By Lauren Gower Clinical Psychologist Bedfordpark, Gauteng [email protected] NICE ACTS ON PSYCHIATRIC MEDICATION GUIDELINES new review on its psychiatric medicine that the high rate of withdrawal withdrawing from guidance so that their final symptoms may be part of the psychiatric medication recommendations will be based reason people are staying on the recommends that on the most up-to-date evidence pills for longer. They can’t cope, Athe UK’s National Institute of possible. In addition to updating so carry on taking the drugs, Health and Care Excellence the existing evidence reviews, or their doctors assume they (NICE) guidance on psychiatric the Director for the Centre for have relapsed and write another medications urgently needs to be Guidelines at NICE, Paul Chrisp, prescription. changed. was quoted in the report as saying The Guardian cites anecdotal NICE’s current guidelines that these would “include new accounts of withdrawal state that withdrawal symptoms work on patient choice and a symptoms, which include from psychiatric medication “are focus on shared decision making.” dizziness, vertigo, nausea, usually mild and self-limiting Adds Chrisp, “We hope the insomnia, headaches, tiredness over about one week”, but a final guideline will allow people and difficulties concentrating. But review (1) commissioned by UK with depression to be offered the NICE guidance said in 2004 parliamentarians says there’s the best treatments and reach that withdrawal symptoms were evidence that “more than half of joint decisions about their care slight and short-lived and was re- all people taking antidepressants that reflect their preferences and adopted without further evidence experience withdrawal problems values.” in 2009. It is similar to US when they try to give them up, and Review authors, Dr James guidance, which says symptoms for many people in the UK, these Davies from the University of usually resolve within one to two problems are severe.” Roehampton and Professor John weeks. According to a recent report in Read from the University of East “This new review of the The Guardian, NICE is reviewing London told The Guardian (2) research reveals what many patients have known for medical bodies will take note of the long-term effects of psychiatric years – that withdrawal from this new research, and update medications. Questions they raise antidepressants often causes their own guidance accordingly.” when considering prescribing or severe, debilitating symptoms Davis and Read’s review will using psychiatric medications which can last for weeks, months find support from the international include: or longer,” Davies said in the Science Psychiatry and Social • Is this going to be worth the report. “Existing NICE guidelines Justice network, Mad in America side-effects? fail to acknowledge how common (MIA) (3). MIA is currently running • What are the different effects withdrawal is and wrongly its second continuing education of going on and coming suggest that it usually resolves course on Withdrawing from off different classes of within one week. This leads Psychiatric Medication, aimed medication? many doctors to misdiagnose mainly at psychiatrists. In this • What are withdrawal withdrawal symptoms, often eight-part webinar series, leading symptoms and are there as relapse, resulting in much experts like UK Critical Psychiatry antidotes? unnecessary and harmful long- Network founder and co-chair, • Can the medicines be term prescribing.” Dr Joanna Moncrieff, and others, iatrogenic? Davies and Read’s review including people with lived • Is it necessary to give consent focused on 14 studies of experience, have been exploring for medication and is the antidepressants that had relevant ways in which psychiatrists information about risks and data on withdrawal symptoms. and patients can together make expected outcomes, and The studies, which were diverse, careful, informed decisions the research on withdrawal showed that between 27% and about what is involved in using syndromes, sufficient? 86% of people suffered from them, psychiatric medication. Joanna with a weighted average of 56%. Moncrieff is the author of The MIA experts encourage Antidepressants are now Bitterest Pills: the troubling story psychiatrists to raise these some of the most commonly of antipsychotic drugs (2013) and questions with patients. They also prescribed drugs in the UK and A Straight Talking Introduction to emphasise psychiatrists’ need to US, say the review authors. In Psychiatric Drugs (2009). be informed about standards of their review they point out that care, and about how to cope with use of psychiatric medication Psychiatrists hosting these legal issues. has risen in the UK by 170% since webinars are realistic about the Some MIA experts have discussed 2000, with over seven million need for psychiatric medications, how joining support groups for adults (16% of the English adult but are circumspect about their coming off medications can be population) being prescribed an ever-increasing use, and concerned helpful to patients. antidepressant in England alone about the fact that in many cases last year. there are few if any studies about References available upon request About half of antidepressant users have been taking the pills for longer than two years. In England, that is 3.5m people – 8% of the population. In the US, 13% of the population (37m adults) were on them by 2011-2014, official data shows. Half have been taking them for five years or more. Sir Oliver Letwin MP, chair of the UK parliamentary group that commissioned the psychiatric medication review, said: “This systematic review provides important new data on antidepressant withdrawal which will be considered by Public Health England as part of their current review into prescribed drug dependence. The data suggests that existing medical guidelines in this area should be urgently updated to reflect the fact that antidepressant withdrawal is much more common, severe and long- lasting than previously stated. Furthermore, we hope that other .