PrescQIPP

Antidepressant Deprescribing Initiative in North West London (NWL) (2025)

Central and North West London NHS Foundation Trust & West London NHS Trust

Project summary

The Antidepressant Deprescribing Initiative in NWL is a comprehensive project aimed at addressing inappropriate long-term antidepressant use and the associated risks. This initiative is a collaborative effort involving various stakeholders, including GPs, pharmacists, mental health specialists, and service users. The project focuses on developing and implementing sustainable deprescribing awareness and practices to optimise medication use, improve patient outcomes, and reduce unnecessary healthcare costs.

In England, 1 in 10 adults takes an antidepressant monthly, with a significant portion using them for over two years. Long-term use of antidepressants is associated with risks such as bleeding, weight gain, falls, and osteoporosis. Surveys suggest that 30 to 50% of long-term antidepressant users may not have a current clinical indication for continued use and could consider stopping.

We reviewed the latest evidence-based guidelines on deprescribing antidepressants and co-produced a local implementation plan and resources to support raising awareness of the issues and healthcare professionals' confidence in this area. The majority of deprescribing happens within primary care so we wanted to ensure GPs understood the topic but also had support available to them in secondary care where complexity arises. Pharmacists also have key opportunities to prompt deprescribing so also needed to be included within the project.

A co-production group was established and consulted throughout. The project incorporates feedback from service users who have experienced antidepressant withdrawal to understand the real experience of stopping antidepressants and use this in the training of our staff. Key themes included the importance of gradual tapering, understanding withdrawal symptoms, and the need for awareness and support from healthcare providers. Collaboration across the system ensures a seamless approach to deprescribing, regardless of the complexity facing the patient.

Resources Developed

  • Primary Care Guidance and Flow Chart: Detailed guidance on tapering methods and when to consider secondary care referral.
  • Patient Information Leaflet (PIL): Guidance on stopping antidepressants safely, emphasizing the importance of gradual tapering and differentiating between withdrawal symptoms and the return of depression/anxiety symptoms.
  • Service User Experience Stories: Stories and quotes for sharing with other service users and staff, including videoed patient stories and information.
  • Exemplar Patient Consultation: Videoed consultations for training staff.

Next Steps

  • Sharing guidance across NWL and sector-wide forums.
  • Delivering training for GPs, pharmacists, and specialist prescribers.
  • Widely sharing patient resources.
  • Trust & ICB websites.
  • Co-production groups.
  • Recovery college.
  • Cascade through trust clinical teams.