NICE Guideline Update Acknowledges Severe Antidepressant Withdrawal

A new update to the NICE guideline for depression suggests providers discuss long-term, severe antidepressant withdrawal symptoms.

Peter Simons
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A new update to the NICE guideline for the treatment of depression suggests that providers inform patients about the potential for long-term, severe withdrawal symptoms when coming off antidepressant medications. The relevant change to the guidelines recommends that psychiatrists and mental health professionals speak to service-users about antidepressant withdrawal:

“Explain that whilst the withdrawal symptoms which arise when stopping or reducing antidepressants can be mild and self-limiting, there is substantial variation in people’s experience, with symptoms lasting much longer (sometimes months or more) and being more severe for some patients.”

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A news article in the scientific journal BMJ provided more detail about the update. According to that article, the UK’s National Institute for Health and Care Excellence (NICE) published the original depression treatment guidelines in 2009. At that time, they suggested that withdrawal symptoms were “usually mild and self-limiting over about one week.”

However, researchers recently filed a freedom of information request to see the evidence NICE used to make that controversial “one-week” claim. It turned out, as reported in BMJ, that NICE couldn’t support the claim. Instead, their sources explicitly contradicted it:

“NICE was able to provide only two short review articles, neither of which supports the one week claim, although both cite numerous sources that contradict it.”

Now, NICE has updated that statement to acknowledge the extensive body of research finding protracted, severe withdrawal symptoms after antidepressant use.

BMJ quotes Paul Chrisp, who is the director of the Centre for Guidelines at NICE: “We have amended the guideline to recognize the emerging evidence on the severity and duration of antidepressant withdrawal symptoms.”

The 2009 NICE guidelines have been roundly criticized for failing to consider the research about withdrawal from antidepressants. A recent article in BMJ suggested that guidelines that minimize the severity and length of withdrawal symptoms serve to misinform providers. Longer, more severe withdrawal symptoms end up misdiagnosed as relapse of depression.

The result is often to reinstate the antidepressant to treat the supposed relapse, rather than considering more extended tapering strategies for minimizing withdrawal.

NICE was scheduled to release a significant revision of their depression treatment guidelines last year. However, concerns were raised by a large group of mental health experts, service users, and survivors. According to that group, there were “significant flaws in methodology, lack of transparency, and several inconsistencies in the document.”

The group documented many of these problems. For instance, recommendations for long-term use of antidepressants are generally based on very short-term studies, often lasting only a month or two. The group also noted problems including cherry-picking data, controversial statistical analyses used to determine efficacy, and inadequate reporting of the dangers of the drugs. Additionally, NICE was criticized for failing to listen to the voices of service users and survivors.

In 2017, the National Survivor User Network (NSUN) issued a statement pointing out that the NICE “guideline has largely ignored the voices of service users, using out-of-date evidence of service user experiences mostly dating back to before 2004 and has failed even to incorporate this evidence into recommendations.”

Because of these concerns, NICE has undergone a process of consultation to base its revised guidelines on more current evidence with better methodology. This update, acknowledging the severity and length of antidepressant withdrawal, is the first result of that process.

 

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National Institute for Care and Health Excellence (NICE). Depression in adults: recognition and management. 2019. www.nice.org.uk/guidance/cg90/chapter/1-Guidance#continuation-and-relapse-prevention

 

 

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Peter Simons
MIA Research News Team: Peter Simons comes from a background in the humanities where he studied English, philosophy, and art. Now working on his PhD in Counseling Psychology, his recent research has focused on conflicts of interest in the psychopharmaceutical research literature, the use of antipsychotic medications in the treatment of depression, and the general philosophical and sociopolitical implications of psychiatric taxonomy in diagnosis and treatment.

6 COMMENTS

  1. “A recent article in BMJ suggested that guidelines that minimize the severity and length of withdrawal symptoms serve to misinform providers. Longer, more severe withdrawal symptoms end up misdiagnosed as relapse of depression,” or “bipolar.” As happened to me, over a million American children, and no doubt millions more adults.

    https://www.alternet.org/2010/04/are_prozac_and_other_psychiatric_drugs_causing_the_astonishing_rise_of_mental_illness_in_america/

    And you are still minimizing “the severity and length of withdrawal symptoms.” I’ve had brain zaps since late 2001, that’s 18 years and counting, for that common symptom of antidepressant discontinuation syndrome. I’ve also read that the sexual side effects of the antidepressants can be permanent as well.

    https://rxisk.org/post-ssri-sexual-dysfunction-pssd/

    • I hear you, Someone Else! I took Effexor for less than a year in 2003 and developed allergies I’d never had. Scented products had never been an issue before that drug. Just this past month I have noticed that I can walk through the laundry aisle now without my nose itching and stuffing up, and the angel trumpets in my backyard are no longer a source of headache. The scent is lovely; I can actually enjoy it again. It took 15 years for the drug to lose its hold on my nose. Maybe there is hope for your brain zaps.

      • One can hope, LavenderSage. But at least I can largely control the brain zaps now, except when I’m sleeping. And they do allow me to brain zap away a headache in a New York second. An ethical doctor, likely embarrassed by my medical knowledge, but who was a decent guy, and called me a “one in a million” medical researcher, tried to turn the brain zaps into a positive by calling them “neuro-protective.” I just laughed, as if they’re a good thing.

        I think the decent doctors are getting embarrassed by the psychiatrists’ massive in scope harm of their clients. The psychiatrists need to stop trusting their big Pharma reps, and start trusting what their clients say instead. For goodness sakes, the “mental health” workers and doctors didn’t even know brain zaps were a common symptom of antidepressant discontinuation syndrome until 2005.

        https://www.cambridge.org/core/journals/psychiatric-bulletin/article/brain-shivers-from-chat-room-to-clinic/642FBBAE131EAB792E474F02A4B2CCC0

        And they only learned about it because lots of patients were discussing brain zaps/shivers on the internet – not because the “mental health” workers listened to or believed their individual clients – which exemplifies their ungodly disrespect of their clients.