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Strategies to reduce use of antidepressants

Strategies to reduce use of antidepressants
Strategies to reduce use of antidepressants
Antidepressant prescribing has increased year on year since the introduction of the selective serotonin reuptake inhibitors (SSRIs) in the 1980s. More than 10% of adults in England are now taking antidepressants for depression/anxiety, with a median length of treatment of more than two years, but antidepressants can cause side effects and withdrawal symptoms which increase with longer use. Surveys of antidepressant users suggest 30-50% have no evidence based indication to continue, but coming off antidepressants is often difficult due to fears of relapse, withdrawal symptoms, and a lack of psychological treatments to replace maintenance treatment and prevent relapse. GPs should not prescribe antidepressants routinely for mild depressive/anxiety symptoms. Patients starting antidepressants should be advised that they are to be taken for only a limited period, and that there is a risk of withdrawal problems on stopping them. Prescribers should actively review long-term antidepressant use and suggest coming off them slowly to patients who are well. The relationship between SSRI dose and serotonin transporter receptor occupancy suggests that hyperbolic tapering regimes may be helpful for patients with troubling withdrawal symptoms who cannot stop treatment within 4 to 8 weeks, and tapering strips can allow carefully titrated slower dose reduction over some months. Internet and telephone support to patients wanting to reduce their antidepressants is being trialled in the REDUCE programme. More research is needed to establish the incidence of withdrawal symptoms in representative samples of patients coming off antidepressants, and large randomised controlled trials are needed to test different tapering strategies.
antidepressants, depression, health policy, prescribing, primary care
0306-5251
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5

Kendrick, Tony (2020) Strategies to reduce use of antidepressants. British Journal of Clinical Pharmacology. (doi:10.1111/bcp.14475).

Record type: Article

Abstract

Antidepressant prescribing has increased year on year since the introduction of the selective serotonin reuptake inhibitors (SSRIs) in the 1980s. More than 10% of adults in England are now taking antidepressants for depression/anxiety, with a median length of treatment of more than two years, but antidepressants can cause side effects and withdrawal symptoms which increase with longer use. Surveys of antidepressant users suggest 30-50% have no evidence based indication to continue, but coming off antidepressants is often difficult due to fears of relapse, withdrawal symptoms, and a lack of psychological treatments to replace maintenance treatment and prevent relapse. GPs should not prescribe antidepressants routinely for mild depressive/anxiety symptoms. Patients starting antidepressants should be advised that they are to be taken for only a limited period, and that there is a risk of withdrawal problems on stopping them. Prescribers should actively review long-term antidepressant use and suggest coming off them slowly to patients who are well. The relationship between SSRI dose and serotonin transporter receptor occupancy suggests that hyperbolic tapering regimes may be helpful for patients with troubling withdrawal symptoms who cannot stop treatment within 4 to 8 weeks, and tapering strips can allow carefully titrated slower dose reduction over some months. Internet and telephone support to patients wanting to reduce their antidepressants is being trialled in the REDUCE programme. More research is needed to establish the incidence of withdrawal symptoms in representative samples of patients coming off antidepressants, and large randomised controlled trials are needed to test different tapering strategies.

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bcp.14475 - Accepted Manuscript
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More information

Accepted/In Press date: 29 June 2020
e-pub ahead of print date: 12 July 2020
Additional Information: The development of the ADvisor Internet support packages for patients and practitioners through the National Institute for Health Research (NIHR) funded REDUCE programme on antidepressant reduction was led by Adam Geraghty, Associate Professor, and Hannah Bowers, Research Fellow, Primary Care, Population Sciences & Medical Education, University of Southampton, UK. The antidepressant tapering schedules in the ADvisor for Health Professionals Internet support package were developed with help from Chris F. Johnson, Antidepressant Specialist Pharmacist, NHS Greater Glasgow & Clyde Pharmacy & Prescribing Support Unit, Pharmacy Services, NHS Greater Glasgow & Clyde, Glasgow. The REDUCE programme is funded by the NIHR Programme Grants for Applied Health Research (PGfAR), grant reference no. RP-PG-1214-20004. The views expressed are the authors' and not necessarily those of the NIHR or the Department of Health and Social Care. The funder played no role in the writing of this paper or the decision to submit it for publication.
Keywords: antidepressants, depression, health policy, prescribing, primary care

Identifiers

Local EPrints ID: 442544
URI: http://eprints.soton.ac.uk/id/eprint/442544
ISSN: 0306-5251
PURE UUID: 6046c8fb-2975-480d-a659-7e74da58e506
ORCID for Tony Kendrick: ORCID iD orcid.org/0000-0003-1618-9381

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Date deposited: 17 Jul 2020 16:35
Last modified: 09 Jan 2022 02:57

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