An Australian university has become the first to teach doctors how to help patients who want to safely reduce or stop taking antidepressants and other psychotropic medications.
Associate Professor Carlo Longhitano, Head of Psychiatry at James Cook University’s College of Medicine, and Dr Sam Manger, GP and Senior Lecturer at JCU, have led the pioneering change by integrating deprescribing into the mental health teaching curriculum of future doctors graduating from JCU.
“Antidepressants are helpful and effective for many people, but they are not generally advised for use longer than 6–12 months and can come with serious side effects,” said Dr Manger. However, some people on antidepressants have trouble stopping their use due to severe withdrawal effects that can sometimes be incorrectly put down to relapse of their mental health condition, he added.
Studies have indicated that withdrawal effects from antidepressants may be more severe and longer in duration than previously believed. In Ireland, a study in 2022 found that antidepressant use in Ireland is rising in line with global trends and that people were taking the drugs long term. The study concluded that the “Irish general practitioners will likely benefit from greater resources being invested in mental health to improve both access to non-pharmacological therapies (psychology) and to help disseminate knowledge on deprescribing strategies for antidepressants when appropriate.” However, there is very little information in Ireland about deprescribing and there is concern that a lack of understanding surrounding antidepressant prescribing poses a risk of inappropriate prescribing.
The 2022 study from Ireland, carried out by researchers at the School of Medicine, University of Limerick, highlighted that “if GPs are not made aware of withdrawal symptoms and their management, patients may be incorrectly reinitiated on antidepressant medication if withdrawal symptoms are mistaken for a relapse. Surveys of antidepressant users suggest 30–50% have no evidence-based indication to continue, but coming off antidepressants is often difficult due to fears of relapse, withdrawal and a lack of psychological treatments.”
Dr Longhitano said coming off antidepressants can be very difficult for some patients, especially if they had been on them for a longer period.
“Sadly, this component of teaching is currently missing from the medical school curriculum and from postgraduate training in psychiatry. I have recently added this component here at JCU’s medical school and am currently talking to the other Mental Health Education Leads in Australia and New Zealand to ensure this will no longer be the case across our countries.
“I am also ensuring locally trained psychiatrists are aware of this subject, leading to better cooperation between specialists and generalist doctors”.
“This is something we urgently need more medical student, GPs and psychiatry trainees educated to help people safely and comfortably reduce their medication use when indicated,” Dr Manger added.
The teaching will use the Maudsley Deprescribing Guidelines – a recognised evidence-based clinical resource on safe deprescribing in combination with lectures from leaders in the field. The ‘landmark’ guidelines were launched to support GPs in safe deprescribing by shining a light on the potential risks of antidepressant withdrawal.The lead author is Australian doctor Mark Horowitz (see video below for more information on this topic). His PhD at King’s College London was in the neurobiology of depression and the pharmacology of antidepressants and he knows firsthand the dangers of antidepressant withdrawal after he personally experienced severe side effects.