RACGP endorses ‘landmark’ safe deprescribing guide

The RACGP has accepted the newly released Maudsley Deprescribing Guidelines as a recognised evidence-based clinical resource.
 
The ‘landmark’ UK guidelines were launched in March this year to support GPs in safe deprescribing by shining a light on the potential risks of antidepressant withdrawal.
 
This week, the college officially endorsed the Maudsley Hospital guidelines for use in Australian general practice.
 
Mental health presentations remain the most common reasons for a patient visit to the GP, increasing from 61% in 2017 to 72% in 2023, according to the 2023 Health of the Nation report. 
 
Overall, mental health and behavioural conditions effect almost half (43%) of the population aged 16–85, and around 45 million mental-health related medications were dispensed in 2022–23.
 
And with 85% of those prescribed by GPs who see more than 22 million patients each year, GPs are ‘at the front line of Australia’s mental health crisis’, according to RACGP President Dr Nicole Higgins.
 
‘Antidepressants generally are a helpful and effective treatment option for many people, but they are not generally advised for use longer than 6–12 months,’ she said.
 
‘While some people can come off these drugs relatively easily, others have side effects severe enough they keep taking a medication they want to stop.
 
‘And people have no way of knowing what their experience will be like until they stop.’
 
Dr Mark Horowitz, an Australian psychiatrist-in-training at King’s College London, knows firsthand the dangers of antidepressant withdrawal after he experienced ‘severe’ psychological side effects.
 
This led him to conduct his own research and eventually co-author and launch the Maudsley Deprescribing Guidelines as a step-by-step resource on safe deprescribing for GPs.
 
‘We took the word “psychiatry” out of the title because we think that GPs will be the primary reader,’ Dr Horowitz recently told newsGP ahead of the guidelines’ publication.
 
The clinical resource is also expected to fill current gaps in Australian guidance on the topic by providing greater clarity and clear, evidence-based recommendations to replace ‘inadequate information’ and prevent unnecessarily ‘traumatic withdrawal symptoms’, including suicidal thoughts.
 
According to the guidelines, antidepressants should not generally be used as lifelong therapy, and the prevalence and severity of withdrawal is high in Australia.
 
Currently in Australia on a lecture tour, Dr Horowitz welcomed the RACGP’s endorsement of the guidelines, saying the decision marks ‘a significant step forward’ for safe deprescribing in the country.
 
‘We hope this support by the college is the first step towards safer practices for stopping these medications and that future clinical education will incorporate the principles and practices outlined in the book,’ he said.
 
‘We also hope that national, state and local hospital guidance for safely stopping these medications is influenced by the gradual, hyperbolic approach promoted in the guidelines. We look forward to other colleges and professional institutions following the lead of the RACGP and making this book available to its members.’
 
Dr Higgins said GPs can use the guidelines to provide evidence-based support to patients to come off antidepressants and other drugs of dependence, such as benzodiazepines.
 
‘We know how hard it can be for people who want to stop using antidepressants to do so,’ she said.
 
‘[But] it’s important to remember that every patient is unique. While antidepressants work for some, others may be able to come off them.’ 
 
The RACGP is also flagging the importance of the guidelines to reiterate calls for higher Medicare rebates for patients who need longer consultations for mental health care.
 
‘The Government needs to ensure all Australians can access affordable general practice care, and help coming off antidepressants if they need it,’ Dr Higgins said.
 
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