctors were still following the college’s set of guidelines on deprescribing, which were out of date.
RACGP psychological medicine chair Cathy Andronis said the college welcomed the Maudsley guidelines, but it was still new information for doctors and the general public.
“The most important thing they’ve indicated is that we have underestimated how severe withdrawal effects can be for some people,” Dr Andronis said.
She said the guidelines had been helpful for doctors to be aware of how to deprescribe slowly.
“Much more slowly than we have assumed in the past or based on information provided by drug companies, and that’s been a real game changer,” she said.
Dr Andronis encouraged patients to speak to their GPs about the new guidelines.
