Guidance on how to stop antidepressants in a tolerable way has been produced by the Royal College of Psychiatrists. Prescriptions of antidepressants, primarily selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors, has steadily increased over recent years. There is ongoing debate about their benefits and increasing recognition of the possibility of withdrawal symptoms from them. Much of the evidence of their efficacy comes from short-term, placebo-controlled trials which tend not to include outcomes that are of greatest relevance to patients, such as social functioning or quality of life, but rather restrict outcomes narrowly to symptom measures. Even on such measures these studies do not demonstrate clinically significant differences from placebo for depression. A range of adverse effects are also recognized, often greater in naturalistic studies of long-term antidepressants users than those measured in short-term efficacy studies, including emotional numbing, sexual difficulties, fatigue, and weight gain. There is increasing recognition that withdrawal symptoms from antidepressants are common and that these symptoms can be severe and long-lasting in some patients. The guidance suggests that reductions of antidepressants need to be made in smaller and smaller decrements as the total dosage gets lower in order to produce even reductions in effect on target receptors (and other biological processes), the process can be roughly approximated by exponential reductions. The final dose before completely stopping antidepressants should be very small to prevent the reduction in effect at receptors from being larger than the reductions previously tolerated. The uncertain balance of benefits and harms should lead to more cautious prescribing practice, with antidepressants given to fewer patients and for shorter periods of time. Source: https://dtb.bmj.com/
