About deprescribing antidepressants
Antidepressants have an important role in the therapeutic management of depression and anxiety, when used appropriately in line with the NICE guidelines on depression in adults or generalised anxiety and panic disorder.
The national medicines optimisation opportunities 2023/24 supports the appropriate use of antidepressants. However, antidepressant use may be considered inappropriate when:
- the antidepressant is not working
- the depression or anxiety has resolved
- the harms of the antidepressant outweigh the benefits
- the patient wants to stop taking the antidepressant
- the patient has experienced previous difficulties with withdrawing
Inappropriate use may lead to patient harm from problematic polypharmacy, adverse-effects, or both.
NICE guidelines on medicines associated with dependence or withdrawal symptoms advises using a shared decision making approach to discuss the deprescribing of antidepressants with the patient. Deprescribing in practice means reducing the dose at a pace that is tolerable for the patient, which for some patients can mean tapering for several months or longer.
Resources to support deprescribing
Useful resources that are available free-of-charge to help plan and support deprescribing of antidepressants in practice include the following.
NICE guidelines
The NICE guideline on depression in adults provides information on stopping antidepressants, including advice to give to patients, and how to withdraw and monitor.
The NICE guideline on medicines associated with dependence or withdrawal symptoms gives further recommendations on withdrawing antidepressants, including withdrawal strategies, interventions to support withdrawal, and the management of unsuccessful antidepressant withdrawal.
Clinical Knowledge Summary (CKS)
The NICE clinical knowledge summary covering depression provides a summary of advice to give to patients when stopping antidepressants.
Maudsley Prescribing Guidelines
The Maudsley Prescribing Guidelines in Psychiatry eBook has a chapter on depression and anxiety that provides information on antidepressant withdrawal and guidance, including details on how to devise a safe taper.
It is freely available to healthcare professionals in England with an NHS England OpenAthens account. Register for an NHS England OpenAthens account.
Royal College of Psychiatrists
Provides patient information on stopping antidepressants including expected withdrawal symptoms and ways to reduce or avoid these. Prescribers may find this resource useful as it also contains examples of tapering plans.
Resources for patients
Useful resources to signpost to patients, who might be considering withdrawing their antidepressant with professional support, include the following.
Royal College of Psychiatrists
Provides patient information on stopping antidepressants including expected withdrawal symptoms and ways to reduce or avoid these.
Mind
Provides patient information and experiences on withdrawal effects of antidepressants, coming off psychiatric medication and alternatives to antidepressants.
NHS website
Brief summary on stopping or coming off antidepressants and the possible withdrawal symptoms.
SPS resources coming soon
As part of implementing the national medicines optimisation priorities, SPS are working with experts and stakeholders to develop additional resources to help healthcare professionals implement antidepressant deprescribing with patients. These will cover:
- Considering and planning an antidepressant withdrawal
- Choosing an appropriate antidepressant withdrawal strategy
- Implementing an antidepressant withdrawal
- Following up, monitoring and advising patients on their antidepressant withdrawal