Deciding to discontinue prescribed psychotropic medication: A qualitative study of service users’ experiences

Abstract

Many mental health service users decide to discontinue their psychotropic medication at some stage in the treatment process; however, few studies have captured these experiences. This study aimed to explore people’s experiences of coming off medication. A qualitative descriptive design and individual interviews with 23 people who experienced coming off medication were employed. COREQ checklist was used. Data were analysed using inductive and deductive approaches and six major themes were developed. Findings suggest that while medication was useful for many in the short‐term, the adverse effects had significant impact and contributed to the decision to come off medication. Participants also reported being driven by a questioning of the biomedical model of treatment and the belief that there were other strategies to manage their distress. Mixed experiences of support from healthcare professionals for the medication cessation process were reported. The discontinuation process was often difficult resulting in changes in mood and behaviour which for many culminated in relapse of distress, rehospitalization and return to medication. To support the process of coming off and staying off medication, participants identified a range of useful strategies but particularly highlighted the importance of peer support. Findings from this study demonstrate the importance of mental health nurses having a collaborative discussion with service users which may support safer decision‐making and lessen the risk of people discontinuing medication abruptly. Finding also indicates a need for robust studies that develop and test interventions to support people who wish to discontinue psychotropic medications.

Supporting safe and gradual reduction of long‐term benzodiazepine receptor agonist use: Development of the SAFEGUARDING‐BZRAs toolkit using a codesign approach

“…This is attributable to individuals' unique experiences of BZRA use (e.g., reasons for initiating and maintaining BZRA use) and the range of barriers that can impact on individuals attempting discontinuation of long‐term BZRA use 16 . This is consistent with previous research on mental health service users' experiences of discontinuing psychotropic medication 32 . The collection of BCTs within the toolkit offers a library of options for individuals and clinicians to use as part of an active partnership in developing a gradual dosage reduction strategy that should include regular monitoring and support.…”

“… 16 This is consistent with previous research on mental health service users' experiences of discontinuing psychotropic medication. 32 The collection of BCTs within the toolkit offers a library of options for individuals and clinicians to use as part of an active partnership in developing a gradual dosage reduction strategy that should include regular monitoring and support. The retrospective coding of interventions in our previous systematic review 12 identified a comparatively smaller repertoire of BCTs, whereby the number of BCTs per intervention ranged between 4 and 8 BCTs and 17 unique BCTs were identified across included studies.…”

“…The authors do not encourage, or support, forced withdrawal or discontinuation of long‐term BZRA use. The toolkit may provide a useful catalyst for collaborative, person‐centred approaches to treatment decisions between individuals and their clinicians and help to prevent situations whereby individuals who have decided that they no longer want to continue taking psychotropic medication encounter challenges in accessing professional support and having their autonomy and choice regarding treatment options respected 35 …”

“…The authors do not encourage, or support, forced withdrawal or discontinuation of long-term BZRA use. The toolkit may provide a useful catalyst for collaborative, personcentred approaches to treatment decisions between individuals and their clinicians and help to prevent situations whereby individuals who have decided that they no longer want to continue taking psychotropic medication encounter challenges in accessing professional support and having their autonomy and choice regarding treatment options respected 35. Future work will look to develop an accompanying tool to help individuals and their clinicians identify priority domains that need to be targeted in designing a tailored BZRA discontinuation plan at an individual level.…”

Mobile phone applications to support psychotropic tapering: a scoping review protocol

“…Some service users decide to discontinue psychotropic medication to recapture lost personal autonomy, to live a life free of medication and, in some cases, because these medications have failed to manage the person's distressful experience and symptoms 18 . However, these individuals have reported challenges in accessing professional support and having their autonomy and choice respected 18,19 .…”