Supporting material (video testimony)

https://youtube.com/shorts/t51Qrou20Z4?is=Rkwl2Cs6MNwsv-uC

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For the attention of

• Department of Health and Social Care
• NHS England
• National Institute for Health and Care Excellence (NICE)
• General Medical Council (GMC)
• Royal College of General Practitioners (RCGP)
• Medicines and Healthcare products Regulatory Agency (MHRA)
• Primary care providers and integrated care systems
• Vitality and Livi UK

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The issue

GPs often do not know about hyperbolic tapering and the need for more granular step down doses i.e. using liquid forms of medications or bead counting from capsules or tablet chopping (less accurate form of tapering) . They also massively shorten the length of time patients need to taper off these brain altering medications people need several months and years yet GPs recommend weeks. It is severely dangerous to do so and as mentioned in the video above can cause significant rebound symptoms including suicidality.

There is currently inconsistent clinical guidance and variable implementation of antidepressant discontinuation support across NHS and private GP services, particularly regarding selective serotonin reuptake inhibitor (SSRI) withdrawal and tapering practices.

In particular, the use and understanding of gradual dose reduction strategies, including hyperbolic tapering approaches, is not consistently implemented in routine primary care practice.

As a result, patients may experience significant variation in:

• tapering speed and methodology
• access to liquid or low-dose formulations
• follow-up and monitoring during discontinuation
• clinician awareness of withdrawal syndromes

This inconsistency may contribute to avoidable distress and deterioration in some patients during or after antidepressant withdrawal.

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Why this matters

Antidepressants such as escitalopram are widely prescribed across the UK. While many individuals discontinue treatment without significant difficulty, a subset experience complex withdrawal effects requiring careful, individualised clinical management.

At present, GP practice can vary significantly between clinicians and services, leading to:

• differences in tapering advice
• limited access to structured discontinuation plans
• inconsistent recognition of withdrawal symptoms
• lack of standardised follow-up pathways

This variation can leave patients without adequate support during clinically vulnerable periods.

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Personal experience (context)

In January 2024, following a period of significant occupational stress and in consultation with healthcare professionals, including a community pharmacist at Boots Market Street Manchester City Centre and Dr Simpson GP via Vitality and Livi, I began discontinuing prescribed escitalopram. No Mental Health referrals like CMHT or signposting to AnE MHLT for HBTT was made as a result of this consultation 

The tapering process took place over a relatively short timeframe using tablet formulations. I was not offered a structured long-term tapering plan or alternative formulation strategies to support a slower dose reduction.

Following discontinuation, I experienced a significant deterioration in my mental health over the following months, requiring repeated contact with primary and secondary care services throughout 2024, and ultimately leading to acute crisis intervention and inpatient care.

During this period, I sought support and medication review on multiple occasions. However, I did not receive consistent or structured guidance specifically addressing antidepressant withdrawal management or slow tapering approaches.

I felt I needed clearer education on how to withdraw safely, and a more structured discussion of alternatives such as dose adjustment or continuation at a stable dose.

From approximately 2017 to February 2024, I received antidepressant treatment for several years, including sertraline 50-100mg for around 6 months, citalopram 10mg - 40mg for approximately 3 years, venlafaxine 75 mg for around 7 months, and escitalopram 5-10mg (mostly 5mg as stepped up and back down due to appetite https://youtube.com/shorts/t51Qrou20Z4?is=Rkwl2Cs6MNwsv-uC for approximately 1 year, with gaps between some courses of treatment. Despite this history, I was advised to discontinue escitalopram over approximately one month using tablets.

Looking back, I believe I should have been assessed as being at increased risk of antidepressant withdrawal and offered an individualised taper. NICE (2023) recommends reducing antidepressants in stages, with the speed and duration agreed between the patient and clinician, and that further dose reductions should occur only once withdrawal symptoms have settled or are tolerable. The Royal College of Psychiatrists advises that tapering should be proportionate to the duration of treatment, noting that people who have taken antidepressants for several years may require tapering over some months. Dr. Mark Horowitz similarly advocates an individualised, hyperbolic taper, explaining that long-term users may require tapering over several months or, in some cases, longer than a year, with progressively smaller dose reductions and consideration of liquid formulations where needed. In light of this guidance and my medication history, I believe a slower, individualised taper with regular review of withdrawal symptoms and consideration of a liquid formulation would have been more appropriate than assuming a one-month tablet taper would be suitable for me.

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What we are calling for

We are calling for national action to improve safety and consistency in antidepressant withdrawal care:

1. Nationally standardised guidance on antidepressant discontinuation, including recognition of gradual and hyperbolic tapering principles where clinically appropriate
2. Mandatory training for GPs both private and NHS and prescribing clinicians on antidepressant withdrawal syndromes and safe discontinuation practices
3. Improved access to tapering resources, including liquid formulations and structured dose-reduction pathways within primary care
4. Standardised follow-up and monitoring pathways for patients undergoing antidepressant withdrawal, including monthly check ins for a 6-12 month period following withdrawal particularly for those with prior complex mental health histories
5. GPs should carefully assess and actively review decisions to discontinue antidepressants, ensuring patients are fully informed about risks of withdrawal and relapse. Dose increases or medication switches should be considered as part of a full clinical review where appropriate before discontinuation
6. Patients undergoing antidepressant withdrawal, particularly those with a history of severe or complex mental health difficulties, should be considered for enhanced monitoring and support, including involvement of local crisis or home treatment teams where clinically appropriate

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Why reform is needed

Greater consistency in antidepressant withdrawal care would:

• support safer prescribing and discontinuation practices
• reduce variability in patient experience across GP services
• improve early recognition and management of withdrawal symptoms
• strengthen continuity of care during medication changes
• align practice more closely with evolving clinical understanding of antidepressant discontinuation

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Closing statement

This petition seeks to improve the safety, consistency, and clinical support available to individuals discontinuing antidepressant medication within GP consultations.

By signing, you are supporting improved training, clearer national guidance, and more consistent and compassionate care for patients undergoing antidepressant withdrawal.

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https://www.change.org/StricterMHWardsBanQuickReadmissionsCapInformalAdmissions

If time travel were to become available I need to do the following

Personal reflection

If time travel were ever possible, the best point I would choose is 10 June 2024.

When the therapist wrote to the GP requesting a Crisis Team referral on 10 June 2024:

* Google the Crisis Team in Manchester city centre and ring the Greater Manchester Mental Health (GMMH) 24/7 Crisis Helpline (0800 953 0285) (now replaced by NHS 111 option 2) to request an urgent mental health assessment and, if clinically appropriate, referral to the Home Based Treatment Team (HBTT), providing a more direct route to crisis services rather than relying on online or routine NHS GPs who may not promptly act on referrals, properly signpost to Crisis Teams/HBTT, or convey the urgency needed to obtain support before a crisis point where admission is deemed necessary with overstated risk to self.

* Register with Bloom Street Surgery in Manchester rather than consulting the Vitality GP through work about my mental health and insomnia, so I could receive ongoing GP care locally rather than through Bolton Community Practice, and speak to a GP there about my worsening depression, anxiety and persistent insomnia.

* Restart or increase escitalopram to 20 mg under medical supervision rather than using a sub-therapeutic 5 mg dose.

* Ask Joe to live with me and Paul once he had finished living with Jack until Paul moved out, after which Joe and I could live together. If he chose not to and instead returned to Southport or lived elsewhere, end the relationship.

* Rent strike for the pipe.

* Stay living in Manchester and don’t move back to my parents’ home no matter what, even if I had to stay with friends temporarily and contribute towards rent – between Dev, Zilla, Mike and Darren.

*NEVER ATTEND ANE FOR MENTAL HEALTH

* 

* Enquire about applying for Personal Independence Payment (PIP).

* Apply for The Voice UK.

* Enquire about obtaining daridorexant privately, if appropriate, after I had been stable following an escitalopram increase for a couple of weeks and after discussion with my clinician (e.g. through the Boots Online Doctor Insomnia Service).

* Start performing at open mic nights, attend Mandem Meet Up, continue singing, write new lyrics and bars, and keep developing my music.

* Book two weeks off work from 24 June 2024 and, if possible, purchase an additional five days of annual leave to take a two-week holiday to the USA and Canada with Harry.

* Continue my long-term nightly supplement regimen of magnesium glycinate and L-theanine, with occasional melatonin if appropriate.

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Additional priorities

* Don’t ever take promethazine, mirtazapine or propranolol.