NICE revises antidepressant guidance warning of ‘severe’ withdrawal symptoms


By Isobel Sims

17 Oct 2019

The National Institute for Health and Care Excellence (NICE) has revised its depression guidelines to warn of ‘severe’ and lengthy antidepressant withdrawal symptoms, having originally said such symptoms were ‘mild’.

The updated guidance on treating depression in adults now includes statements on withdrawal symptoms, clarifying that symptoms may be severe and last for months in some patients.

This is a revision of the original guidance, which advised that symptoms are generally mild and self-limiting over the course of a week.

NICE delayed the release of the full guideline update in 2018 after the draft guideline came under scrutiny by doctors who said that the ‘flawed’ methodology and out-of-date evidence would ‘seriously impede’ patient care and choice.

A second consultation was launched last year to address concerns raised by mental health leaders before publication.

The update also follows a position statement released by the Royal College of Psychiatrists in May, which recommended that NICE guidelines should acknowledge the potential for severe withdrawal and provide evidence-based guidance for gradual withdrawal from antidepressants.


Severity of withdrawal symptoms


The updated recommendations say that patients should be advised to talk to their GP before coming off their antidepressants.

They also say that patients may experience symptoms such as restlessness, trouble sleeping and sweating if they miss a dose or suddenly stop their medication, and that although these symptoms are usually mild and self-limiting, they may last for months and be more severe in some patients.

Dr Paul Chrisp, director of the Centre for Guidelines at NICE, said: ‘We have amended the guideline to recognise the emerging evidence on the severity and duration of antidepressant withdrawal symptoms.

‘The updated recommendations are in line with the statement from the Royal College of Psychiatrists and were agreed by our independent committee.’

The full guideline update is still in progress, with a publication date to be confirmed.

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