We are repeating mistakes from the 1970s when it comes to antidepressants

We could and should draw on the experience of women who were prescribed benzodiazepines

Many patients fear even beginning a conversation with their doctor about coming off medicines (Getty)

When I trained as a mental health nurse in the Eighties, we didn’t routinely collaborate with patients other than being trained to listen to the individual’s story. The idea that a patient would have a say in their treatment was not the norm. I’m pleased to say this has changed. There is now an expectation that all mental care should be carried out in partnership with an individual and that we don’t “do” things to patients, we work with them.

Seems the National Institute of Health and Care Excellence (NICE) didn’t get the memo. It has published new guidelines on medicines that can create dependence – such as diazepam, opiates or antidepressants – but there is no mention of patient-doctor collaboration. It also completely fails to include a recommendation that any tapering of these medications is done in partnership, rather than a prescriber solely deciding the pace and way these medications should be withdrawn.

There are good reasons to be concerned about this.

There has been rising worry about medicines like antidepressants, which have been prescribed in increasing numbers over recent years. This has triggered the NICE guidelines. The worries were sparked by the testimony of patients who described significant discomfort, physically and psychologically, when these prescriptions were reduced or abruptly stopped. It took decades for their voices to be heard as the pharmaceutical companies and regulators failed to acknowledge that this was even possible. The symptoms patients described by coming off antidepressants looked similar to those describing withdrawing from diazepam or opiate type medication.

Patients have often given evidence or shared their experiences of being abruptly taken off prescribed medicines known to cause significant withdrawal symptoms. Although in the main these are not life threatening, they can be extremely uncomfortable. Understandably many patients fear even beginning a conversation with their doctor about coming off these medicines, knowing the process may not be handled correctly or worse, without empathy.

The failure by NICE was picked up by the All Party Parliamentary Group for Prescribed Drug Dependence, which published a press release on the same day that NICE published its guidelines. The group make clear their disappointment and concern about the lack of patient involvement in the process.

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When I was training in the Eighties, I was surprised to find that the majority of people we would see in the community service were women who had been prescribed benzodiazepines like diazepam in the Seventies for depression and anxiety. These women had been prescribed these medicines for years and often on staggering doses that went way beyond the recommended daily amount. It took years for their concerns about dependence and tolerance to this class of medicines to be taken seriously and for an intervention to be offered. The team I worked with recognised how uncomfortable and futile withdrawal could be so would taper these medicines down over months if not years, reducing the dose by small amounts over time to minimise discomfort and maximise recovery.

The point is the idea that some medicines can create dependency, even if this was not understood when they were originally developed and made available, is not new. We could and should draw on the experience of women who were prescribed benzodiazepines in the Seventies. But it seems we are destined to repeat the same mistakes made then with the current dependence forming medications being prescribed in ever greater numbers now.

NICE justifies its position by arguing that it is only randomised control trials (RCTs) that meet the threshold of evidence for these guidelines. No doubt RCTs have a place in informing the evidence, but so do those with first-hand experience of the treatment.

Failing to listen to this group is not only illogical it sends a message to them that they don’t matter, the very reasons that instigated a prescription for these medicines.

Ian Hamilton is a senior lecturer in addiction and mental health at the University of York