In September 2017 the All-Party Parliamentary Group for Prescribed Drug Dependence (APPG for PDD) met senior representatives from Public Health England (PHE) to present data and research (including work undertaken by the British Medical Association, 20161) revealing the mounting social and individual problems associated with prescribed drug dependency and withdrawal.
As a result, Steve Brine MP, then Under Secretary of State for Public Health and Primary Care, commissioned PHE to undertake the largest review to date into prescribed drug dependency and withdrawal. This comprehensive review has now been published and has called for the following:
- A 24-hour national helpline and associated website to provide advice and support for those adversely affected by prescribed drug dependency and withdrawal.
- Updated clinical guidance and improved doctor training.
- Provision for better patient-information about drug risks and benefits, as well as alternatives such as therapy and social prescribing.
- Further research into the nature and severity of withdrawal and its successful treatment.
- Appropriate support from the NHS for patients, including dedicated support services.2
In May 2019 the Royal College of Psychiatrists issued a new position statement on antidepressant withdrawal,3 following new research4,5 and campaigning by people who have been harmed by psychiatric drugs, (also known as the prescribed-harm community), the Council for Evidence-based Psychiatry (CEP) and the APPG for PDD. The Royal College’s statement acknowledged that antidepressant withdrawal is more widespread than previously thought and can be more severe and protracted than our current clinical guidelines acknowledge.6 Joining the campaigners, the Royal College also called for NICE to update its guidelines to better reflect the evidence base.
In October 2019, NICE heeded calls by CEP, the APPG for PDD and the RCPsych to remove its previous advice that antidepressant withdrawal is usually mild, self-limiting and resolving over 1-week, and acknowledge that, while many people may experience only mild withdrawal, there is ‘substantial variation’ in people’s experience ‘with symptoms lasting much longer (sometimes months or more) and being more severe for some patients’.7
While these changes largely relate to antidepressants (and, in the case of PHE, benzodiazepines, Z-drugs, GABA-ergic medicines and opioid pain medications), they demonstrate that thinking around psychiatric drug withdrawal has shifted considerably since early 2018. Today, in the UK, it is now widely acknowledged that we previously underestimated the incidence, severity and duration of withdrawal effects and the extent to which those people affected need support. Relevant organisations are therefore now considering how best to support people who have suffered harm. PHE has recommended a helpline, better training for doctors on appropriate withdrawal management, and more support for GPs; recommendations now supported by the Royal College of General Practitioners, the Royal College of Psychiatrists , the British Medical Association and all the organisations involved in either the creation and/or endorsement of this current document (i.e. the APPG for PDD, CEP, the British Association for Counselling and Psychotherapy (BACP), United Kingdom Council for Psychotherapy (UKCP), the British Psychological Society (BPS), and the National Counselling Society (NCS)).8
In endorsing this document these organisations are taking their share of responsibility for addressing the withdrawal problem, by equipping psychological therapists with the information and guidance necessary to help them better inform and support clients who are either taking or withdrawing from psychiatric drugs.
1. BMA (2016). Supporting individuals affected by prescribed drugs associated with dependence and withdrawal. (Accessed July 2019.) Website: https://www.bma.org.uk/collective-voice/policy-and-research/public-and-population-health/prescribed-drugs-dependence-and-withdrawal.
2. Taylor, S., Annand, F., Burkinshaw, P., Greaves, F., Kelleher, M., Knight, J., Perkins, C., Tran, A., White, M. & Marsden, J. (2019). Dependence and withdrawal associated with some prescribed medicines: An evidence review. London: Public Health England.
3. Royal College of Psychiatrists (2019). Position statement on antidepressants and depression. (Accessed July 2019) Website: https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/position-statements/ps04_19—antidepressants-and-depression.pdf?sfvrsn=ddea9473_5.
4. Davies, J., Read, J. (2018). A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence based? Addictive Behaviors. pii: S0306-4603(18)30834-7. doi: 10.1016/j.addbeh.2018.08.027. [Epub ahead of print].
5. Horowitz, M.A. & Taylor, D. (2019). Tapering of SSRI treatment to mitigate withdrawal symptoms. The Lancet Psychiatry.
6. National Institute for Health and Clinical Excellence (NICE) (2009). Depression in adults: Recognition and management. Website: https://www.nice.org.uk/guidance/cg90/resources/depression-in-adults-recognition-and-management-pdf-975742638037. (Accessed July 2018.)
7. National Institute for Health and Clinical Excellence (NICE) Depression in adults: recognition and management (2009–2019 update) https://www.nice.org.uk/guidance/cg90/chapter/1-Guidance#care-of-all-people-with-depression
8. APPG for PDD, (2019), Statement of Support. Available online: www.prescribeddrug.org/news/