Bonebase

Urology Grand Rounds

Sponsored by the University of Connecticut School of Medicine and the Department of Psychiatry
~ There is no CME credit associated with this session ~

Target Audience: UConn Health faculty, residents, medical students, and other mental health professionals

Learning Objectives:
1. Identify when, why and in whom to stop antidepressants and other psychiatric drugs
2. Describe the risks of stopping these medications too quickly
3. Be able to distinguish between withdrawal effects from these drugs and relapse of an underlying condition
4. Be able to apply the latest principles in safe tapering to stopping these drugs classes, adjusted to the individual patient

Summary:
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 on stopping medication are relapse and withdrawal effects. Withdrawal effects from antidepressants are more common, severe and long-lasting than previously recognized. 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 rationalization of medication regimens.

About the Speaker: 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 Royal College of General Practice in Australia, and the Royal Pharmaceutical Society in the UK.

He co-authored the recent Royal College of Psychiatrists’ guidance on ‘Stopping Antidepressants’, and his work informed the recent NICE guidelines on safe tapering of psychiatric medications, including antidepressants, benzodiazepines and z-drugs. He has worked with the NHS to develop national guidance for safe deprescribing for clinicians and has been commissioned by Health Education England to prepare a teaching module on how to safely stop antidepressants for the NHS.

He has written several papers about safe approaches to tapering psychiatric medications including publications in The Lancet Psychiatry, JAMA Psychiatry and Schizophrenia Bulletin. He is an Associate Editor of the journal Therapeutic Advances in Psychopharmacology. He has an interest in rational psychopharmacology and deprescribing psychiatric medication. He has experienced the difficulty of coming off psychiatric medications firsthand which has informed much of his work.

For more information, contact: Sharon Freeman at sfreeman@uchc.edu, 860-679-1283

CAM Presentation

Speaker: Jinhong Dong

Title: TBD 

Via Webex: https://uconnhealth.webex.com/meet/pmendes

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