Depression in adults

Quality statement

Adults with depression who are stopping antidepressant medication have the dose reduced in stages. [new 2023]

Rationale

Reducing the dose of antidepressant medication in stages over time (known as 'tapering') helps to reduce withdrawal effects and supports withdrawing from the medication when their long-term use is not indicated. The decision to stop antidepressant medication, including speed and duration of withdrawal, should be taken after discussion and agreement between the adult and their healthcare professional. It is important that adults are monitored and reviewed while their dose is being reduced, both for withdrawal symptoms and the return of symptoms of depression. The frequency of monitoring is based on the person's clinical and support needs. Any withdrawal symptoms need to have been resolved or be tolerable before making the next dose reduction.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

What the quality statement means for different audiences

Service providers (such as GP practices and mental health services) ensure that procedures and protocols are in place to ensure that adults with a diagnosis of depression who are stopping antidepressant medication have the dose reduced in stages, following discussion and agreement with their healthcare professional. They monitor prescribing patterns during withdrawal.

Healthcare professionals (such as GPs, specialist nurses and mental health professionals) reduce the adult's dose of antidepressant medication in stages to optimise withdrawal. This follows a discussion and agreement with the adult with depression to stop taking antidepressant medication, including the speed and duration of withdrawal. Healthcare professionals offer follow-up appointments (which could be by telephone) to monitor and review adults while their dose is being reduced, both for withdrawal symptoms and the return of symptoms of depression. Healthcare professionals should base the frequency of monitoring on the adult's clinical and support needs, ensuring that any withdrawal symptoms have resolved or are tolerable before making the next dose reduction.

Commissioners ensure that services monitor prescribing patterns for antidepressant medication for adults with depression. They commission services from providers who demonstrate that, following discussion and agreement to stop antidepressant medication, the dose is reduced in stages.

Adults with depression who are stopping antidepressant medication have the dose of their medication reduced in stages. The aim is to reduce the likelihood and severity of withdrawal symptoms, and to help them come off the medication successfully.

Source guidance

Definitions of terms used in this quality statement

Equality and diversity considerations

There are risks associated with taking and stopping antidepressants for depression in pregnancy or during breastfeeding. Therefore, when planning pregnancy, during pregnancy, postnatally or when considering breastfeeding, healthcare professionals should consult NICE's guidelines on antenatal and postnatal mental health and medicines associated with dependence or withdrawal symptoms.