Palmer et al’s article aiming to translate recent change in NICE guidance to GPs is timely and useful.1 Some GPs may have a negative response to the article and understandably, given how big a shift the updated NICE guidance on stopping antidepressants represents from previous guidance.
Double-blind randomised controlled trials demonstrate that 53.9% of patients who stop antidepressants will experience withdrawal effects.2 The minimisation of these effects in guidelines for decades has meant that withdrawal effects are commonly misdiagnosed as relapse.3 This is why there are currently 10s of 1000s of English patients seeking advice on how to stop antidepressants on peer support sites,4 rather than from their doctors.
Though it was considered thrifty to avoid prescription of liquid versions of medications, a shift in policy has been signalled by NICE specifically recommending to GPs: ‘if … slow tapering cannot be achieved using tablets or capsules, consider using liquid preparations if available’.5 At present, 8 out of 10 of the most commonly used antidepressants are available as liquids; sertraline is available in liquid form as a ‘Special’.
GMC guidance is clear that doctors are permitted to prescribe medications off-licence when ‘the dosage specified for a licensed medicine would not meet the patient’s need’.6 The Specialist Pharmacy Service for the NHS has a dedicated webpage to explain how to make up antidepressant tablets into suspensions,7 and manufacturers of antidepressant liquids allow for dilution with water for easier measurement of small doses.8
Competing interests
MA Horowitz has been commissioned: a) by Health Education England for a module on how to safely stop antidepressants using hyperbolic tapering for NHS staff on the SCRIPT website; b) to write the Maudsley Deprescribing Guidelines, Wiley-Blackwell. He is a Collaborating Investigator on the RELEASE trial (Australia) investigating supported, gradual, hyperbolic tapering of antidepressants; a member of the Critical Psychiatry Network; an associate of the International Institute for Psychiatric Drug Withdrawal; and cofounder of Outro Health, which helps people who wish to stop unnecessary antidepressant medication in Canada and the US using gradual, hyperbolic tapering.
REFERENCES
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