Outcome of antidepressant drug discontinuation with taperingstrips after 1–5 years

Background: Antidepressant withdrawal is experienced by about half of people who try to reduce or come off their medication. It can be a debilitating, long lasting process. Many clinicians misdiagnose or minimise symptoms, inadvertently prolonging suffering. Most are unable to help patients safely taper off. There has been little research into the peer support communities that are playing an increasingly important role in helping people withdraw from psychiatric medications. Methods: To illustrate the growth and activities of Facebook withdrawal groups, we examined 13 such groups. All were raising awareness of, and supporting individuals tapering off, antidepressants and were followed for 13 months. A further three groups were added for the last 5 months of the study. Results: In June 2020, the groups had a total membership of 67,125, of which, 60,261 were in private groups. The increase in membership for the 13 groups over the study period was 28.4%. One group was examined in greater detail. Group membership was 82.5% female, as were 80% of the Administrators and Moderators, all of whom are lay volunteers. Membership was international but dominated (51.2%) by the United States (US). The most common reason for seeking out this group was failed clinician-led tapers. Discussion: The results are discussed in the context of research on the prevalence, duration and severity of antidepressant withdrawal. We question why so many patients seek help in peer-led Facebook groups, rather than relying on the clinicians that prescribed the medications. The withdrawal experiences of tens of thousands of people remain hidden in these groups where they receive support to taper when healthcare services should be responsible. Further research should focus on the methods of support and tapering protocols used in these groups to enable improved, more informed support by clinicians. Support from Governments and healthcare agencies is also needed, internationally, to address this issue.

Section: Discussionmentioning

confidence: 99%

The role of Facebook groups in the management and raising of awareness of antidepressant withdrawal: is social media filling the void left by health services?

White¹,

Read

Julo³

2021

“…This suggests that the NICE guidance on how to discontinue antidepressants needs to be updated, and new guidance on Safe Prescribing and Withdrawal from prescribed drugs associated with dependence will hopefully contribute to best practice in this area. 52 Overall, there has been scant attention paid to the issue of antidepressant tapering previously in the academic literature, 48,53–56 which has been focused primarily on starting medication. 57 The ANTLER and REDUCE trials are ongoing, but further trials will be required in order to provide detailed advice to GPs on how to taper medications.…”

Section: Discussionmentioning

confidence: 99%

The ‘patient voice’: patients who experience antidepressant withdrawal symptoms are often dismissed, or misdiagnosed with relapse, or a new medical condition

Guy¹,

Brown²,

Lewis³

et al. 2020

Background: Stopping antidepressants commonly causes withdrawal symptoms, which can be severe and long-lasting. National Institute for Health and Care Excellence (NICE) guidance has been recently updated to reflect this; however, for many years withdrawal (discontinuation) symptoms were characterised as ‘usually mild and self-limiting over a week’. Consequently, withdrawal symptoms might have been misdiagnosed as relapse of an underlying condition, or new onset of another medical illness, but this has never been studied. Method: This paper outlines the themes emerging from 158 respondents to an open invitation to describe the experience of prescribed psychotropic medication withdrawal for petitions sent to British parliaments. The accounts include polypharmacy (mostly antidepressants and benzodiazepines) but we focus on antidepressants because of the relative lack of awareness about their withdrawal effects compared with benzodiazepines. Mixed method analysis was used, including a ‘lean thinking’ approach to evaluate common failure points. Results: The themes identified include: a lack of information given to patients about the risk of antidepressant withdrawal; doctors failing to recognise the symptoms of withdrawal; doctors being poorly informed about the best method of tapering prescribed medications; patients being diagnosed with relapse of the underlying condition or medical illnesses other than withdrawal; patients seeking advice outside of mainstream healthcare, including from online forums; and significant effects on functioning for those experiencing withdrawal. Discussion: Several points for improvement emerge: the need for updating of guidelines to help prescribers recognise antidepressant withdrawal symptoms and to improve informed consent processes; greater availability of non-pharmacological options for managing distress; greater availability of best practice for tapering medications such as antidepressants; and the vital importance of patient feedback. Although the patients captured in this analysis might represent medication withdrawal experiences that are more severe than average, they highlight the current inadequacy of health care systems to recognise and manage prescribed drug withdrawal, and patient feedback in general.

“…The results of this study are remarkably similar to those of two previous studies. 20 , 21 Duration of antidepressant use, number of previous attempts, antidepressants other than venlafaxine, female sex and more severe withdrawal during the tapering trajectory reduced the odds of tapering success. Multivariable regression suggested the association with paroxetine and the association with number of previous attempts was reducible to other factors in the model.…”

Section: Discussionmentioning

confidence: 99%

“…There was no overlap between the current sample and the two previously reported samples. 20 , 21 The questionnaire was the same as the one that was used in the first published study. 21 …”

Section: Methodsmentioning

confidence: 99%

“…In two previous studies, we reported that 71% and 66% of patients using a tapering strip, mainly for venlafaxine and paroxetine, were able to come off their drug in both the short term (71%) and the long term (66%), using a median of two 28-day tapering strips. 20 , 21 Here, we report an attempt to provide a third replication on the outcome of antidepressant tapering strips in a non-overlapping sample of 824 patients who used tapering strips to discontinue their antidepressant medication. Main outcome was the proportion of these 824 users of tapering strips who indicated they were off antidepressant drugs after completion of the last tapering strip.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Successful use of tapering strips for hyperbolic reduction of antidepressant dose: a cohort study

Groot

2021

Self Cite

Background: Tapering strips facilitate antidepressant discontinuation, allowing for personalised titration of discontinuation to the intensity of withdrawal. A tapering strip consists of antidepressant or other medication, packaged in a 28-day roll of daily pouches, each with the same or slightly lower dose than the one before. Previous studies demonstrated 70% real-world effectiveness of tapering strips. Here, we present a third, questionnaire-based retrospective cohort study in a large sample. Methods: Patients whose doctor had prescribed tapering strips between October 2015 and December 2018 were sent a questionnaire for participation after completion of tapering between December 2015 and January 2020. Of 1240 individuals who returned a questionnaire (response rate: 59%), 987 (80%) used an antidepressant, of whom 824 (83%) had wished to discontinue their antidepressant. Results: The sample was demographically representative of antidepressant users in the Netherlands. Less than 40% of participants had heard of tapering strips through their clinicians – Internet was the most frequent source. Of the 824 individuals, 341 (41%) had used strips for tapering venlafaxine, 206 (25%) for paroxetine and 277 (34%) for other antidepressants. Median duration of antidepressant use was 5–10 years, and most (71%) had tried to come off without tapering strips at least once. Most patients (72%) were able to discontinue their antidepressant, using a median of two strips to taper over a median period of 56 days. Females and individuals with (1) more severe experience of withdrawal during the use of tapering strips, (2) more years of use of antidepressant medication and (3) more previous attempts at discontinuation were less likely to be able to discontinue their antidepressant medication with tapering strips. Conclusion: The results of this study validate, for the third time, the observation that tapering strips can address the problem of antidepressant withdrawal symptoms in individuals attempting to discontinue antidepressants.