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The Brighton guide considers practical strategies that constitute ‘tricks of the trade’ for GP consultations. These are brought together within a framework of therapeutic history, therapeutic examination, clinical decision tools (where appropriate), and stepwise management that starts with ‘low level’ self-help advice. The management approach differs for mild-to-moderate and severe cases. The strategic principles have diverse origins in postgraduate GP training, medical education theory and the grey literature. They do not relate to specific clinical presentations but, instead, convey a ‘tactical’ understanding of the consultation. This approach takes account of the potential for divergence, even conflict, between the agendas of doctors and their patients. The Brighton guide embraces the everyday challenges faced by GPs in their consultations, including the achievement of safe management plans within the typical 10-minute encounter with relationships intact. This means conducting consultations that maintain boundaries, safe practice and punctuality while preserving time and energy for the next patient.

BACKGROUNDAll major classes of antidepressants can cause a withdrawal syndrome when removed. 1 Withdrawal is common, experienced by 56% of those stopping a selective serotonin reuptake inhibitor (SSRI), with rates varying between antidepressants. [1][2][3] Historically, withdrawal was thought to be mild and self-limiting, misnamed a 'discontinuation syndrome'; the 2022 National Institute for Health and Care Excellence (NICE) depression guidance still states that withdrawal symptoms 'usually go away within 1 to 2 weeks'. 4 However, most patients will experience symptoms of longer than 2 weeks. 2 Additionally, contrary to previous understanding, symptoms of withdrawal are often severe, and can include increased suicidal ideation. 1,2 Inaccurate guidance on antidepressant withdrawal has resulted in many patients experiencing distressing, debilitating symptoms; this is highlighted through the thousands of posts on online support groups, such as 'Surviving Antidepressants' (https:// www.survivingantidepressants.org/). Some of these patients have been misdiagnosed as suffering from a relapse of their original mental health condition, with others left fearful to stop their antidepressant in the future. 2 This has likely contributed to the increasing numbers of patients taking an antidepressant for an unnecessarily extended duration. 5 Benefits to stopping antidepressants in stable patients include preventing side effects, and avoiding drug interactions and burden, alongside reducing costs.Despite more widespread understanding of withdrawal syndrome and methods to taper antidepressants safely, there remains uncertainty on how to best manage patients wishing to stop their antidepressant, or already experiencing withdrawal symptoms. This article primarily discusses withdrawal from SSRIs as they are the most prescribed antidepressant class by GPs in England and are the main focus of research into withdrawal. 5

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