Urgent research needed on how to safely stop using antidepressants – experts

Ella Pickover, PA Health Correspondent
·3-min read

There is an “urgent” need for research to help find the best way for people to stop using antidepressants, academics have said.

The UK has one of the highest rates of antidepressant use in the world.

In England about 17% of the adult population had a prescription for an antidepressant in 2017/18 – about 7.3 million people.

Academics performed an overview of research into the topic and found that while there are hundreds of studies on people starting treatment with antidepressants, there are just 33 randomised control trials which examined stopping them.

The Cochrane review of antidepressant discontinuation examined the studies to try to assess which method is best to help patients stop taking the medication.

A number of methods were studied, including stopping medication abruptly, gradually stopping the drugs over several weeks – also known as tapering – and in some studies psychological support was offered as patients discontinued their medicine.

But the authors said that there is little high-quality evidence which points towards the best route of discontinuation.

Lead review author and Belgium-based researcher Dr Ellen Van Leeuwen said: “We know the rise in long-term antidepressant use is a major concern around the world.

“As a GP myself, I see first-hand the struggles many patients have coming off antidepressants.

“It’s of critical concern that we don’t know enough about how to reduce inappropriate long-term use or what the safest and most effective approaches are to help people do this.

“For example, there are over 1,000 studies looking at starting antidepressants, yet we found only 33 randomised controlled trials (RCTs) around the world that examined stopping them. It’s clear that this area needs urgent attention.”

She added: “In a nutshell there was only very low certainty evidence on the pros and cons of each of the different approaches to stopping – making it difficult to reach any firm conclusions at this time.”

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UCL-based researcher and training psychiatrist Dr Mark Horowitz, who co-authored the review, added: “For me this is such a critical issue both from a personal and a professional perspective.

“I’m one of the hundreds of thousands of people who have had or are having long, difficult and harrowing battles coming off long-term depressants because of the severity of the withdrawal effects.

“And yet rather than being able to find or access any high quality evidence or clinical guidance in this situation, I could only find useful information on peer support sites where people who had gone through withdrawal from antidepressants themselves have been forced to become lay experts.

“Since then the Royal College of Psychiatrists has taken a great step forward in putting out guidance on stopping antidepressants in 2020, however, there is still a lack of research and therefore evidence in this area on what works for different people.

“I want other people to have the evidence base to come off without the same trouble I had.”

In 2017 Public Health England was tasked with examining the scale, distribution and causes of prescription-drug dependence.

The review covered five types of medication – including antidepressants – and found that a quarter of all adults were prescribed one of these types of medication.

The authors said that people who use the drugs should receive “regular reviews” of whether the treatment is working.

And “patients who want to stop using a  medicine must be able to access appropriate medical advice and treatment, and must never be stigmatised”.

They also said that patients should not attempt to come off these medicines on their own and should seek medical advice.

PHE also called for more research on the prevention and treatment of dependence on, and withdrawal from, prescribed medicines.