Tapering (medicine)

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In medicine, tapering is the practice of gradually reducing the dosage of a medication to reduce or discontinue it. Generally, tapering is done is to avoid or minimize withdrawal symptoms that arise from neurobiological adaptation to the drug. [1] [2]

Contents

Prescribed psychotropic drugs that may require tapering due to this physical dependence include opioids, [3] [4] [5] selective serotonin reuptake inhibitors, [6] antipsychotics, [7] anticonvulsants, [8] and benzodiazepines. [9] [10]

Cross-tapering

Cross-tapering refers to the practice of a reducing one drug, while introducing a new medication that is titrated to an effective dose. This can be used, for example, when changing antipsychotic medications. [11] : 156 

Peer support groups

Peer support groups, such as survivingantidepressants.org, provide a medium where those tapering medication can discuss approaches and withdrawal symptoms. [12] Surviving antidepressants advocate for a slower rate of tapering than that used in standard medical practice. [13] : 4  Many such groups exist on Facebook and other social media platforms. [14] Along with sharing tapering tips, members of the groups discuss the risks of prescription cascade, where withdrawal symptoms or the side effects of a psychotropic medication result in further medication, and the risk of neurobiological "kindling" effects where repeated unsuccessful withdrawal attempts yield progressively poor results upon drug reinstatement or, later, may increase the risk of withdrawal symptoms. [15] [16] [13] : 5 

See also

Related Research Articles

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<span class="mw-page-title-main">Antipsychotic</span> Class of medications

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<span class="mw-page-title-main">Benzodiazepine</span> Class of depressant drugs

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<span class="mw-page-title-main">Psychopharmacology</span> Study of the effects of psychoactive drugs

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<span class="mw-page-title-main">Atypical antipsychotic</span> Class of pharmaceutical drugs

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<span class="mw-page-title-main">Diazepam</span> Benzodiazepine sedative

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<span class="mw-page-title-main">Flumazenil</span> GABA receptor antagonist drug and benzodiazepine antidote

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<span class="mw-page-title-main">Oxazepam</span> Benzodiazepine medication

Oxazepam is a short-to-intermediate-acting benzodiazepine. Oxazepam is used for the treatment of anxiety and insomnia and in the control of symptoms of alcohol withdrawal syndrome.

Physical dependence is a physical condition caused by chronic use of a tolerance-forming drug, in which abrupt or gradual drug withdrawal causes unpleasant physical symptoms. Physical dependence can develop from low-dose therapeutic use of certain medications such as benzodiazepines, opioids, stimulants, antiepileptics and antidepressants, as well as the recreational misuse of drugs such as alcohol, opioids and benzodiazepines. The higher the dose used, the greater the duration of use, and the earlier age use began are predictive of worsened physical dependence and thus more severe withdrawal syndromes. Acute withdrawal syndromes can last days, weeks or months. Protracted withdrawal syndrome, also known as post-acute-withdrawal syndrome or "PAWS", is a low-grade continuation of some of the symptoms of acute withdrawal, typically in a remitting-relapsing pattern, often resulting in relapse and prolonged disability of a degree to preclude the possibility of lawful employment. Protracted withdrawal syndrome can last for months, years, or depending on individual factors, indefinitely. Protracted withdrawal syndrome is noted to be most often caused by benzodiazepines. To dispel the popular misassociation with addiction, physical dependence to medications is sometimes compared to dependence on insulin by persons with diabetes.

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<span class="mw-page-title-main">Amisulpride</span> Atypical antipsychotic and antiemetic medication

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Antidepressant discontinuation syndrome, also called antidepressant withdrawal syndrome, is a condition that can occur following the interruption, reduction, or discontinuation of antidepressant medication following its continuous use of at least a month. The symptoms may include flu-like symptoms, trouble sleeping, nausea, poor balance, sensory changes, akathisia, intrusive thoughts, depersonalization and derealization, mania, anxiety, and depression. The problem usually begins within three days and may last for several weeks or months. Rarely psychosis may occur.

<span class="mw-page-title-main">Benzodiazepine withdrawal syndrome</span> Signs and symptoms due to benzodiazepines discontinuation in physically dependent persons

Benzodiazepine withdrawal syndrome is the cluster of signs and symptoms that may emerge when a person who has been taking benzodiazepines as prescribed develops a physical dependence on them and then reduces the dose or stops taking them without a safe taper schedule.

<span class="mw-page-title-main">David Taylor (professor)</span>

David Taylor FFRPS FRPharmS is a British professor. He is the head of the Pharmaceutical Sciences Clinical Academic Group within King's Health Partners. Taylor has been lead author and editor of the Maudsley Prescribing Guidelines in Psychiatry since 1994. In 2014, Taylor was named as one of the top 100 clinical leaders in the UK National Health Service.

References

  1. ↑ Reidenberg, Marcus M. (2011-11-01). "Drug Discontinuation Effects Are Part of the Pharmacology of a Drug". Journal of Pharmacology and Experimental Therapeutics. 339 (2): 324–328. doi:10.1124/jpet.111.183285. ISSN   0022-3565. PMC   3200000 . PMID   21849624.
  2. ↑ Lerner, Alicja; Klein, Michael (2019-01-01). "Dependence, withdrawal and rebound of CNS drugs: an update and regulatory considerations for new drugs development". Brain Communications. 1 (1): fcz025. doi:10.1093/braincomms/fcz025. ISSN   2632-1297. PMC   7425303 . PMID   32954266.
  3. ↑ Dowell, Deborah; Haegerich, Tamara M.; Chou, Roger (2016). "CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016". MMWR. Recommendations and Reports. 65 (15): 1624–1645. doi:10.15585/mmwr.rr6501e1er. ISSN   1057-5987. PMC   6390846 . PMID   26977696.
  4. ↑ Centers for Disease Control and Prevention. Pocket guide: tapering opioids for chronic pain. https://www.cdc.gov/drugoverdose/pdf/clinical_pocket_guide_tapering-a.pdf . Accessed July 30, 2023.
  5. ↑ Davis, Mellar P.; Digwood, Glen; Mehta, Zankhana; McPherson, Mary Lynn (2020). "Tapering opioids: a comprehensive qualitative review". Annals of Palliative Medicine. 9 (2): 586–610. doi: 10.21037/apm.2019.12.10 . PMID   32008341.
  6. ↑ Horowitz, Mark Abie; Taylor, David (2019). "Tapering of SSRI treatment to mitigate withdrawal symptoms". The Lancet Psychiatry. 6 (6): 538–546. doi:10.1016/s2215-0366(19)30032-x. ISSN   2215-0366. PMID   30850328. S2CID   73507008.
  7. ↑ Potla, Shanthi; Al Qabandi, Yousif; Nandula, Savitri Aninditha; Boddepalli, Chinmayi Sree; Gutlapalli, Sai Dheeraj; Lavu, Vamsi Krishna; Abdelwahab Mohamed Abdelwahab, Rana; Huang, Ruimin; Hamid, Pousette (2023-02-07). "A Systematic Review of the Need for Guideline Recommendations; Slow Tapering vs. Maintenance Dose in Long-Term Antipsychotic Treatment: 2022". Cureus. 15 (2): e34746. doi: 10.7759/cureus.34746 . ISSN   2168-8184. PMC   9904861 . PMID   36777974.
  8. ↑ Schachter, Steven C. (2018). "Determining when to stop antiepileptic drug treatment". Current Opinion in Neurology. 31 (2): 211–215. doi:10.1097/WCO.0000000000000530. ISSN   1350-7540. PMID   29324507. S2CID   206124004.
  9. ↑ FDA. (2020). U.S. Food and Drug Administration FDA Requiring Boxed Warning Updated to Improve Safe Use of Benzodiazepine Drug Class Includes Potential for Abuse, Addiction, and Other Serious Risks.https://www.fda.gov/media/142368/download
  10. ↑ Baandrup, Lone; Ebdrup, Bjørn H; Rasmussen, Jesper Ø; Lindschou, Jane; Gluud, Christian; Glenthøj, Birte Y (2018-03-15). Cochrane Drugs and Alcohol Group (ed.). "Pharmacological interventions for benzodiazepine discontinuation in chronic benzodiazepine users". Cochrane Database of Systematic Reviews. 2018 (3): CD011481. doi:10.1002/14651858.CD011481.pub2. PMC   6513394 . PMID   29543325.
  11. ↑ Keks, Nicholas; Schwartz, Darren; Hope, Judy (2019-10-01). "Stopping and switching antipsychotic drugs". Australian Prescriber. 42 (5): 152–157. doi:10.18773/austprescr.2019.052. PMC   6787301 . PMID   31631928.
  12. ↑ Hengartner, Michael P.; Schulthess, Lukas; Sorensen, Anders; Framer, Adele (2020). "Protracted withdrawal syndrome after stopping antidepressants: a descriptive quantitative analysis of consumer narratives from a large internet forum". Therapeutic Advances in Psychopharmacology. 10: 204512532098057. doi:10.1177/2045125320980573. ISSN   2045-1253. PMC   7768871 . PMID   33489088.
  13. 1 2 Framer, Adele (2021). "What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications". Therapeutic Advances in Psychopharmacology. 11: 204512532199127. doi:10.1177/2045125321991274. ISSN   2045-1253. PMC   7970174 . PMID   33796265.
  14. ↑ White, Edward; Read, John; Julo, Sherry (2021). "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?". Therapeutic Advances in Psychopharmacology. 11: 204512532098117. doi:10.1177/2045125320981174. ISSN   2045-1253. PMC   7816538 . PMID   33520155.
  15. ↑ Amsterdam, Jay D.; Lorenzo-Luaces, Lorenzo; DeRubeis, Robert J. (2016). "Step-wise loss of antidepressant effectiveness with repeated antidepressant trials in bipolar II depression". Bipolar Disorders. 18 (7): 563–570. doi:10.1111/bdi.12442. ISSN   1399-5618. PMC   5123793 . PMID   27805299.
  16. ↑ Fava, Giovanni A. (2020). "May antidepressant drugs worsen the conditions they are supposed to treat? The clinical foundations of the oppositional model of tolerance". Therapeutic Advances in Psychopharmacology. 10: 204512532097032. doi:10.1177/2045125320970325. ISSN   2045-1253. PMC   7649913 . PMID   33224471.
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