Withdrawing from SSRI antidepressants: advice for primary care was published in British Journal of General Practice in March 2023. The authors: Emilia G Palmer, Sangeetha Sornalingam, Lisa Page and Maxwell Cooper
The full article can be accessed [free-to-view] by clicking on this link: British Journal of General Practice 2023; 73 (728): 138-140.
There have been a number of e-responses and these can all be read here.
Withdrawing from SSRI antidepressants: advice for primary care begins by providing this background:
The following, is my e-response to this BJGP article:
Learning from experience
It is welcome to see this advice on withdrawing from SSRI drugs published[1]. I congratulate the authors and the BJGP. Four years ago, the Royal College of Psychiatrists published a position statement on antidepressants and depression[2], so I had expected similar advice to be published in the equivalent journal for psychiatry. This has not yet happened.
The BJGP article states that “Inaccurate guidance on antidepressant withdrawal has resulted in many patients experiencing distressing, debilitating symptoms” and in ‘Take-home messages’ [Box1] that “GPs should educate patients on withdrawal”. Box 1 returned my mind back to when I was training in psychiatry. At this time, a 5 year long “Campaign” was underway to “Defeat Depression”. I recall the “key messages”, for example in this paper ‘General Practice: Lay people’s attitudes to treatment of depression: results of opinion poll for Defeat Depression Campaign just before its launch’[3] which stated unequivocally “Patients should be informed clearly when antidepressants are first prescribed that discontinuing treatment in due course will not be a problem”.
In 2023, across the UK, 1 in 6 adults are now taking an antidepressant. Such mass prescribing is well beyond the 1 in 20 prevalence on which the Defeat Depression Campaign was based.
Vanessa Cameron, the Chief Executive Officer for the Royal College of Psychiatrists for nearly 4 decades, offered the following candid reflection[4] on her retirement in 2016: “After the Defeat Depression Campaign we produced guidance that said we wouldn’t use Pharma for any public education activities.”
The Cumberlege report ‘First Do No Harm’[5] was published in July 2020. This acknowledged mistakes made in the adoption of new medical interventions and made a number of recommendations to prevent future iatrogenic harm to patients. To my best knowledge, the Royal College of Psychiatrists has made no public comment on any of the recommendations made in the Cumberlege Report. We all need to acknowledge the consequences of failing to learn lessons from our and patients’ experience, otherwise history will repeat itself.
Dr Peter J Gordon, retired NHS psychiatrist
[1] Palmer EG, Sornalingam S, Page L, Cooper M. Withdrawing from SSRI antidepressants: advice for primary care. Br J Gen Pract 2023; 73: 138–40
[2] Royal College of Psychiatrists, Position Statement: Antidepressants and depression. PS04/19, May 2019
[3] Priest RG, Vize C, Roberts A, Roberts M, Tylee A. Lay people’s attitudes to treatment of depression: results of opinion poll for Defeat Depression Campaign just before its launch. BMJ, 5 October 1996
[4] Poole, R and Robiinson, CA. Profile: Vanessa Cameron – 36 years at the Royal College of Psychiatrists. BJPsych Bulletin, 6 December 2016
[5] Cumberlege J. The report of the Independent Medicines and Medical Devices Safety Review. UK Government, 8 July 2020
The Position Statement of the Royal College of Psychiatrists can be read in full by clicking on the image below:
Some of the immediate reactions to this position statement by members of the Royal College of Psychiatrists can be read here.
The following table provides ‘Key Messages’ as given in this article: Lay people’s attitudes to treatment of depression: results of opinion poll for Defeat Depression Campaign just before its launch. To access full article please click here.
The former CEO of the Royal College of Psychiatrists, writing in 2016 at the time of her retirement. The full article can be read here [it is necessary to point out that the reassurance that the Royal College is “appropriately puritanical in its relationship with Pharma” is not backed by any evidence, rather, evidence such as this, reveals continuing enmeshment].
To read, in full, the Cumberlege Report: First Do No Harm, please click here.
