Coming off antidepressants is notoriously difficult, with many experiencing horrendous side-effects including stomach problems, irritability and insomnia.
And with some seven million Britons estimated to be taking the mood balancing drugs, knowing exactly how to stop this powerful drugs of class is paramount—but has eluded experts for decades.
But new research, published in The Lancet Psychiatry, has suggested the best way to come off the pills is to slowly reduce dosage, with the support of a trained mental health professional, such as a psychiatrist.
This, researchers say, could prevent relapse in 20 per cent of patients, enabling them to live more freely and not be reliant on prescription medication.
‘Our findings suggest that while antidepressants are effective in preventing depressive relapses, they do not need to be a long term treatment for everyone,’ study co-author, Dr Debora Zaccoletti, said.
Antidepressants are not only used to treat depression, but a number of mood disorders including anxiety, obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).
Selective serotonin reuptake inhibitors (SSRIs), one of the most widely prescribed types of the drug, work by increasing the amount of available serotonin—dubbed the happiness hormone—in the brain.
But, as Christine Villelongue, co-head of the France Depression Association, explained: ‘As soon as an antidepressant is changed or reduced, it is a source of anxiety for the person.
The powerful drugs — taken by millions — have long been known to potentially trigger symptoms including dizziness, headaches, insomnia and nausea when coming off them
‘However, there are no real guidelines: When medication is stopped, there is no follow up.’
To assess the health impact of overprescribing, experts from the World Health Organisation’s (WHO) Collaborating Centre for Research and Training in Mental Health and Service Evaluation, cross-examined over 75 studies to work out the best way for a patient to come off the medication.
Analysing medical records from over 17,000 individuals, the researchers found the most effective method is gradually lowering the dosage alongside seeing a therapist.
According to the researchers, this could help prevent relapse in one in five patients, helping dramatically reduce the number of patients unable to get off of antidepressants.
Patients were followed for around a year, with those who abruptly stopped taking their medication found to be at a 40 per cent risk of relapse.
Those who gradually came off antidepressants, whilst seeing a psychiatrist, however reduced their risk of relapse by nearly 50 per cent.
This, the study found, was almost as effective as continued drug usage without psychological support.
The researchers concluded that guidelines on coming off antidepressants should ‘promote individualised deprescribing with gradual tapering and structured psychological support.’
Professor Giovanni Ostuzzi, study co-author also from the University of Verona, added: ‘Continuing with or without psychological support, slow tapering with the psychological support and continuing at the antidepressant at reduced doses had similar benefits in preventing relapse within the first year after stopping.
‘Abrupt stopping or fast tapering carried the highest risk of relapse.’
The researchers hope that their study will pave the way for more personalised prescribing practices and help more patients come off the drugs sooner.
‘Our new review clarifies the scientific evidence about the most effective way to come off antidepressants for individuals successfully treated for depression and could change how coming off antidepressants is managed globally,’ Prof Oztuzzi added.
‘These findings highlight the need for clinical guidelines to be updated to promote regular treatment reviews and individualised deprescribing with gradual tapering and structured psychological support for patients with depression who are feeling better and wish to come off their medication.’
But, experts who were not involved in the current study have expressed concern over patients coming off medication too quickly, without the support of their doctor.
Dr Jonathan Henssler, MD, an expert in evidence-based mental health, stressed: ‘The best patient outcomes were achieved with strategies that maintained antidepressant therapy.’
He added that currently both pharmaceutical treatment and psychotherapy are limited in their curative capacity- meaning that for effective usage, both need to be used in adjunct, which is not always feasible.
Other experts highlighted the the follow-up period of the study was relatively short, meaning it is difficult to make long-term conclusions.
However, Dr Alberto Oritz Lobo, a leading psychiatrist at La Paz University, welcomed the findings.
He said: ‘This is a crucial study given the alarming increase in antidepressant prescriptions and the need to consider strategies for reducing their use.
‘The usual clinical reality is that, after people improve, antidepressant treatment is often continued for months, years, or indefinitely, leading to chronic adverse effects of the medication, exposure to its risks, and brain neuroadaptation that makes stopping the medication difficult.
He added that gradually reducing the dose helps support changes in the brain.
Continuing, he said: ‘Psychological support provides confidence and security in this process, in which the person regains their agency and autonomy, reappropriates their emotions and stops delegating their well-being to a medication.’
Latest NHS data shows a record 8.8million people in England are now on the mood-boosting drugs.
Common SSRIs prescribed in the UK include citalopram, fluoxetine and sertraline, sometimes known by brand names Cipramil, Prozac and Lustral.
But their use has been linked to long-term and even permanent sexual dysfunction by researchers.
The NHS has warned that side effects such as a loss of libido and achieving orgasm, lower sperm count and erectile dysfunction ‘can persist’ after taking them — and patients have described feeling ‘carved out’, relationships wrecked, from their use.
Most medics, and the NHS, consider the use of SSRI for depression, particularly persistent or severe cases, as worthwhile given the debilitating nature of the condition.
