Patients have expressed dissatisfaction – and sometimes outrage – with available medical assistance for stopping psychiatric medications. This has led to many tens of thousands of patients seeking advice from online peer-support forums. When surveyed, these patients report that their doctors were often unhelpful either because they recommended tapering too quickly or because they were not familiar enough with withdrawal effects to provide helpful advice. Some doctors are apparently still suggesting that antidepressants do not cause withdrawal symptoms. The main requests from these patients are that health professionals are sufficiently well informed to provide personalised, flexible reduction plans and that access is provided to smaller doses to facilitate tapering (either liquid versions of medication, or specially compounded smaller dose tablets or capsules). We hope this textbook will contribute to a broader understanding of these issues, a greater expertise in helping patients and a better outcome for all.
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We wrote this book partly because of our own difficulties in coming off various psychiatric drugs. Our main motivation has been that, by clarifying what is known about safe deprescribing and applying that to practice, we will spare others some of the difficult experiences we have endured. It is perhaps the book that we wished our prescribers had possessed.
It is sobering to consider that had we not experienced stopping medication first-hand we would have found it hard to believe the accounts of patients, which can seem almost fantastical in the variety and severity of symptoms (what one experienced practitioner in this field has called 'the unbelievability factor'). We hope this book will help clinicians develop a greater appreciation for the difficulties some patients experience when trying to stop psychotropic medication.
We recognise that much of the guidance included in this book requires confirmation and clarification from further research but we also appreciate that people are already reducing and stopping their medication and we should not let the perfect be the enemy of the good. The main messages of this textbook could be summed up in a few words: go slowly, at a rate the patient can tolerate and proceed even more cautiously for the last few milligrams, which are often the hardest to stop.
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We have also sought to empower patients in the process of coming off their drugs. Patient autonomy is increasingly highlighted in medicine (and psychiatry more widely), but in the area of deprescribing where relatively little is known and where patient experience is so central, it is even more important. We have observed that patients soon become the experts in understanding what rate they can tolerate in reducing their medications and we hope that clinicians will support patients in this process. An old adage from another area of medicine – 'Pain is what the patient says it is' – might be borrowed here. Withdrawal is what the patient says it is.
excerpt from the preface of the maudsley deprescribing guidelines: antidepressants, benzodiazepines, gabapentinoids and z-drugs (2024) by mark horowitz and david taylor, with significant input from patient advocate and surviving antidepressants founder adele framer.
this book is available as a pdf on anna's archive and provides detailed discussion on what we think is actually going on during discontinuation of psychotropic medications, as well as how to taper off them as safely as possible.
be aware that some of these medications are also widely prescribed for various kinds of chronic pain (e.g., cymbalta/duloxetine, neurontin/gabapentin, lyrica/pregabalin, elavil/amitriptyline, desyrel/trazodone, remeron/mirtazapine, and klonopin/clonazepam) while specifically benzodiazepines and "z-drugs" (e.g., ambien/zolpidem) are commonly prescribed for insomnia (of the antidepressants mirtazapine and trazodone are often used for insomnia as well). doctors prescribing these medications are often equally unlikely to have informed patients about the withdrawal process and to provide meaningful support during tapering
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theartofmadeline
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2087
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