GPs could support almost half of patients to quit antidepressants, finds trial

GPs could support almost half of patients taking long-term antidepressants – who are well and willing to stop – to safely come off the drugs, researchers have claimed.

The study, which was looking at the addition of a phone hotline or internet support to GP review in patients discontinuing antidepressants, found more than 40% safely stopped taking the drugs whichever approach was taken.

Those who could access online support and psychologists by phone had lower rates of depression, fewer withdrawal symptoms, and reported better mental wellbeing but the differences were small.

However, the additional support did tend to reduce calls on health services and therefore may be cost-effective at a population level, they reported.

The researchers from the Universities of Southampton, Hull and Liverpool said the trial of 330 participants across 131 GP practices around the country was the first to show that helping people stop taking antidepressants is possible at scale without providing resource-intensive psychological therapy.

After six months, 41.9% of patients in the control group who had support from their GP had successfully stopped taking the drugs compared with 45.5% of people in the group who also had access to internet or telephone helplines.

All those taking part did not currently have depression or were judged to not be at significant risk of relapse by their GP and wanted to discontinue treatment, the researchers reported in JAMA Network Open Psychiatry. They had been taking antidepressants for more than a year for a first instance of depression or more than two years for recurrence.

Roughly 15% of patients in each arm reported adverse events with one serious adverse reaction in each group, leading the researchers to conclude that discontinuation is safe to attempt in primary care, as long as patients are monitored for relapse and treatment can be quickly restarted.

Lead author Professor Tony Kendrick, professor of primary care at the University of Southampton, said the research showed high numbers of patients withdrawing from the drugs do not need costly intense therapy sessions.

‘This approach could eliminate the risk of serious side-effects for patients using antidepressants for long periods who have concerns about withdrawal.’

He added that offering patients internet and psychologist telephone support in addition to GP care was also cost-effective for the NHS.

‘Our findings show that support not only improves patient outcomes but also tends to reduce the burden on primary health care while people taper off antidepressants.’

Co-author Una Macleod, professor of primary care medicine at Hull York Medical School, said: ‘Many patients are taking antidepressants for depression for longer than two years, when they probably no longer need them.

‘The evidence in our study is clear and suggests the UK should establish a national helpline, by phone and online, to help people intending to come off the medication.’

Professor of general practice Mark Gabbay, a co-author from the University of Liverpool, added: ‘This is the first study to demonstrate that stopping inappropriate long-term antidepressant treatment is possible at scale without psychological therapy.

‘From our findings, we are calling for active family practitioner reviews for antidepressant discontinuation to be promoted.’

It follows a study last month which showed only one in six people who stop taking antidepressants will experience withdrawal symptoms as a direct result, a much lower proportion than other studies have suggested.

Around one in 35 people (3%) will likely experience ‘severe symptoms’, the study in the Lancet Psychiatry also found.