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Caught in the blues

Antidepressant prescribing rates have increased year on year over the past 25 years with now more than 60 million prescriptions for the medication being issued in England per year. Patients are being kept on these medications for longer, on average around two years, but around a third to a half of patients have no evidence-based justification for continued treatment beyond one year, and could stop with help. However, doctors sometimes maintain patients on antidepressants because it is easier than weaning them off.

Possible long-term effects of antidepressants include weight gain, sexual dysfunction, sleep disturbance, and gastrointestinal bleeding (with concomitant NSAID use), which increase with longer-term use. SSRI use in older patients has been found to be associated with increased risks of stroke or transient ischaemic attack, falls, fractures, seizures, hyponatraemia, and death. Furthermore side effects are known to be under-reported, and surveying antidepressant users reveals significant levels of unreported adverse reactions. If people taking them could stop they would avoid the side effects and potentially feel more reliant on themselves.

Our new study, funded by the NIHR, will identify safe, reliable and cost-effective ways of helping patients withdraw from long-term antidepressants, where appropriate.

We appreciate that stopping antidepressants is not easy. Withdrawal symptoms, including anxiety and low mood, are usually temporary but feel similar to the reason why patients were first put on antidepressants. Therefore people are understandably reluctant to come off the medication – they feel like they’re getting depressed again. Our research team will develop a web-based intervention which will be available around the clock, together with some GP or nurse monitoring, telephone support from a mental health worker, and possibly ‘buddying’ support from people who have previously come off antidepressants. This will be tested through a randomised control trial where participants will either receive the intervention or usual care.

Our six-year study has been funded by a £2.4 million NIHR Programme Grant for Applied Research and is a collaboration between the universities of Southampton (including the Faculty of Health Sciences and the NIHR Southampton Clinical Trials Unit), Liverpool, York, Hull, University College London, and Solent NHS Trust in Southampton.

Antidepressant prescribing rates are rising very quickly and a significant proportion don’t need to be prescribed at all. We hope our intervention will identify where alternative support could be best used. If our programme works we’d like to roll it out across the NHS, publishing practical guidance for professionals, and advice for patients.

Professor Tony Kendrick
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