Dr Mark Horowitz, an Australian based in London, said he “almost died” after taking antidepressants due to severe withdrawal effects.
When he tried to stop using antidepressants after 15 years of use, the insomnia, panic attacks, dizziness and anxiety felt so unbearable that he considered suicide.
Then, in his early 30s, Horowitz researched his symptoms online and found “thousands of people saying the exact same thing as me” on Internet forums. This led him on a path of research with King’s College London, to investigate why so many patients have difficulty stopping the drugs once their depression has resolved.
Together with Prof. David Taylor, Horowitz wrote landmark descriptive guidelines for clinicians which includes evidence-based advice to stop using antidepressants.
Titled the Maudsley Deprescribing Guidelines, the instructions were officially endorsed by the Royal Australian College of General Practitioners (RACGP) on Wednesday amid growing concern about a lack of advice for doctors and patients.
RACGP president Dr Nicole Higgins said antidepressants are generally a useful and effective treatment option for many people, but are usually not advised to be used for longer than six to 12 months.
“While some people can get off these drugs relatively easily, others have side effects that are serious enough they continue to take a medication they want to stop,” Higgins said.
She described the guidelines as “useful” for GPs to use to support patients to come off antidepressants and other drugs of dependence.
While the general advice for stopping antidepressant medications has been to slowly reduce daily doses by between 25% and 50% every week for up to four weeks, Horowitz said that’s not a gradual enough decrease for most patients. Horowitz is now a psychiatrist in training at the National Health Service.
He said the current guidance lacks details about how slowly to reduce doses, how reduced doses can vary depending on the type of antidepressant, and how to advise patients to take doses smaller than those produced by the manufacturer.
The guidelines offer advice specific to Australia, including how patients can access smaller doses through pharmacies or by crushing tablets. It also offers advice specific to different antidepressant classes and brands.
The guidelines also advise on the safe prescribing of medicines for insomnia, benzodiazepines – used for stress, anxiety and insomnia – and gabapentinoids, used for seizures, nerve pain and restless legs syndrome.
Barbara Mintzes, a professor of evidence-based pharmaceutical policy at the University of Sydney, said: “It can be very difficult to stop using antidepressants.
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“Studies of their use in primary care show that many people are prescribed antidepressants even though they do not meet criteria for major depression, for example because of a life event that has led to distress or sometimes because depression is a side effect of another medication can be. .
“We also know that the evidence on the effectiveness of antidepressants is exaggerated because of selective publication of more positive clinical trials.”
For mild to moderate depression, Mintzes said non-drug treatment was often as effective as prescribing drugs. The Maudsley Deprescribing Guidelines also challenge the inappropriate prescribing of antidepressants.
Dr Elizabeth Moore, the president of the Royal Australian and New Zealand College of Psychiatrists, said the guidelines would be reviewed and considered by the college alongside other emerging clinical guidance and evidence in the field.
“Antidepressants can be beneficial for many people who need treatment for depression and anxiety,” she said.
“It is important to recognize that discontinuation and withdrawal symptoms from antidepressants are common and can be severe, sometimes persisting for a significant period of time.”
