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NHS plan to help millions stop using antidepressants and painkillers


jon1

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This is an article in the Times (London), it's behind a paywall, so I've pasted it here.

 

Personally, while it's a positive move, I think they don't really know what they're letting themselves in for. It's going to involve a lot of people going through withdrawal at the same time. Plus free mental health services in the UK are currently very poor. They need to be robust and ready for the onslaught, otherwise, millions are going to be taken off antidepressants without a safety net.

 

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NHS to offer art classes instead of prescription drugs

Patients helped off antidepressants in drive to avoid US-style opioid crisis

 

Millions of patients will be offered help to come off antidepressants and painkillers under an NHS drive to tackle addiction to prescription pills.

 

New national guidance urges GPs to stop writing repeat prescriptions for those who have become dependent on common medications.

 

The NHS England plan, which aims to avoid a US-style opioid crisis, recommends that patients be sent to art, music or gardening classes instead of being prescribed painkillers such as tramadol or codeine. The health service will also set up support groups and clinics to help people to come off prescription drugs and manage withdrawal symptoms such as insomnia.

 

Every year one in four adults are prescribed potentially addictive drugs, including sleeping pills, strong painkillers and benzodiazepines such as diazepam, better known as Valium, for anxiety.

 

New figures show 8.4 million adults in England were prescribed antidepressants in the past 12 months, an 8 per cent increase on 2019. Two thirds of patients on the drugs have been taking them for more than a year, the NHS says, and many lack the support needed to wean themselves off.

 

There is little evidence that antidepressants are addictive, but they can cause withdrawal symptoms that make it difficult to stop taking them.

 

Some 5.23 million patients have taken opioids in the past year, down from 5.68 million in 2019. The fall in prescriptions — which has been linked to heightened concerns about addiction — is estimated to have saved nearly 350 lives and prevented more than 2,100 harmful incidents.

 

Health officials believe that too many people remain addicted to prescription pills months or years after they are first prescribed as a “quick fix”, calling for doctors to be strict about ensuring that they are taken only if there is a clinical benefit. Inappropriate use can harm patients’ health and cause side-effects that require further medications.

 

Professor Sir Stephen Powis, the national medical director for NHS England, said: “We know that patients who require prescriptions for potentially addictive drugs can become dependent and struggle with withdrawal, and this new action plan helps NHS services to continue positive work in this space having already slashed opioid prescriptions by almost half a million over the past four years.”

 

In addition to showing restraint on who receives the drugs in the first place, GPs are also being urged to carry out regular medication reviews to decide whether to “move patients away from potentially addictive prescribed drugs”. Patients on antidepressants should be contacted every six months to see if they are ready to taper off.

Pharmacists will also be urged to play a greater role, for example by spotting people who frequently buy codeine over the counter.

 

The new framework follows a government review in 2019, which highlighted an alarming rise in dependence on prescription drugs.

 

Professor Tony Avery, the national clinical director for prescribing at NHS England, said: “Medicines offer a fantastic range of tools for NHS staff to provide care that can be positively life-changing. However, we need to be alert to the risks of some medicines, and the framework we are publishing today empowers local services to work with people to ensure they are being effectively supported when a medicine is no longer providing overall benefit.”

 

NHS bosses urged local systems to follow the example of a scheme in Gloucestershire, which has helped to reduce dependence on painkillers by holding music and art classes. The classes have been shown to help patients manage chronic pain by distracting them, reducing isolation and providing group support.

 

Dr Benjamin Ellis, from the charity Versus Arthritis, said: “Medicines like opioids can be very helpful for some people with arthritis. We must take care not to stigmatise these medicines or the people who use them.”

 

Behind the story

What starts as a short-term prescription after an injury can turn into a long-term drug addiction (Eleanor Hayward writes).

 

One in four adults in England are prescribed drugs including opioids that can cause dependence and about half of those have been taking the pills for at least a year.

For some, the pills are a lifeline. Others end up hooked — needing a higher dose to get the same benefits, suffering horrible withdrawal symptoms, or seeking out illegal sources.

 

Prescriptions for opioids have finally started to fall in England after doubling between 1998 and 2008, but there are still more than five million people taking them every year. Since 2019 there has been an effort to restrict use of the painkillers because of fears the UK could face a similar epidemic to that in the US.

 

Rates of antidepressant prescriptions are soaring, with more than eight million last year. Some 23 per cent of women take antidepressants, along with 12 per cent of men.

While the drugs do not cause harm as opioids do, there are concerns too many people take them instead of alternatives such as therapy, which are more effective. And, once on them, patients often struggle to get the support needed to stop.

 

Not only does this put people at risk of side-effects, there is also a danger of interaction with other medication. More than eight million adults take at least five pills a day, with thousands ending up in hospital due to side-effects. The NHS says 10 per cent of prescriptions, costing up to £1 billion a year, are not needed.

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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  • Mentor

Very interesting.  It shows that the tide is ever-so-slowly turning in the right direction.  There is a long way to go but at least this is a start.  Hopefully other countries will follow suit.  Thanks for sharing! 🙂

Disclaimer:  This is not professional medical advice but is based on personal experience only.

1994 - 2017:  Prozac, Cymbalta, Celexa, Paxil, Wellbutrin, Zoloft, Seroquel, Buspar, Lorazepam, Xanax, Ambien

2005-present:  Trazodone 50 mg 

2017:  Effexor XR 37.5 >> 75 mg 

2020 (March):  Began 10% monthly taper of Effexor XR (got down to 12 mg)

2021 (September):  Completely crashed.  Went back up to 37.5 mg but in doing so I kindled myself for two years

2024:  1/1:  35.6 mg (-6 beads)  |  2/1:  33.8 mg (-11 beads)  |  3/1:  32.1 mg (-16 beads)

Reasons for starting psych meds:  PMDD/Depression, Generalized Anxiety Disorder

Other medications:  Levothyroxine 75 mcg

Supplements:  Dr. Berg's Electrolyte Powder on occasion   

 

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Lets hope the GPs follow the latest NICE and similar guidance regarding tapering and don't just whip people off these potent drugs.  I'm a mental health nurse and services are indeed stretched to the limit.  But even more concerningly, my learned psychiatrist colleagues fail to acknowledge the damage antidepressant withdrawal can do.  I dread to think what could happen... :(

  • August 2004:  Citalopram 20mg for "postnatal anxiety".  
  • May-Sept 2011:  Adverse reaction to the contraceptive pill, causing severe anxiety and panic.  Was switched from 7 years on Citalopram to Lofepramine briefly, then Mirtazapine 30mg.  Was an anxious, depressed, suicidal wreck and got misdiagnosed with GAD by a psychiatrist.  I now realise my symptoms were all medication related, as opposed to so-called psychiatric diagnosis.
  • October 2011:  Pregabalin 450mg and propranolol 40mg TID added by psychiatrist. 
  • Feb 2013: Tapered off pregabalin 450mg; stopped propranolol.
  • July 2013: Switched from Mirtazapine 30mg to Cipralex 10mg in a two-week cross titration, which caused horrific withdrawal symptoms lasting months.
  • April 2015: Increased to 15mg Cipralex. 
  • 2017:  Was treated by a clinical psychologist for medication-related trauma and slowly tapered down to 2mg Cipralex over the next four years. 
  • December 2021: Switched from Cipralex tablets to drops to facilitate further tapering; this caused withdrawal reaction lasting approx 6 weeks. 
  • May 2022: Experienced severe withdrawal reaction after inadvertently taking expired drops.  
  • 3rd June 2022: Reinstated 2mg Cipralex drops. Stabilisation hindered by drinking alcohol socially; didn't realise impact of this. Nil alcohol since September 2022.
  • Supplements: Cycling Magnesium, Omega 3, Evening Primrose, Vitamin D3, Vitamin C, Vitamin B Complex, Zinc, Ashwagandha, Sage.  Had been taking these prior to withdrawal incident.
  • Feb 2023:  Relatively stable and aiming to hold on 2mg Cipralex and with a view to tapering down in 2024.  Tapered off Ashwagandha.
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Thanks for sharing this.  On the one hand it's positive but I share your concerns about whether they're going to slow taper and subsequent withdrawal.  Hopefully the next generation will not be prescribed them in the future unless absolutely necessary.  

 

Luckily I have a good relationship with my GP and hopefully she won't try and rush my taper which I'm expecting to take years.

Approx 2010 - 120mg Duloxetine, 20mg Olanzapine

2018 - 60mg duloxetine, 7.5 mg Olanzapine

7 aug 2023 stopped 40mg propranolol (only taken rarely).

11 Feb 2023, 57 mg duloxetine

Supplements - Omega 3 - 2000 mg/day 

 

 

 

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It's quite annoying how the media tends to equivocate subjects like this.

 

In the Times on the same day - I think just the online version - there's an article by a journalist who's had mental health issues and anxiety all her life and SSRI's gave her relief after 40 years.

 

So, as you'd expect, she spends all her time saying antidepressants aren't 'bad' by using all the usual buzzwords, like they're not addictive. She's clearly been a bit triggered by the thought her medication will be taken away (which isn't what's going to happen) and is ignoring the facts that millions of people are on the drugs unnecessarily, and the horrific withdrawal symptoms they cause.

 

It wouldn't be so bad if there were another article with an alternative point of view.

 

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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