NICE publishes new guidelines to improve mental health care in England and Wales

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NICE (the National Institute for Health and Care Excellence) has published new guidelines to improve mental health care in England and Wales.
The new information is designed to improve mental health outcomes and service provision and covers a wide range of issues, including reducing antidepression medication dosage gradually and paying more attention to the ethnic backgrounds of patients.

One of the focal points of the new guidance is to encourage the gradual withdrawal of antidepressant medication. Experts recommend lowering the dosage in stages with the help and support of medical professionals. Reducing antidepressant doses gradually will help individuals and their care teams to manage withdrawal symptoms, which can occur in some patients who take antidepressants. 

The guidelines suggest that care teams should work with individual patients to draw up a personalised care plan, which determines whether it is the right time to start reducing antidepressant doses and how long the process should take. Another important recommendation is paying more attention to ethnic backgrounds when treating patients with mental health disorders. NICE guidelines indicate that service providers and healthcare professionals should be proactive in removing barriers, which may restrict access to treatment. Figures from NHS Digital show that 64% of people from white backgrounds completed a full course of treatment in 2021, compared to 57% of people from minority ethnic backgrounds. NICE recommends delivering mental health services in a way that eliminates problems caused by language barriers and respects cultural differences and traditions. 

The new guidelines build on previous recommendations from NICE, which were published in November 2021 and include treating mild depression with group or behavioural therapies before prescribing medication. In 2022, the number of people taking antidepressants in England hit a record high of 8.3 million. Dr Paul Chrisp, from NICE, explained that some people experience withdrawal symptoms when coming off antidepressants and the length of time it takes to adjust varies according to the individual and the type of drug. The committee has recommended gradual withdrawal in stages with the help of medical professionals to help individuals to cope with withdrawal symptoms and reduce risks. Dr Chrisp added that there was “no one-size fits all approach to coming off antidepressants” and said that each patient should have access to support and advice from their care team.

The new guidance has been welcomed by experts, including Prof Allan Young from the Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience. Prof Young said that the recommendations “make complete sense” but questioned whether the NHS would be able to deliver the required service due to operational pressures. John Junior is one of many patients who have experienced the effects of coming off antidepressants. John was prescribed medication for depression and generalised anxiety disorder in 2017. He found that taking the medication “really did help” to nullify the suicidal thoughts he had suffered with in the past but he found the side-effects incredibly difficult to deal with. He had headaches and migraines, intense anxiety and heart palpitations and was subsequently prescribed additional drugs to reduce the severity of the effects. 

At one point, John said he felt as though he would always be dependent on antidepressants and he decided to come off his medication during the Covid lockdown. Unfortunately, John was unable to get through to his doctor for advice and opted to go “cold turkey.” After stopping his medication, John said that he felt like he was enduring a “constant hangover.” He had insomnia, severe headaches, nausea, night sweats and “raw anxiety.” Talking about the new NICE guidelines, John said that it will be beneficial for people who are going through a similar experience to him to have access to medical support and reassurance and to go through the process based on a personalised treatment plan. He is now coping well without medication and manages his mental health with meditation and regular exercise.