Brain Zaps

Public Health England’s report published in 2019 described a steep rise in prescriptions (which have broadly doubled in the last 20 years) which means that most psychological therapists now work with clients who have either taken or are taking or withdrawing from psychiatric drugs. However there has been a lack of summarised evidence, information and training about the impact of these drugs on clients and on therapy itself, and this constitutes a growing problem whatever the modality or therapeutic setting. The guidance aims to provide evidence based information that will empower and support conversations often already taking place between psychological therapists and their clients within the frame of therapy. Therapists will need to decide for themselves whether, and to what extent, they wish to use this information.

In the 2017-19 parliament the All-Party Parliamentary Group (APPG) for Prescribed Drug Dependence facilitated the creation of this guidance by bringing together key professional bodies representing psychological therapists in the UK with key practitioners and academics. The Beyond Pills APPG (2020-2024) under the chairmanship of Danny Kruger MP continued to support the guidance. The British Association for Counselling and Psychotherapy (BACP), British Psychological Society (BPS) and United Kingdom Council for Psychotherapy (UKCP) have collectively funded and steered the creation of the guidance in conjunction with members of the Beyond Pills APPG 2020-24 (previously for Prescribed Drug Dependence) Secretariat (all members of the Council for Evidence-based Psychiatry (CEP)). The above professional bodies, including in addition the National Counselling Society (NCS, now NCPS), the International Institute for Psychiatric Drug Withdrawal (IIPDW) and the Hearing Voices Network, endorse the guidance and will promote it to their members and relevant training organisations. A team of leading practitioners and academics, many of whom are members of both the professional bodies and CEP, has authored the document. CEP and its members are the copyright owners and will update the content, which will be freely distributed under a Creative Commons licence which allows users to copy and redistribute the work. The guidance has been developed in conjunction with and reviewed by experts by experience (clients, carers, therapists and campaigners).

Why is this important?A survey of 1,200 practising psychological therapists revealed that the majority felt ill-equipped to manage such issues in the therapeutic setting, with 93.1% reporting they would find it ‘useful’ or ‘very useful’ to have guidance to help them work more confidently with people either taking or withdrawing from psychiatric drugs. By supporting the creation of this guidance, the endorsing bodies have taken responsibility for offering support to their members on the front line. An example of the kind of information provided is that current evidence shows that 50% of all patients withdrawing from antidepressants will experience withdrawal effects, with 25% describing these as ‘severe’. If such experiences aren’t recognised as being possible withdrawal effects, drugs can be mistakenly reinstated on the assumption that an original problem has returned. It is believed this may be contributing to the increased time people are now taking such drugs. If a psychological therapist is aware of the possibility of withdrawal effects, not just when someone stops taking them but even if they miss a dose, they may have the opportunity of flagging this to a client who can then discuss it with their prescriber. Psychological therapists are also potentially well placed to support a client who decides, with their prescriber, to withdraw from their drugs.

This guidance relates to prescribed psychiatric drugs including antidepressants, antipsychotics, stimulants, tranquilisers, and anxiolytics. It does not tackle prescribed painkiller/opioid use or any illicit or recreational drug use and any associated problems.

While this guidance advocates the importance of informed client choice based on full information about potential benefits and risks, it does not advocate psychological therapists telling their clients to take, not take, stay on or withdraw from psychiatric drugs. These matters should be left to the prescriber and client to decide. This guidance is not making the case that psychological therapy should always be used alone without drugs or that drugs should never be used – there are times when they are helpful.

Please contact the member service team for your professional body by following these links: BACP https://www.bacp.co.uk/about-us/contact-us/ BPS https://www.bps.org.uk/contact-us UKCP https://www.psychotherapy.org.uk/contact-us/ NCS https://ncps.com/help/contact or contact Dr Anne Guy UCKP Reg; co-author and lead editor of the Guidance, including for any translation enquiries, at [email protected]