REDUCE study

There is considerable concern about increasing antidepressant use in England. GPs are giving out more than 50 million prescriptions a year, to more than 1 in 10 adults.

Some people need long-term antidepressants to stop them getting depressed, but a third to a half could probably stop them without relapsing. However, stopping is not easy, due to withdrawal symptoms including anxiety and low mood which are usually temporary but feel similar to the reason why patients were first put on antidepressants. So understandably some people restart their antidepressant quickly. Others are reluctant to try stopping because they feel well on medication and are afraid their symptoms may come back.

People taking antidepressants have told us their GPs often do not review them and just give repeat prescriptions. Studies show that when GPs review patients on long-term antidepressants and advise them where appropriate to withdraw, only 1 in 14 is able to stop. Patients can be fearful and withdrawal can be tricky so GPs and Nurse Practitioners (NPs) who prescribe anti-depressants need to guide patients who want to withdraw, and patients need around the clock support.

• We aim to identify feasible, safe, reliable and cost-effective (value for money) ways of helping patients withdraw from long-term antidepressants, where this is appropriate.

• We will first review all published relevant research, to identify successful ways to help patients withdraw from treatment.

• We will identify the difficulties in withdrawing, and things that patients and practitioners think might help withdrawal, through interviews with patients taking antidepressants long-term, and through focus groups with GPs, NPs and primary care mental health workers (PCMHWs).

• We will try out support through the Internet for patients, and their GPs, to help them.

• An interactive programme will be developed to help support patient withdrawal from antidepressants, available around the clock.

• It will be developed through a process of 'co-design' and 'co-production' which means taking the views of patients and practitioners into account throughout its development and initial trial run.

• We will also explore whether 'buddying' support from people who have come off antidepressants might help.

• We will check the usefulness of the programme in helping patients stop treatment through a randomised controlled trial in three centres, and estimate financial benefits for the NHS.

• If the programme works we will spread it throughout the NHS, by publishing practical guidance for professionals, and advice for patients to follow, publicised through patient support groups.

We have developed the ideas for this project with the help of people having long-term treatment for depression. They will continue to work with us to help make sense of the information we gather, and advise on the support we develop for antidepressant withdrawal, from the patient’s point of view.

Contact: reduce@soton.ac.uk