RACGP accepts new antidepressant deprescribing resource

One in seven Australians, or around 3.9 million people, take antidepressants, with the number of people using them steadily rising.
 
Most of this medication, about 92%, is prescribed by GPs, which means the profession also plays a crucial role in deprescribing it.
 
Longer term use of antidepressants is increasingly associated with more severe and longer lasting withdrawal symptoms, but a lack of clear guidelines for deprescribing has been hard to find – until now.
 
A suite of clinical resources designed to support GPs in deprescribing antidepressants has been accepted as a clinical resource by the RACGP, and is now available on the college’s website.
 
Called RELEASE (REdressing Long-tErm Antidepressant uSE), the tapering plans are based on and designed for use with the recently approved Maudsley Deprescribing Guidelines.
 
The new resources support shared decision-making between patients and health professionals in safely stopping the use of antidepressants over time (usually months), including a range of tapering plans for different medications ranging from ‘faster’ to ‘slower’ to ‘even slower’.
 
It also has animated instructional videos and printed resources for patients, family and friends.

The University of Queensland developed the resources, funded by a National Health and Medical Research Council grant that the RACGP partnered on.

Professor Katharine Wallis, Head of the Mayne Academy of General Practice at the University of Queensland, led the development of the resources.
 
She told newsGP that feedback from patients and GPs who have been using the resources has been positive.
 
‘GPs have said they are useful, and patients feel reassured to have step-by-step instructions for how to slowly decrease their dose and how to minimise the withdrawal symptoms, and how to look after themselves while they’re slowly coming off antidepressants,’ Professor Wallis said.
 
The RELEASE resource also helps GPs to discern the difference between symptoms of withdrawal and relapse, and flags which medications are at higher risk of triggering withdrawal symptoms, and in which patients.
 
The process of weaning patients off antidepressants has long been what the RELEASE resource calls ‘a poorly understood area in clinical practice’.
 
‘We know that longer-term use of these medications is associated with higher risk of experiencing withdrawal,’ Professor Wallis said.
 
‘We don’t have good evidence of health outcomes associated with long-term use, because most of the research into antidepressants have been short-term studies … very little research looking at the effects, good or bad, beyond a year.
 
‘And that’s the problem, we don’t have good evidence for their safety, and we don’t have good evidence for them benefiting people when used long term, other than preventing relapse.’
 
In an article published this week, ‘Antidepressant prescribing in Australian primary care: time to reevaluate’, Professor Wallis, the report’s lead author, wrote that the increase in antidepressant use is ‘due largely to rising long-term use (longer than 12 months); that is, people failing to stop antidepressants’.
 
She also wrote that there was ‘little evidence’ of benefits in long-term antidepressant therapy, ‘although there is evidence of harm’.
 
‘Adverse effects include lethargy or fatigue, weight gain, emotional numbing, and sexual dysfunction that may be permanent,’ she wrote.
 
The RELEASE resources will undergo a hybrid design trial for effectiveness and implementation until the end of the year, at which point Professor Wallis hopes RELEASE will be disseminated more broadly across general practices, ‘to help people safely stop antidepressants’.
 
‘These drugs were never meant to be used for life,’ she said

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