Patients are STILL not being warned of withdrawal pain from depression pills, say experts

Patients are still not being warned how difficult it can be to come off antidepressants, say psychiatrists campaign-ing for a reduction in the needless use of the drugs.

Yet the withdrawal symptoms are frequently mistaken for a relapse in the condition for which the drugs were prescribed and, as a result, patients end up being put back on them. the psychi-atrists are now calling for prescribing guidelines to be updated urgently.

Under current niCe guidance, unchanged since 2004, withdrawal symp-toms from antidepressants are described as ‘usually mild and self-limiting over about one week’. But both research and patients’ experience suggest otherwise, with severe symptoms including nausea, insomnia, anxiety and panic attacks that can last for weeks — or longer.

Major research, published by the Mail in October, confirmed that the frequency, severity and duration of reactions to antidepressant withdrawal was ‘more widespread, severe and long-lasting’ than doctors had been led to believe, with nearly half of patients suffering severe symptoms (that’s 1.8 million in Britain).

now, in a letter published today in the BMJ, 14 of the world’s lead-ing experts on antidepressant withdrawal are calling on niCe and the Royal College of Psychia-trists to review their guidelines urgently ‘to bring them in line with the scientific evidence base’.

they say it’s ‘concerning’ that, despite overwhelming evidence that millions of patients battle to come off antidepressants for

months or even years, two recent surveys show only a tiny propor-tion recall being told anything about withdrawal effects, dependence, or potential difficul-ties coming off the drugs.

‘the guidelines are misleading doctors about the extent to which withdrawal is an issue and this is causing devastating problems for many people,’ says Dr James Davies, a reader in medical anthro-pology and mental health at the University of Roehampton, and one of the letter signatories. a review by Dr Davies, published last year in the journal addictive Behaviors, looked at 14 studies and found that half of patients experience withdrawal when trying to stop or reduce their anti-depressants; nearly half described their withdrawal as severe.

Dr Davies says the faulty guid-ance explains why, although the number of people being prescribed the drugs for the first time is slowly falling, millions are being kept on them for years. He says: ‘so what happens to a person who turns up at their GP surgery four weeks after stopping a drug, still experiencing withdrawal effects?

‘We fear those symptoms will be misdiagnosed as a return of their condition, and that doctors simply put them back on the antidepres-sants, leading to long-term use.’

the letter’s signatories cite evidence of the physical and emotional consequences of long-term antidepressant use, which range from weight gain and a wors-ening of depression, to an increased risk of dementia and even death.

Nice is reviewing its guide-lines on the diagnosis and management of depression. it is also developing separate guidelines on the ‘safe prescribing and with-drawal management of prescribed drugs’. a spokesman said it was ‘too early to confirm’ antidepres-sants would be included, though ‘we’d envisage they would be’.

But even if they are, consulta-tion has yet to begin and ‘this means we could be waiting for three or four more years before these necessary guideline changes are made,’ says Dr Davies.

Last week, the Royal College of Psychiatrists revealed to Good Health that it has completed a year- long ‘ assessment of the current evidence about antide-pressants and our views on how to promote optimal use and manage-ment’. it will be published soon.

Professor Wendy Burn, president of the college, adds: ‘We need high-quality research to improve our understanding of withdrawal problems so these can be mini-mised. For many people with more severe depression, antidepres-sants are an effective treatment.’