Gippsland PHN invites General Practitioners and interested health professionals to attend this webinar on the art and science of safely stopping antidepressants and other psychiatric drugs: the Maudsley Deprescribing Guidelines approach.
How to safely stop psychiatric drugs has been relatively neglected in psychiatric teaching and guidelines. We have attempted to fill this gap with the Maudsley Deprescribing Guidelines. The major risks of stopping medications are relapse and withdrawal effects. Withdrawal effects from antidepressants are more common, severe and long-lasting than previously recognised. Protracted withdrawal syndromes occur in some people who have stopped psychiatric medications and can be debilitating.
Antidepressant withdrawal effects can manifest as both psychological and physical symptoms. Poor recognition of these effects can lead to misdiagnosis of relapse of an underlying condition or onset of a new physical or mental health condition. Tips are provided to distinguish these conditions from withdrawal effects. Safely stopping antidepressants and other psychiatric drugs after long-term use in people who have difficulties involves three principles:
- stopping more slowly than previously recommended (months and sometimes years);
- reducing dose at a rate the individual can tolerate (involving some degree of controlled trial and error); and
- reducing according to a hyperbolic pattern (smaller and smaller doses as the total dose gets lower)
The Maudsley Deprescribing Guidelines provides fast, moderate and slow reduction regimens for all licensed antidepressants, benzodiazepines, gabapentinoids and z-drugs, as well as guidance on which formulations of medication are suitable for this approach, including ‘off-label’ options where relevant. It is hoped that this guidance will help prevent some of the difficulties patients have when stopping medication and thus enable rationalisation of medication regimens.
Learning Outcomes:
1. Identify when, why and in whom to stop antidepressants and other psychiatric drugs (e.g., benzodiazepines)
2. Describe the risks of stopping these medications too quickly
3. Distinguish between withdrawal effects and relapse of an underlying condition
4. Apply evidence-based principles to safely taper these drugs classes, adjusted to the individual patient
Presenters Bio: Dr Mark Horowitz MBBS PhD
Dr Mark Horowitz MBBS PhD is Clinical Research Fellow in Psychiatry in the National Health Service (NHS) in England, Visiting Lecturer in Psychopharmacology at King’s College London, and a trainee psychiatrist. He has a PhD from the Institute of Psychiatry, Psychology and Neuroscience at King’s College London in the neurobiology of depression and antidepressant action. He is the lead author of the Maudsley Deprescribing Guidelines, which provides the basis for national guidance in the UK from the NHS for prescribers on how to safely stop psychiatric drugs and has been endorsed by the RACGP in Australia, and the Royal Pharmaceutical Society in the UK.
