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NICE guidelines in the UK change in treating depression with ADs


CyclistN
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Hi All, 

Have I got my understanding correct, that NICE guidelines in the UK have changed regarding prescribing AD for depression?

I'm sort of feel it's too good to be true?!

 

Many thanks,

CyclistN ūüôā

 

 

Paroxetine - February 13, 2021 - tapered by 0.2mg from 4mg to 3.8mg.

Paroxetine - Mid April, 2021, tapered by 0.08mg from 3.86mg to 3.78mg.

Paroxetine - June 12, 2021 - tapered by 0.08mg from 3.78mg to 3.7mg.

Paroxetine - August 1, 2021, tapered by 0.09mg from 3.7mg to 3.61mg.

Paroxetine - October 1, 2021, tapered by 0.08mg from 3.61mg to 3.53mg.

Paroxetine - November 1, 2021, tapered by 0.08mg from 3.53mg to 3.45mg.

Paroxetine - December 1, 2021, tapered by 0.09mg from 3.45mg to 3.36mg

Paroxetine - January 16, 2022, tapered by 0.08 from 3.36mg to 3.28mg.

Paroxetine - March 2, 2022, tapered by 0.085mg from 3.28mg to 3.195mg.

Paroxetine - May 1, 2022, tapered by 0.08mg from 3.19mg to 3.11mg.

Quetiapine - 1999 - ongoing. 50mg per day before going to bed.

Citalopram - November 28, 2019 - ongoing. 10mg at breakfast.

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  • Moderator Emeritus

Q:  Do you have a link to something which has made you ask this question?  If yes, please provide the link.

 * * * * * *   PLEASE WATCH THIS VIDEO   * * * * * *

Antidepressant Withdrawal Syndrome and its Management

 

MISSION ACCOMPLISHED:    (6 year taper)      0mg Pristiq      on 13th November 2021

Woohoo!!!  Finally off Pristiq    Post 0 updates start here

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

My full tapering program     My Intro (goes to my tapering graph)    My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions. 

Please DO NOT TAG me - thank you.

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  • Moderator Emeritus

We have this topic which was posted by Alto October 2019:

 

uks-nice-health-guidelines-now-caution-about-severe-and-prolonged-antidepressant-withdrawal-symptoms

 

 * * * * * *   PLEASE WATCH THIS VIDEO   * * * * * *

Antidepressant Withdrawal Syndrome and its Management

 

MISSION ACCOMPLISHED:    (6 year taper)      0mg Pristiq      on 13th November 2021

Woohoo!!!  Finally off Pristiq    Post 0 updates start here

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

My full tapering program     My Intro (goes to my tapering graph)    My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions. 

Please DO NOT TAG me - thank you.

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  • Moderator Emeritus

 * * * * * *   PLEASE WATCH THIS VIDEO   * * * * * *

Antidepressant Withdrawal Syndrome and its Management

 

MISSION ACCOMPLISHED:    (6 year taper)      0mg Pristiq      on 13th November 2021

Woohoo!!!  Finally off Pristiq    Post 0 updates start here

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

My full tapering program     My Intro (goes to my tapering graph)    My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions. 

Please DO NOT TAG me - thank you.

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Hi ChessieCat,

 

Hope this link thingy works?

https://www.msn.com/en-gb/health/medical/gps-told-to-avoid-offering-antidepressants/ar-AAR0Vnk?ocid=msedgntp

 

Thanks for your reply. I'll read them all.

 

Cheers,

CyclistN 

Paroxetine - February 13, 2021 - tapered by 0.2mg from 4mg to 3.8mg.

Paroxetine - Mid April, 2021, tapered by 0.08mg from 3.86mg to 3.78mg.

Paroxetine - June 12, 2021 - tapered by 0.08mg from 3.78mg to 3.7mg.

Paroxetine - August 1, 2021, tapered by 0.09mg from 3.7mg to 3.61mg.

Paroxetine - October 1, 2021, tapered by 0.08mg from 3.61mg to 3.53mg.

Paroxetine - November 1, 2021, tapered by 0.08mg from 3.53mg to 3.45mg.

Paroxetine - December 1, 2021, tapered by 0.09mg from 3.45mg to 3.36mg

Paroxetine - January 16, 2022, tapered by 0.08 from 3.36mg to 3.28mg.

Paroxetine - March 2, 2022, tapered by 0.085mg from 3.28mg to 3.195mg.

Paroxetine - May 1, 2022, tapered by 0.08mg from 3.19mg to 3.11mg.

Quetiapine - 1999 - ongoing. 50mg per day before going to bed.

Citalopram - November 28, 2019 - ongoing. 10mg at breakfast.

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  • ChessieCat changed the title to NICE guidelines in the UK change in treating depression with ADs
  • Moderator Emeritus

Thanks Cyclist.

 

I'm going to quote the first few paragraphs below from https://www.msn.com/en-gb/health/medical/gps-told-to-avoid-offering-antidepressants/ar-AAR0Vnk?ocid=msedgntp:

 

Quote

 

GPs told to avoid offering antidepressants

 

Laura Donnelly        22/11/2021

 

Doctors will be told not to offer antidepressants to those with mild illness and instead suggest options such as meditation, mindfulness and talking therapies.

 

Doctors will be told not to offer antidepressants to those with mild illness and instead suggest options such as meditation, mindfulness and talking therapies.

 

GPs are being urged not to offer antidepressants to those with mild or borderline depression - Robert Brook

The new NHS guidance comes after the number of pills prescribed for depression doubled over the last decade, with the condition soaring since the pandemic.

 

England already has one of the highest rates of antidepressant use in the world, with one in seven people estimated to be taking the pills.

 

The draft guidance from the National Institute for Health and Care Excellence (Nice) says patients with symptoms of mild depression should be free to choose from a ‚Äúmenu‚ÄĚ of options. These include cognitive behavioural therapy, exercise, mindfulness, meditation, counselling and psychotherapy.

 

...

 

 

 * * * * * *   PLEASE WATCH THIS VIDEO   * * * * * *

Antidepressant Withdrawal Syndrome and its Management

 

MISSION ACCOMPLISHED:    (6 year taper)      0mg Pristiq      on 13th November 2021

Woohoo!!!  Finally off Pristiq    Post 0 updates start here

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

My full tapering program     My Intro (goes to my tapering graph)    My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions. 

Please DO NOT TAG me - thank you.

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Hi ChessieCat,

 

Thanks ChessieCat. By the sounds it's a mild change?

 

Cheers,

CyclistN 

Paroxetine - February 13, 2021 - tapered by 0.2mg from 4mg to 3.8mg.

Paroxetine - Mid April, 2021, tapered by 0.08mg from 3.86mg to 3.78mg.

Paroxetine - June 12, 2021 - tapered by 0.08mg from 3.78mg to 3.7mg.

Paroxetine - August 1, 2021, tapered by 0.09mg from 3.7mg to 3.61mg.

Paroxetine - October 1, 2021, tapered by 0.08mg from 3.61mg to 3.53mg.

Paroxetine - November 1, 2021, tapered by 0.08mg from 3.53mg to 3.45mg.

Paroxetine - December 1, 2021, tapered by 0.09mg from 3.45mg to 3.36mg

Paroxetine - January 16, 2022, tapered by 0.08 from 3.36mg to 3.28mg.

Paroxetine - March 2, 2022, tapered by 0.085mg from 3.28mg to 3.195mg.

Paroxetine - May 1, 2022, tapered by 0.08mg from 3.19mg to 3.11mg.

Quetiapine - 1999 - ongoing. 50mg per day before going to bed.

Citalopram - November 28, 2019 - ongoing. 10mg at breakfast.

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  • Moderator Emeritus
Posted (edited)

I'm in Australia like you.  I have no idea what the system is like in the UK.  It seems good in theory but the reality is that if doctors continue to get benefits from a pharmaceutical company (which are businesses making profits for their shareholders) for prescribing their drugs as opposed to getting no benefit from referring a person for counselling/therapy, I think only the doctors who truly want to help their patients the better/best way are going to choose the non-beneficial (to the doctor) option.  I know this sounds very cynical, but after what I've learned since joining SA (for example the *FDA only requires 2 clinical trials to be submitted but the pharma company can do as many trials as they want and also that if a person drops out from a study but does not go to hospital then that person is not counted in the trial data or something along those lines, and I have also read Gwen Olsen's book who was a pharma rep for 15 years, there are videos about her if you want to watch them I'll put them below) I think I am being realistic because it all boils down to what's in it for the pharma company and doctor?

 

Interview:  Confessions of an Rx Drug Pusher (51 minutes Gwen Olsen - ex pharmaceutical representative)
 

 

*  drug trial information is from  here: 

Antidepressants and the Placebo Effect by Irving Kirsch (link to full article)

(see under the heading:  How Did These Drugs Get Approved?)

 

Edited by ChessieCat

 * * * * * *   PLEASE WATCH THIS VIDEO   * * * * * *

Antidepressant Withdrawal Syndrome and its Management

 

MISSION ACCOMPLISHED:    (6 year taper)      0mg Pristiq      on 13th November 2021

Woohoo!!!  Finally off Pristiq    Post 0 updates start here

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

My full tapering program     My Intro (goes to my tapering graph)    My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions. 

Please DO NOT TAG me - thank you.

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Hi ChessieCat,

 

Yeah, I hear what you are saying. I've read or seen pretty much all of what you mentioned. 

 

Nice to know there is someone else in Australia that has been there. Congratulations on getting there!

 

Thanks so much for the videos. I'll be sure to have a look. 

 

Cheers,

CyclistN 

Paroxetine - February 13, 2021 - tapered by 0.2mg from 4mg to 3.8mg.

Paroxetine - Mid April, 2021, tapered by 0.08mg from 3.86mg to 3.78mg.

Paroxetine - June 12, 2021 - tapered by 0.08mg from 3.78mg to 3.7mg.

Paroxetine - August 1, 2021, tapered by 0.09mg from 3.7mg to 3.61mg.

Paroxetine - October 1, 2021, tapered by 0.08mg from 3.61mg to 3.53mg.

Paroxetine - November 1, 2021, tapered by 0.08mg from 3.53mg to 3.45mg.

Paroxetine - December 1, 2021, tapered by 0.09mg from 3.45mg to 3.36mg

Paroxetine - January 16, 2022, tapered by 0.08 from 3.36mg to 3.28mg.

Paroxetine - March 2, 2022, tapered by 0.085mg from 3.28mg to 3.195mg.

Paroxetine - May 1, 2022, tapered by 0.08mg from 3.19mg to 3.11mg.

Quetiapine - 1999 - ongoing. 50mg per day before going to bed.

Citalopram - November 28, 2019 - ongoing. 10mg at breakfast.

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  • Moderator Emeritus

And it's not just from hearsay, I have a 2 excellent recent personal examples where drugs didn't end up being needed.

 

A couple of years ago I had a pain in my back top right quadrant, had scan done, blood test.  There was no definitive answer.  The blood test showed up inflammation.  Doctor wanted me to take fluoroquinolone antibiotics.  I did my own research because of what I have learned here at SA and from other information I have found on the internet.  There have been 3 FDA warnings about this drug.  The one that really concerned me was that there was a risk for older people (I'm now 64) for tendon rupture.  When I was 36 I snapped a ligament in my outer ankle (went over in it when roller skating) and even though it is reasonable, it does still cause me issues now.  She was shocked when I told her I would not take it and told her the reason she checked it and said oh it is only about 1% or whatever the number was.  My thought was that is all that has been reported; going back to SA and ADWD and my own experience with undiagnosed serotonin syndrome (doctor should have made the connect of AD dose doubled and diastolic BP increase afterwards GRR), my thought was how many people have had it happen and not made the connection that it was caused by the drug.  I said I would be willing to start with a weaker one and if it didn't clear then consider other options.  She said that fluoro was the go to (my term) antibiotic to use in this situation.  She never even looked at other options even though she knew I was very concerned.  She was an intern and I requested that she speak to the owner of the practice (who I seen over the years so he knew me and he knew I was tapering Pristiq) but I don't think she ever did.  She told me to come back in a few days and get another blood test to see what was happening with the inflammation.  I did that and it was clear!

 

The other one was more recent, just October last year.  I was diagnosed as diabetic with an A1c of 7.0, and high cholesterol.  Statin (which can cause/worsen diabetes), Metformin (which can cause/worsen obesity). and of course see a dietician.  I said no, I am not going to take drugs but I will try diet first (I decided long ago that I would never take a statin - they can actually cause muscle weakness).  And I also stated very clearly you do not change more than one thing at a time otherwise if things improve/worsen you will not know the cause (again from SA).  Again I think this doctor was shocked by my "defiance".  Anyway I came home and did my own research about diabetes (I was shocked because I didn't realise it can lead to lose of toes/legs, blindness and kidney damage), thinking that I would go on a low FAT diet, but during my searching I found out about low CARB.  And I did 3 months of that I got my A1c down to 5.2, my cholesterol improved, BP has gone down, I have lost weight and my liver function ALT has gone from 45 to 28 (Jan) and now 22 which means my liver is working well.  Now of course if I had taken the drugs and gone low fat (carbs would have ended up being reduced from what I had been eating but not as low as I am doing; no potatoes, bread, pasta, flour, rice, sugar; incidentally low fat products are usually higher in carbs than the regular product, due to having to increase the sugar to give it taste after reducing the fat content) I think we both know what the improvements would have been attributed to, and of course I would have ended up staying on the drugs "for life" (with the side effects from them) because "we know" (yes sarcastically) they work.  And I might have gone off the diet and then things might/probably would have got worse.

 

The latest one, I have to have a stress test at the cardiologist but I cannot walk, let alone run, on a treadmill, but I read online that there is now a drug that they can give people who don't exercise so they can measure the hearts response to exertion.  And I bet you can get what I will say if that is what they want to do.  A big fat NO.  I'm hoping that I might be able to manage an bike, but I need to ring them to ask what is the alternative to the treadmill.

 * * * * * *   PLEASE WATCH THIS VIDEO   * * * * * *

Antidepressant Withdrawal Syndrome and its Management

 

MISSION ACCOMPLISHED:    (6 year taper)      0mg Pristiq      on 13th November 2021

Woohoo!!!  Finally off Pristiq    Post 0 updates start here

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

My full tapering program     My Intro (goes to my tapering graph)    My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions. 

Please DO NOT TAG me - thank you.

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Hi ChessieCat, 

 

I feel very moved by your story. You show a lot of courage. 

I had a Dr who told me that I can't be doing very well because my psych drugs were too a lower dose! The solutions I found through meditation, healthy diet and exercise were not medical solutions!

Reminds me of a cartoon I saw recently. A picture of a Dr talking to a patient, saying, "The problem is that you are overmedicated. Luckily there are drugs that can help with that."

It's funny until it happens to you or someone you care about!

Wishing you and everyone at Surviving Antidepressants well. I will be forever greatful to you all.

 

Cheers,

CyclistN 

Paroxetine - February 13, 2021 - tapered by 0.2mg from 4mg to 3.8mg.

Paroxetine - Mid April, 2021, tapered by 0.08mg from 3.86mg to 3.78mg.

Paroxetine - June 12, 2021 - tapered by 0.08mg from 3.78mg to 3.7mg.

Paroxetine - August 1, 2021, tapered by 0.09mg from 3.7mg to 3.61mg.

Paroxetine - October 1, 2021, tapered by 0.08mg from 3.61mg to 3.53mg.

Paroxetine - November 1, 2021, tapered by 0.08mg from 3.53mg to 3.45mg.

Paroxetine - December 1, 2021, tapered by 0.09mg from 3.45mg to 3.36mg

Paroxetine - January 16, 2022, tapered by 0.08 from 3.36mg to 3.28mg.

Paroxetine - March 2, 2022, tapered by 0.085mg from 3.28mg to 3.195mg.

Paroxetine - May 1, 2022, tapered by 0.08mg from 3.19mg to 3.11mg.

Quetiapine - 1999 - ongoing. 50mg per day before going to bed.

Citalopram - November 28, 2019 - ongoing. 10mg at breakfast.

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  • Moderator Emeritus
3 hours ago, CyclistN said:

Reminds me of a cartoon I saw recently. A picture of a Dr talking to a patient, saying, "The problem is that you are overmedicated. Luckily there are drugs that can help with that."

 

Just found it.  Yes funny but at the same time not funny. 

 

ed1ecc5ab1fc6206af540ccea9e6d7dd.jpg

 * * * * * *   PLEASE WATCH THIS VIDEO   * * * * * *

Antidepressant Withdrawal Syndrome and its Management

 

MISSION ACCOMPLISHED:    (6 year taper)      0mg Pristiq      on 13th November 2021

Woohoo!!!  Finally off Pristiq    Post 0 updates start here

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

My full tapering program     My Intro (goes to my tapering graph)    My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions. 

Please DO NOT TAG me - thank you.

Link to comment
Share on other sites

That's the one!

Paroxetine - February 13, 2021 - tapered by 0.2mg from 4mg to 3.8mg.

Paroxetine - Mid April, 2021, tapered by 0.08mg from 3.86mg to 3.78mg.

Paroxetine - June 12, 2021 - tapered by 0.08mg from 3.78mg to 3.7mg.

Paroxetine - August 1, 2021, tapered by 0.09mg from 3.7mg to 3.61mg.

Paroxetine - October 1, 2021, tapered by 0.08mg from 3.61mg to 3.53mg.

Paroxetine - November 1, 2021, tapered by 0.08mg from 3.53mg to 3.45mg.

Paroxetine - December 1, 2021, tapered by 0.09mg from 3.45mg to 3.36mg

Paroxetine - January 16, 2022, tapered by 0.08 from 3.36mg to 3.28mg.

Paroxetine - March 2, 2022, tapered by 0.085mg from 3.28mg to 3.195mg.

Paroxetine - May 1, 2022, tapered by 0.08mg from 3.19mg to 3.11mg.

Quetiapine - 1999 - ongoing. 50mg per day before going to bed.

Citalopram - November 28, 2019 - ongoing. 10mg at breakfast.

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  • 5 weeks later...

The main problem in the UK is that the mental health services are really, really sparse. Despite the government saying for years they‚Äôre going to make it better, (I‚Äôm surprised they haven‚Äôt still called it ‚Äėworld beating‚Äô like they‚Äôre so fond of saying about everything else), it only got worse.

 

When I initially had my issues, in my local area it was at least a 12 week wait to see a mental health professional. Even then it might have been a group session, rather than one to one. That was even before the pandemic.

 

So doctors really do have a difficult choice to make. If someone is sitting in front of them, desperate for help, and they can’t offer any support for 3 months or more, what do they do? For many, giving their patient drugs feels like the only option.

 

Obviously being on this site and suffering from withdrawals means I think the drugs are evil incarnate, but at the same time I do have empathy for the predicament many doctors find themselves in.

 

I’ve waffled a bit, so I guess my point it that the authorities can issues all the guidelines they like, but if doctors have no viable alternative treatment available immediately, nothing will change.

Oct 2018 - Jun 2020: 10 mg per day generic Escitalopram in pill form.

Jul 2020 - Aug 2020: Switched to 9 mg per day of Cipralex drops to aid tapering.

Sep 2020 - Oct 2020: Taper to 8 mg.

Nov 2020 - Dec 2020: Taper to 7 mg.

Jan 2021 - Feb 2021: Taper to 6 mg.

Mar 2021 - Apr 2021: Taper to 5 mg.

May 2021 - Jun 2021: Taper to 4 mg.

Jul 2021 - Sep 2021: Taper to 3 mg.

Sep 2021 - Jan 2022: Taper to 2 mg.

Jan 2022: Stopped taking altogether.

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Hi jon1,

 

Thanks so much for an "on the ground" perspective. I think it's sad when governments use "PR political talk," instead of actually listening to everyday people and then do something about it. Especially when it comes to health and mental health. Not sure about structural differences between the UK and Australia, where I am?

I sort of had a thought that it is left to the discretion of Drs. Makes sense what you posted.

A 12 week wait to see a mental health professional, that's terrible!

I can relate to what you said about drugs being "evil incarnate" and often Drs are caught between a rock and a hard place. I often feel conflicted having Type 1 diabetes, as the manufacturer of one type of insulin I'm on is the same one who owns the rights to an SSRI. 

Alto Strata and the volunteers who administer this site, really saved my life. I will ever be grateful to them!

Never thought you waffled on, not even as a micro dose!

All the best jon1,

CyclistN 

Paroxetine - February 13, 2021 - tapered by 0.2mg from 4mg to 3.8mg.

Paroxetine - Mid April, 2021, tapered by 0.08mg from 3.86mg to 3.78mg.

Paroxetine - June 12, 2021 - tapered by 0.08mg from 3.78mg to 3.7mg.

Paroxetine - August 1, 2021, tapered by 0.09mg from 3.7mg to 3.61mg.

Paroxetine - October 1, 2021, tapered by 0.08mg from 3.61mg to 3.53mg.

Paroxetine - November 1, 2021, tapered by 0.08mg from 3.53mg to 3.45mg.

Paroxetine - December 1, 2021, tapered by 0.09mg from 3.45mg to 3.36mg

Paroxetine - January 16, 2022, tapered by 0.08 from 3.36mg to 3.28mg.

Paroxetine - March 2, 2022, tapered by 0.085mg from 3.28mg to 3.195mg.

Paroxetine - May 1, 2022, tapered by 0.08mg from 3.19mg to 3.11mg.

Quetiapine - 1999 - ongoing. 50mg per day before going to bed.

Citalopram - November 28, 2019 - ongoing. 10mg at breakfast.

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