At the end of last year, 29-year-old Sarah* decided she wanted to stop taking her antidepressants. Having taken the medication for over 10 years, she felt like she was in a position where her mental health was under control, so she made an appointment with her GP to discuss what the process of coming off the medication would look like. But when the day of her appointment arrived, she was left feeling anything but confident.

“I had a telephone call with my GP, but they were pushed for time,” Sarah, who is based in Manchester, tells Stylist. “I was told if I struggled coming off the antidepressants, I could get in touch with the GP again to arrange going back on them.”

Three months on from that GP appointment, Sarah is doing well – but she’s still surprised by how little support she received after asking for help to reduce her dosage.

“As a Mental Health First Aider, I was surprised that I wasn’t offered additional support,” she says. “For example, I wasn’t given any guidance about where else I could go for information, what symptom changes to expect or the mental health charities that are available. Luckily, I have a good support system and professional contacts (such as a counsellor) I can go to should I need anything – but just going to the GP doesn’t feel like enough.” 

8.4 million people in England were prescribed antidepressants last year – but despite all the negative coverage surrounding rising prescriptions, many patients like Sarah still feel like they’re being left in the dark when it comes to the process of stopping their medication.

The NHS website recommends patients speak to their doctor before stopping their medication and lists the recommended ‘taper’ period as four weeks, during which the dosage of the antidepressant is slowly reduced. But this information heavily focuses on the logistical side of tapering – and fails to consider the emotional rollercoaster many patients experience when faced with the prospect of coming off antidepressants.  

35-year-old Nicky from Plymouth knows how important this emotional support can be. After seven years on antidepressants, she decided to come off her medication in 2018 – but ended up relapsing (a term used to describe the return of depression symptoms) several months later due to factors outside her control. 

After going back on medication for two more years, she decided to try and stop again in 2020. But the memory of her first experience made the process anxiety-inducing.

“I’d finally found myself in such a good place, and I was so scared of going backwards,” Nicky explains. “I genuinely felt like there was a risk of everything falling apart again.”

Francesca*, 25, from London, also found it hard to overcome the fear of relapse when deciding to come off her antidepressants, which she’d been prescribed for OCD.

“The idea of being back in that headspace – and having to wait for the antidepressants to kick in again – was a really scary prospect for me,” she says. “I wanted some kind of concrete plan or reassurance about what I could do if things didn’t work out.”

However, while Francesca’s doctor simply told her she “probably wouldn’t” relapse – a response which left her feeling unsure whether to take that next step – Nicky’s GP worked with her anxiety to help her feel supported during the process.

“The GP was really supportive,” Nicky, who has been off antidepressants for three years now, explains. “He advised me to take it really slowly, even slower than last time. At the end I was taking a tablet every other day until I finally stopped. I’ve had a couple of tiny wobbles since I stopped, but it’s been nothing I couldn’t cope with myself.” 

It’s clear that experiences of coming off antidepressants vary from patient to patient, but steps are being taken to remedy this. Earlier this month, The Times reported that GPs are to be urged to stop writing repeat prescriptions for people on antidepressants by providing additional support – such as sending people to art or gardening classes – instead.  

And at the beginning of the year, the National Institute of Care Excellence (NICE) published a new draft quality standard for the care of adults with depression, which suggested GPs and medical professionals should help those on antidepressants to taper their dose as part of a “staged withdrawal” tailored to the patient’s individual needs. It also signposted those interested in stopping their medication to information located on the Royal College of Psychiatrists’ website, which details what to expect when tapering your dose.

However, despite these positive changes, there are concerns about how much work it will take to ensure GPs have the skills to follow these guidelines. 

“Unfortunately, we know that the vast majority of GPs don’t feel they really have the skills to help people taper their medicines,” Stephen Buckley, head of information at Mind, said when the draft quality standard was first published. “As such, GPs will need to receive proper support, resources and training to effectively help patients to do this

“It’s also important that patients are given enough information when they’re first prescribed medication so that they understand the length of time for which they may be being prescribed them or the potential difficulties they might face to stop taking them.”

At a time when the NHS is struggling to meet patient demand when it comes to mental health – last year, the number of people on waiting lists to receive mental health support reached 1.2 million – these concerns hardly seem unfounded.  

And this squeeze on NHS resources also has the potential to make this process harder for patients, too. Medication is, after all, simply a tool used to manage mental health – and a lot of people who come off antidepressants will need to switch their medication for other forms of support such as therapy or counselling, at least in the short term.

“Support for your mental health doesn’t end when you make the decision to stop taking medication,” says Aisling Traynor, head of advice and training at Rethink Mental Illness.

“It’s important that people can access the reassurance, guidance and advice they need while they’re tapering off antidepressants, but possible side effects won’t be the only factor putting people at risk of relapse. Recovery is rarely linear, and if you find yourself struggling with your mental health again in the future, it’s important to revisit that conversation with your GP to ensure you’re receiving the appropriate support.” 

If one thing’s for sure, communication is essential – not just during the tapering process, but throughout a patient’s entire medication journey. Antidepressants are life-saving drugs that should be available to those who need them, but they’re also a much bigger commitment than a week-long course of antibiotics. 

Nicky believes making the reality of going on antidepressants clearer at the beginning could make the process of coming off easier.

“I think because antidepressants are so common now, people underestimate or forget that they are still very serious drugs that can have serious withdrawal symptoms,” she says. “I wish medical professionals explained or considered how hard it is to get off antidepressants once you’re on them before prescribing them.”

It’s also important that this communication comes from verified sources, such as a GP or healthcare body. Dr David McLaughlan, a visiting consultant at The Priory Hospital, Roehampton, says one of the biggest issues he faces when dealing with patients is the amount of inaccurate information being shared on social media.  

“Access to knowledge is incredibly empowering and helps give patients ownership of their mental health, but it’s critical that information comes from a reliable source,” he says. “I’ve noticed that my patients are increasingly learning about their mental health through social media platforms, but much of this content is produced by people who may not be qualified to give advice. 

“Many of these ‘mental health advocates’ overgeneralise their own personal experiences and can be quite prescriptive with their advice, without appreciating the potential dangers of stopping medication without professional support.” 

Coming off of antidepressants is a daunting process no matter how long someone has been on them. And as more people are prescribed medication to manage their mental health, it’s vital that patients are given the support they need to navigate this complex journey.

Taking medication for mental health reasons may be becoming more normalised, but we mustn’t forget how complex the withdrawal process can be. It’s not only a medical process, but an emotional one – and we need to ensure people feel supported and informed at all stages. 

Frame Of Mind is Stylist’s home for all things mental health and the mind. From expert advice on the small changes you can make to improve your wellbeing to first-person essays and features on topics ranging from autism to antidepressants, we’ll be exploring mental health in all its forms. You can check out the series home page to get started.

If you or someone you know is struggling with their mental health, you can find support and resources on the mental health charity Mind’s website and NHS Every Mind Matters or access the NHS’ list of mental health helplines and services.

If you are struggling with your mental health, you can also ask your GP for a referral to NHS Talking Therapies, or you can self-refer.

For confidential support, you can also call the Samaritans in the UK on 116 123 or email jo@samaritans.org. In a crisis, call 999.

*names have been changed

Images: Getty