What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications

Framer, Adele

doi:10.1177/2045125321991274

Cited by 52 publications

(54 citation statements)

References 165 publications

(362 reference statements)

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“…47 This guideline was derived from existing studies, pharmacological principles relevant to tapering antidepressants, 55 and expert consensus including from experts by experience. 48 There is a clear need for further studies to clarify these principles, including establishing how to determine the ideal taper method for a given individual. It is worth bearing in mind that the current NICE guidance suggesting tapering antidepressants over 4 weeks was based on a single trial demonstrating that stopping antidepressants abruptly caused significant withdrawal effects 45 ; it was the consensus of the panel that 4 weeks was a reasonable period of time for tapering.…”

Section: How To Discontinuementioning

confidence: 99%

Newer generation antidepressants and withdrawal effects: reconsidering the role of antidepressants and helping patients to stop

Horowitz

Wilcock

2021

DTB

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In England, the prescribing of antidepressants, primarily the newer generation antidepressant classes, has steadily increased over recent years. There is ongoing debate about how the efficacy of these drugs is viewed, their place in therapy and the harms associated with stopping them. Much of the evidence of their efficacy comes from short-term placebo-controlled trials which tend not to include outcomes that are of greatest relevance to patients, such as social functioning or quality of life, but rather restrict outcomes narrowly to symptom measures. On such measures these studies do not demonstrate clinically significant differences from placebo for depression. A range of adverse effects are also recognised, often greater in naturalistic studies of long-term antidepressants users than those measured in short-term efficacy studies, including emotional numbing, sexual difficulties, fatigue and weight gain. There is increasing recognition that withdrawal symptoms from antidepressants are common and that these symptoms can be severe and long-lasting in some patients. Recent guidance on how to stop antidepressants in a tolerable way has been presented by the Royal College of Psychiatrists. We believe that increasing awareness about the difficulty that some patients have in stopping antidepressants should lead to more cautious prescribing practice, with antidepressants given to fewer patients and for shorter periods of time. This article discusses the perceived benefits and harms of antidepressant use.

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Section: How To Discontinuementioning

confidence: 99%

Newer generation antidepressants and withdrawal effects: reconsidering the role of antidepressants and helping patients to stop

Horowitz

Wilcock

2021

DTB

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“…Understanding drugs according to the Drug-Centered Model of Action would suggest using medications as a last resort for long-term therapy, only when other options have been tried and failed or when the patient is convinced that this is the best solution available. This would require a truly informed consent on the side of the patient informed about possible risks and harms and still a careful and responsible assessment of the prescriber, especially in the case of drugs such as benzodiazepines, which are now well established to be habit-forming, or the emerging data about common, long-lasting and severe SSRI withdrawal symptoms [ 71 , 72 ].…”

Section: Alternative Theory and Researchmentioning

confidence: 99%

From Mental Health Industry to Humane Care. Suggestions for an Alternative Systemic Approach to Distress

Stupak

Dobroczyński

2021

IJERPH

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The article proposes a rough outline of an alternative systemic approach to mental health issues and of a more humane mental health care system. It suggests focusing on understanding mental distress as stemming from problems in living, using medications as agents facilitating psychotherapy, or as a last resort and short-term help, according to the principles of harm reduction. It argues that understanding drugs as psychoactive substances and studying the subjective effects they produce could lead to better utilization of medications and improvements in terms of conceptualizing and assessing treatment effects. Qualitative research could be particularly useful in that regard. It also advocates a radical departure from current diagnostic systems and proposes a synthesis of already existing alternatives to be used for both research and clinical purposes. Accordingly, a general idea for an alternative mental health care system, based on a combination of Open Dialogue Approach, Soteria houses, individual and group psychotherapy, cautious prescribing, services helping with drug discontinuation, peer-led services and social support is presented. The proposition could be seen as a first step towards developing a systemic alternative that could replace the currently dominating approach instead of focusing on implementing partial solutions that can be co-opted by the current one.

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“…The service user and carer community have called for alternatives to antipsychotics and greater support for coming off these drugs, and have tried to fill this unmet need by establishing their own guidance and peer support groups for reducing and stopping psychotropic medications (Framer, 2021;Oedegaard et al, 2020;Read & Sacia, 2020;RRASMQ/ÉRASME, 2014;Smith, 2019). This includes, "The Harm Reduction Guide to coming off Psychiatric Drugs", which has been translated into 17 languages (The Icarus Project and Freedom Center, 2012) and the online site the "Inner Compass Initiative" which links to "The Withdrawal Project", which in 2020 had 215,000 visits from 122 countries (personal communication).…”

Section: Treatment For Schizophrenia and Psychosismentioning

confidence: 99%

Opinion Piece: The case for establishing a minimal medication alternative for psychosis and schizophrenia

et al. 2021

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The development of severe mental health conditions is strongly linked to our environments, particularly experiences of trauma and adversity. However treatments for severe mental health conditions are often primarily biomedical, centred around medication. For people diagnosed with schizophrenia or psychosis, this is antipsychotic medication. Although antipsychotics have been found to reduce symptoms and risk of relapse, some patients derive little benefit from these drugs, and they can lead to severe adverse effects. Subsequently, a high proportion of people do not want to take antipsychotics and request an alternative. Yet in the UK and in many countries there are currently no guidelines for stopping antipsychotics or formal treatment alternatives, despite such alternatives being available in some countries. For example, in Norway and Vermont (USA), in response to pressure from service user organisations, governments have mandated the establishment of "minimal medication" services. We examine whether everyone with a psychotic condition needs long-term antipsychotic treatment and evidence for alternative models of care. We recommend that healthcare providers should be encouraged to develop a psychosocial treatment package for people with psychosis or schizophrenia that provides a realistic possibility of minimising antipsychotic exposure.

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What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications

Cited by 52 publications

References 165 publications

Newer generation antidepressants and withdrawal effects: reconsidering the role of antidepressants and helping patients to stop

Newer generation antidepressants and withdrawal effects: reconsidering the role of antidepressants and helping patients to stop

From Mental Health Industry to Humane Care. Suggestions for an Alternative Systemic Approach to Distress

Opinion Piece: The case for establishing a minimal medication alternative for psychosis and schizophrenia

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