Australians have been urged to see their GP for help stopping long-term use of antidepressants following the Royal Australian College of GP endorsement of the new Maudsley Deprescribing Guidelines.
RACGP President Dr Nicole Higgins said that even while antidepressants were a helpful and effective treatment option for many people, they were not generally advised for longer use than six to12 months, or enough time to allow the patient to deal with the underlying causes of their depression.
“Some people can come off these drugs relatively easily, others have side effects severe enough to keep taking a medication they want to stop and there is no way of knowing what their experience will be like until they do stop,” Dr Higgins said.
“Every patient is unique. I urge anyone who wants to stop using antidepressants to see their GP for evidence-based support.”
Authored by the UK National Health Service’s Dr Mark Horowitz (who authored the Royal College of Psychiatrists’ guide on stopping antidepressants) and psychopharmacology Professor David Taylor, the latest Maudsley guideline outlines a new approach to recognising potential withdrawal in patients.
Dr Horowitz explained that the main messages of the textbook could be summed up in just a few words: “go slowly, at a rate the patient can tolerate and proceed even more cautiously for the last few milligrams, which are often the hardest to stop.”
“The core tenet is that decisions are made jointly in the patient’s best interest. Patients have expressed dissatisfaction – and sometimes outrage – with available medical assistance for stopping psychiatric medications,” Dr Horowitz said.
“This has led to many tens of thousands of patients seeking advice from online peer-support forums. When surveyed, these patients report that their doctors were often unhelpful either because they recommended tapering too quickly or because they were not familiar enough with withdrawal effects to provide helpful advice.
“Some doctors are apparently still suggesting that antidepressants do not cause withdrawal symptoms. The main requests from these patients are that health professionals are sufficiently well informed to provide personalised, flexible reduction plans and that access is provided to smaller doses to facilitate tapering.”
The latest Health of The Nation report, published last year, highlighted that mental health was the most prominent emerging health issue concerning Australian healthcare professionals, with a steady increase in the proportion of GPs reporting psychological issues among the top three reasons for patient presentations – up from 61% in 2017 to 72% in 2023.
“Australia’s disease burden from mental and neurodevelopmental disorders is among the highest in the world, with GPs taking on a significant proportion of the workload associated with mental health,” the report said, noting that an estimated 38% of weekly GP consultations included a mental health component.
“We took the word ‘psychiatry’ out of the title because we think that GPs will be the primary reader,” Dr Horowitz recently told newsGP. “We hope this support by the college is the first step towards safer practices for stopping these medications and that future clinical education will contribute to a broader understanding of these issues, a greater expertise in helping patients, and a better outcome for all.”