Dr Mark Horowitz, an Australian based in London, said he “almost died” coming off antidepressants because of severe withdrawal effects.
When he tried to stop taking antidepressants, after 15 years of use, the insomnia, panic attacks, dizziness and anxiety felt so unbearable he considered suicide.
Then in his early 30s, Horowitz researched his symptoms online and found “thousands of people saying the exact same thing as me” on internet forums. It led him down a road of research with King’s College London, examining why so many patients struggle to cease the drugs once their depression resolves.
Together with Prof David Taylor, Horowitz has written landmark deprescribing guidelines for clinicians that include evidence-based advice on stopping antidepressant use.
Titled the Maudsley Deprescribing Guidelines, the instructions were officially endorsed by the Royal Australian College of General Practitioners (RACGP) on Wednesday amid growing concern about a lack of advice for doctors and patients.
The RACGP president, Dr Nicole Higgins, said generally antidepressants are a helpful and effective treatment option for many people, but not generally advised for use longer than six to 12 months.
“While some people can come off these drugs relatively easily, others have side effects severe enough they keep taking a medication they want to stop,” Higgins said.
She described the guidelines as “helpful” for GPs to use to support patients to come off antidepressants and other drugs of dependence.
While the general advice for stopping antidepressant medication has been to slowly reduce daily doses by between 25% and 50% every week to four weeks, Horowitz said this is not a gradual enough tapering down for most patients. Horowitz is now a clinical research fellow in psychiatry with the National Health Service.
He said current guidance lacked detail about how slowly to reduce doses, how reduced doses may differ depending on the type of antidepressant, and how to advise patients to take doses smaller than those produced by the manufacturer.
The guidelines offer advice specific to Australia, including how patients can access smaller doses through compounding pharmacies or by crushing up tablets. It also offers advice specific to different antidepressant classes and brands.
The guidelines also advise on safely deprescribing insomnia medicines, benzodiazepines – used for stress, anxiety and insomnia – and gabapentinoids, used for seizures, nerve pain and restless legs syndrome.
Barbara Mintzes, a professor of evidence-based pharmaceutical policy at the University of Sydney, said: “It can be very hard to stop using antidepressants.
“Studies of their use in primary care show that many people are prescribed antidepressants although they do not meet criteria for major depression, for example because of a life event that has led to distress or sometimes because depression can be a side-effect of another medication.
“We also know that the evidence on the effectiveness of antidepressants has been exaggerated because of selective publication of more positive clinical trials.”
For mild to moderate depression, Mintzes said non-drug treatment was often as effective as prescribing drugs. The Maudsley Deprescribing Guidelines also challenge the inappropriate prescribing of antidepressants.
Dr Elizabeth Moore, the president of the Royal Australian and New Zealand College of Psychiatrists, said the guidelines would be reviewed and considered by the college alongside other emerging clinical guidance and evidence in the field.
“Antidepressants can be beneficial for many people needing treatment for depression and anxiety,” she said.
“It is important to recognise that discontinuation and withdrawal symptoms from antidepressants are common and can be severe, sometimes persisting for a significant period.”
In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978. In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, Mental Health America is available on 800-273-8255
