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The National Institute for Health and Care Excellence (NICE) have published draft guidelines calling for healthcare professionals to use shared decision making best practice to highlight the risks of medicines associated with dependence.
Dr Sameer Jauhar, Senior Clinical Lecturer in Affective Disorders and Psychosis, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London (IoPPN) and Consultant Psychiatrist, South London and Maudsley NHS Foundation Trust, said:
“This guidance from NICE is to be welcomed. Anyone looking after the care of people prescribed any medication, for their physical or mental health will be aware that it is sometimes easier to start a medicine than stop it at times.
“The best example of this is clearly the opiates, where we have clear evidence of a surge in use, and the advice given is pragmatic, and focuses on the individual, making sure use of these medicines is reviewed regularly and that people make educated choices about their treatment.
“A strength of this guidance is also identifying the areas for further research, in terms of interventions for people with withdrawal or dependence syndromes associated with these drugs.
“It is sometimes difficult to distill the contents of a consensus guideline into a press release, though it should be noted that antidepressants used in clinical practice do not cause dependence, i.e. are not addictive. The guideline is helpful in regard to antidepressant withdrawal in that it identifies risk factors for this, acknowledges the heterogeneity of this class of drugs, and emphasising that withdrawal can sometimes be mistaken for relapse.
“Therefore, in summary, this was a necessary guideline, and no one could argue that anything that engenders regular review of medication with people, and encourages them to be involved in their treatment can only be a good thing.”
Prof Anthony Cleare, Professor of Psychopharmacology, King’s College London, said:
“Lumping antidepressants together with addictive drugs like opiates as “dependence forming drugs” risks doing patients a disservice. While the body of the guideline does make a clear distinction and states “Antidepressants, although historically not classified as dependence forming medicines, can cause withdrawal symptoms when they are stopped”, it’s important that this message reaches the public.
“Barely a third of patients get any form of treatment for depression in the UK, and one of the commonest reasons patients give for not starting antidepressant medication is a fear of getting addicted to tablets. The scientific consensus is that antidepressants are not addictive. Categorising them alongside other drugs like opiates that clearly are addictive may lead to even fewer patients getting treatment and risks setting back decades of work to reduce the stigma of taking antidepressants.”
Dr Adrian James, President of the Royal College of Psychiatrists, said:
“Shared decision-making and supporting patients to understand the benefits and risks are essential to good practice, so we welcome these draft guidelines. Antidepressants are effective and can be lifesaving for many people, but they are not and should not be the ‘go-to’ for first instances of mild depression.
“They do not work for everyone and can have side effects, including withdrawal symptoms, so discussing this with patients is vital. Clinicians should be regularly reviewing whether they are still providing benefits or if they might no longer be needed. If a patient wants to come off them, this should be done slowly at a rate tolerable for the patient.”
Draft NICE Guideline: ‘Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults’ was published at 00:01 UK time Friday 22 October.
Declared interests
Dr Sameer Jauhar: “Dr Juahar has received honoraria from Sunovian for educational talks given on psychosis, and his employer KCL has received honoraria for educational talks he has given for Lundbeck.”
Prof Anthony Cleare: “Prof Cleare has in the last three years received honoraria for educational activities from Janssen; honoraria for consulting from Allergan and Janssen; sponsorship for conference attendance from Janssen; and research grant support from Protexin Probiotics International Ltd.”
None others received.