General practitioners’ and psychiatrists’ attitudes towards antidepressant withdrawal

Abstract

Background There has been a recent rise in antidepressant prescriptions. After the episode for which it was prescribed, the patient should ideally be supported in withdrawing the medication. There is increasing evidence for withdrawal symptoms (sometimes called discontinuation symptoms) occurring on ceasing treatment, sometimes having severe or prolonged effects. Aims To identify and compare current knowledge, attitudes and practices of general practitioners (GPs) and psychiatrists in Cornwall, UK, concerning antidepressant withdrawal symptoms. Method Questions about withdrawal symptoms and management were asked of GPs and psychiatrists in a multiple-choice cross-sectional study co-designed with a lived experience expert. Results Psychiatrists thought that withdrawal symptoms were more severe than GPs did (P = 0.003); 53% (22/42) of GPs and 69% (18/26) of psychiatrists thought that withdrawal symptoms typically last between 1 and 4 weeks, although there was a wide range of answers given; 35% (9/26) of psychiatrists but no GPs identified a pharmacist as someone they may use to help manage antidepressant withdrawal. About three-quarters of respondents claimed they usually or always informed patients of potential withdrawal symptoms when they started a patient on antidepressants, but patient surveys say only 1% are warned. Conclusions Psychiatrists and GPs need to effectively warn patients of potential withdrawal effects. Community pharmacists might be useful in supporting GP-managed antidepressant withdrawal. The wide variation in responses to most questions posed to participants reflects the variation in results of research on the topic. This highlights a need for more reproducible studies to be carried out on antidepressant withdrawal, which could inform future guidelines.

The lived experience of withdrawal from Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants: A qualitative interview study

“…The subtheme of self‐managed withdrawal with limited resources aligns with other research, with one prior survey study ( n = 342) identifying subthemes related to insufficient information and support 9 . Research also indicates a discrepancy between healthcare professionals’ claims that patients are informed about withdrawal symptoms and patient reports 38 . This was evident in a recent large online survey ( n > 1000) which revealed that less than 5% of patients reported being told anything about antidepressant withdrawal effects by their prescribers 39 .…”

What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications

“…Further, symptoms may not occur for weeks. The ambiguity may reinforce the tendency to not inquire about co-occurring physiological withdrawal symptoms (as well as reinforcing the belief that these syndromes are rare), 47,80,81 but timing tells the tale 3,56,82 : any dosage decrease may trigger any type of withdrawal symptom, even if reported weeks later. 4,16,83 In light of their tendency to emerge after dosage reductions, 82 it is not difficult to distinguish withdrawal symptoms from relapse.…”

Global prevalence of antidepressant drug utilization in the community: protocol for a systematic review

“…Conversely, other studies suggest a relatively stable prevalence of mental disorders or under-recognition and undertreatment 20 21. Other facilitating factors possibly contributing to the rise in antidepressant prescriptions and use are the availability of new medications with a better risk–benefit profile (e.g., selective serotonin reuptake inhibitors (SSRIs)),22 the introduction of generics on the market,23 experience or fear of withdrawal symptoms,24 other socioeconomic and cultural factors (e.g, stigma mental health well-being campaigns)25 26 or increased duration of treatment 27 28…”