#185 Deprescribing Psychotropic Medications with Dr Mark Horowitz
Jun 20, 2024
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Dr Mark Horowitz, a psychiatrist with expertise in antidepressants, discusses safe deprescribing practices, challenges of long-term medication use, withdrawal effects, emotional numbing, and the importance of considering social factors in mental health treatment. He highlights the risks of abrupt discontinuation and the necessity for healthcare professionals to be well-informed about proper deprescribing techniques.
Emphasize fully informed consent when deprescribing psychotropic medications.
Consider alternative treatments due to limited efficacy and withdrawal challenges of antidepressants.
Gradually taper off psychiatric drugs to minimize withdrawal effects and prioritize non-drug interventions.
Deep dives
The Importance of Safe Psychotropic Deprescribing
Ensuring safe and appropriate deprescribing of psychotropics is crucial in healthcare. Dr. Mark Horowitz discusses the relevance of safely discontinuing potent psychotropic medications. The focus is on the right person receiving the medication for the correct duration, emphasizing fully informed consent, understanding risks and benefits, and addressing underlying determinants of mental health.
Challenges and Misconceptions in Antidepressant Use
Antidepressant use poses challenges and misconceptions in healthcare. Studies show antidepressants have limited efficacy, with only a small benefit over placebo. Long-term use leads to adaptation in the brain, making it harder to stop the medication. Withdrawal effects can be severe and long-lasting, including emotional and physical symptoms, impacting patients' lives. It's essential to provide informed consent and explore alternative treatments.
The Debate on Antidepressant Effectiveness and Deprescribing
Understanding antidepressant effectiveness and deprescribing challenges conventional practices. Antidepressants may work by numbing emotions and have various side effects, impacting patients' quality of life. The concept of deprescribing involves safely stopping medication, considering factors like apt duration, patient response, and range of alternatives. Critical appraisal and informed decision-making are vital in addressing mental health treatment approaches.
The Importance of Slowly Tapering Off Antidepressants
One key principle discussed in the podcast is the importance of slowly tapering off antidepressants to minimize withdrawal effects. It is emphasized that rapid withdrawal from psychiatric drugs can lead to severe consequences such as akathisia, which can cause panic, heightened suicidality, and extreme distress. Recommendations suggest that stopping over four weeks may not be suitable for long-term users, urging a much more gradual approach, potentially taking months to over a year for significant drug users.
Mitigating Withdrawal Effects Safely
The podcast highlights the significance of mitigating withdrawal effects while deep prescribing psychiatric drugs, emphasizing non-drug interventions such as relaxation techniques. The discussion underlines the physiological impact of small drug doses on the brain, elucidating that reducing doses slowly and methodically can help manage withdrawal symptoms effectively. Furthermore, the importance of informed consent, shared decision-making, and diligent monitoring during the deep prescribing process is stressed to ensure patient safety and minimize risks associated with abrupt discontinuation.
Dr Mark Horowitz is a training psychiatrist, split between UK and Australia, working in London as a Clinical Research Fellow in the NHS and an Honorary Clinical Research Fellow at University College London. He has completed a PhD in the neurobiology of depression and the pharmacology of antidepressants at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London and for this received two prizes from the British Association of Psychopharmacology. He is also the lead author of the recently published Maudsley Deprescribing Guidelines, a handbook on how to safely stop psychiatric drugs.
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