A survey of UK general practitioners about depression, antidepressants and withdrawal: implementing the 2019 Public Health England report

Abstract

Background: In 2019, a literature review indicated that more than half of people who try to come off antidepressants experience withdrawal effects. Both the National Institute of Health and Care Excellence and the Royal College of Psychiatrists updated their positions in line with that review, and Public Health England published a 152-page report called Dependence and withdrawal associated with some prescribed medicines: an evidence review. The report made several recommendations relevant to general practice. Method: In order to facilitate implementation of these recommendations, an online survey was designed to explore United Kingdom general practitioner (GP) experiences, opinions, knowledge and needs in relation to depression, ADs and withdrawal. A total of 66 GPs had completed the survey when COVID-19 occurred. Results: In keeping with previous findings, this small sample of GPs had a predominantly psycho-social perspective on the causes of, and treatments for, depression. They broadly considered ADs effective for moderate/severe depression and ineffective for minimal/mild depression, for which they preferred psychological therapies and social prescribing. There was a marked lack of consistency in GPs’ knowledge about the incidence and duration of withdrawal effects. Only a minority (29%) felt their knowledge about withdrawal was ‘adequate’ and fewer (17%) believed this about their ‘Ability to distinguish between withdrawal effects and return of the original problem (e.g. depression)’. Two-thirds (68%) would like more training on these matters. Conclusion: It is hoped that even this small sample will be helpful when designing, and seeking funding for, GP training programmes, and when implementing the PHE recommendations for support services, based in the primary care system, for the millions of people contemplating or initiating withdrawal from ADs every year in the UK.

The ‘patient voice’: patients who experience antidepressant withdrawal symptoms are often dismissed, or misdiagnosed with relapse, or a new medical condition

“…50 A lack of sufficient information on discontinuation was also identified as a key issue for GPs. 27,49 The same concerns were reported by GPs in Holland. 28,51…”

“…Patients reported that GPs recommended tapers that were too quick, causing intolerable withdrawal symptoms. Previous research has identified that GPs do not feel confident in their knowledge of helping patients to come off antidepressants 49 ; in particular, they described being dissatisfied with current NICE guidance, indicating that ‘it is unclear (especially regarding tapering regimes), limited, not accessible and at times not applicable to real patients’, 50 with one GP describing the current NICE guidance on discontinuing antidepressants ‘as a bit pants’. 50 A lack of sufficient information on discontinuation was also identified as a key issue for GPs.…”

The role of Facebook groups in the management and raising of awareness of antidepressant withdrawal: is social media filling the void left by health services?

“…It is encouraging that a recent survey of UK general practitioners (GPs) (albeit with a curtailed sample size due to Covid-19) just reported that although there was ‘a marked lack of consistency in GPs’ knowledge about the incidence and duration of withdrawal effects’ two-thirds said they would welcome more training on these matters. 59 …”

Surging trends in prescriptions and costs of antidepressants in England amid COVID-19

“…A recent survey conducted in the United Kingdom found that the number of individuals living with depression had almost doubled during the pandemic [ 5 ]. Given the significant rise in the prevalence of depression associated with COVID-19, the consumption of antidepressants (ADs) had also increased worldwide [ 4 , 6 ]. The sharp rise in the consumption of ADs is a major concern given the limited evidence on long-term effectiveness and safety of ADs.…”