Intended for healthcare professionals

Rapid response to:


NHS prescribed record number of antidepressants last year

BMJ 2019; 364 doi: (Published 29 March 2019) Cite this as: BMJ 2019;364:l1508

Rapid Response:

Re: NHS prescribed record number of antidepressants last year


In late 2017 I raised a petition with the Welsh Assembly’s Petitions Committee urging the Government “to take action to appropriately recognise and effectively support individuals affected and harmed by prescribed drug dependence and withdrawal.” The first part of that – to appropriately recognise – was specifically about SSRI and SNRI antidepressant withdrawal. The Committee requested written evidence from the Royal Pharmaceutical Society of Wales, BMA Wales, the seven Welsh Health Boards and from people with lived experience of prescribed drug dependence. From that evidence they compiled a formal report making 10 recommendations for change in Wales. The Welsh Government responded last week accepting nine of the 10 recommendations.1 On Wednesday 22nd May, the petition, the report, and the Government’s response will be debated in the Welsh parliament.

The Welsh Government has stated:
“The Welsh Government recognises SSRI and SNRI antidepressants are, in some cases of discontinuation, associated with withdrawal symptoms consistent with inadvertent dependence. These can occur despite appropriate therapeutic use.”

This level of recognition of the experience of so many patients taking and struggling to withdraw from antidepressants is a huge step forward, particularly because many have had to also deal with the ignominy of being disbelieved by their doctors, and leading on from that, also by their families.

But the Welsh Government’s very next words throw into relief exactly why this situation arose in the first place:
“Where they occur, withdrawal symptoms typically last for a few weeks.”

The Government, of course, has to quote from existing guidelines.

And finally:
“There is good evidence to demonstrate how withdrawal effects can be minimised through structured tapering of SSRIs and SNRIs overseen by the prescribing clinician.”

The people who have access to the detailed tapering plans necessary to help a patient slowly reduce and withdraw from their antidepressant medication are those who run either the only NHS funded Prescribed Medication Support Service in North Wales, or charities such as the Bristol and District Tranquiliser Project, the Bridge Project, or MIND in Camden. Why would a GP refer to and instigate a slow structured taper, together with the necessary monitoring and advice, if the guidelines indicate withdrawal is short lived?

Until we have updated clinical guidelines from NICE on antidepressant withdrawal, the Welsh Government is going to be unable, both at policy level and strategically, to make the changes it has committed to in its response to the Petitions Committee’s report. Unless of course we are able to make a paradigm shift in our thinking and pay heed first and foremost to the real experts on antidepressant withdrawal – those who became inadvertently dependent on them – rather than out-of-date guidelines that are used, on this subject, to straightjacket GPs.

See first para under “News” – links to Petitions Committee Report and Government Response

Competing interests: No competing interests

21 May 2019
Stevie Lewis
Property Landlord
Catbrook, Monmouthshire