Wendy Burn: Medical community must ensure that those needing support to come off antidepressants can get it

In 2018, while I was still President of the Royal College of Psychiatrists (RCPsych), I co-signed a letter to The Times which stated that “in the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment.” 

To my astonishment the letter sparked a furore. A group of psychologists, psychiatrists and patients complained publicly. They were unhappy as they had found stopping antidepressants led to symptoms in patients that were often misinterpreted as a relapse of depression, which in turn led to taking medication for longer periods of time. 

Formal complaints were made to RCPsych and to the General Medical Council. I was widely and upsettingly trolled on social media, as were several of my colleagues. 

In my many years of clinical practice, stopping antidepressants had not been a problem that my patients had reported to me. Possibly because I have always slowly tapered any medication that my patients were on.

While our letter had been in line with the NICE guidance on antidepressant discontinuation which states  “symptoms are usually mild and self-limiting over about one week” we had not included the further guidance from NICE that stated symptoms “can be severe, particularly if the drug is stopped abruptly.” 

As the President of the College I felt it was my responsibility to find out more from patients who were experiencing these symptoms and consider how they could be supported

Over the next year, I met patient groups who reported harm from using antidepressants. They describe themselves as the “prescribed harm community.” 

I visited a charity in Bristol which supports people coming off psychiatric medication, working with their doctors. I attended an event run by a group called “Drop the Disorder” who challenge the culture of medical psychiatric diagnoses. 

Many people attending this event told me they had been damaged by antidepressants, particularly by their experiences of coming off them.  

I talked to “Altostrata” in San Francisco who founded the Surviving Antidepressants website in 2011, this supports people who are having problems stopping psychiatric medication and has a huge collection of case histories. She describes experiencing acute withdrawal symptoms, followed by Post-Acute-Withdrawal Syndrome (PAWS) with ongoing symptoms.

It became clear that I had underestimated the number of people experiencing difficulties in stopping antidepressants and that the problem was widely under-recognised across healthcare.   

I spoke to people who reported feeling abandoned with little or no support for symptoms after stopping their antidepressants. Meanwhile, I feared that heated and often polarised arguments were deterring people with mental illness from speaking about their experiences and seeking support.

The College’s position in 2018 had not been right.  

We worked together with patients, GPs, psychiatrists, stakeholders, campaigners, NICE and PHE to produce a statement on antidepressants and depression which changed our position and gave clear recognition to the difficulties that can arise for some people when coming off antidepressants.

With this position statement we put patients at the centre of our work, listening to critics with an open mind and using this to inform our practice—a significant step in the right direction.  

The following extract from the position statement marks this vital change to our approach: “Whilst the withdrawal symptoms which arise on and after stopping antidepressants are often mild and self-limiting, there can be substantial variation in people’s experience, with symptoms lasting much longer and being more severe for some patients. Ongoing monitoring is also needed to distinguish the features of antidepressant withdrawal from emerging symptoms which may indicate a relapse of depression.” 

We also recommended that better support is provided to people who are stopping antidepressants. 

Following this update, NICE changed its guidance to reflect the importance and range of withdrawal symptoms. NICE also advise people on antidepressant medication to talk to their practitioner before stopping and to get their support with managing withdrawal symptoms.

This week RCPsych is launching a Patient Information Resource on withdrawing from antidepressants. The resource offers advice to patients on carefully managing the process for stopping antidepressants. 

It’s been written by a pharmacist and a psychiatrist with their own personal, as well as professional, experience of withdrawal symptoms, along with input from multiple stakeholders. 

The online patient resource, available free on the RCPscych website, has been endorsed by the Royal College of General Practitioners and the Royal Pharmaceutical Society. 

I’m hoping that the whole medical community will get behind this work to ensure that those needing support to come off antidepressants can get it. Most of all, I hope the resource proves helpful to people on antidepressants, and that no one experiencing mental illness is shamed or intimidated from seeking help.

Wendy Burn, Consultant Old Age Psychiatrist, immediate past president of Royal College of Psychiatrists, National Mental Health Clinical Advisor to Health Education England and Chair of Equally Well Clinical Group.

Competing interests: None declared.