The new guidelines focus on key areas of prescription, management of withdrawal and severity of withdrawal symptoms
The National Institute for Health and Care Excellence (NICE) has released new guidelines outlining the prescription and management of withdrawal from opioids, benzodiazepines, gabapentinoids, Z-drugs and antidepressants in primary and secondary care.
The guidelines share that while antidepressants are not ‘dependence-forming’ drugs, they can still cause withdrawal symptoms. “Antidepressants, although historically not classified as dependence-forming medicines, can nevertheless cause withdrawal symptoms when they are stopped,” the guidelines stated.
The guidelines also highlight dose reduction, managing withdrawal symptoms and interventions to support withdrawal.
In 2017 Public Health England was commissioned to identify the scale, distribution and causes of drug dependence, and found that in 2017 to 2018, 7.3 million adults in England (17% of the adult population) received, and had dispensed, antidepressants.
Between 2015 to 2016 and 2017 to 2018, the rate of prescribing antidepressants increased from 15.8% of the adult population to 16.6%.
Furthermore, the pandemic saw the prescription and use of antidepressants in the UK soaring, as access to counselling decreased. In 2021, there were 235,000 fewer referrals for talking therapies in England between March and August, compared to the same period of 2020.
The guidelines released yesterday also correlate to the NICE recommendation from October 2021 that GPs should regularly review patients withdrawing from addictive medication. NICE has previously warned of the ‘severe’ and lengthy antidepressant withdrawal symptoms, a revision of earlier designations of these symptoms as ‘mild’.
In conclusion, NICE emphasised that GPs should “not withhold the medicine solely on the basis of one of these factors”, but should “consider delaying prescribing if the person needs more time to think about their options or the prescriber needs to consult with other members of the healthcare team. If prescribing is delayed, ensure that a follow-up appointment is arranged”.
