Mad in America: Rethinking Mental Health

Peter Groot and Akansha Vaswani - Tapering Strips and Shared Decision-Making

Jul 6, 2018

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On MIA Radio this week, Akansha Vaswani and Dr Peter Groot discuss Tapering Strips, a novel and practical solution for those who wish to taper gradually from a range of prescription drugs.

Akansha is a doctoral candidate at the University of Massachusetts, Boston and her dissertation research will involve interviewing psychiatrists in the US about their experiences helping people stop or reduce their dose of antidepressant medication. Dr Groot is a researcher and geneticist who has led the development of Tapering Strips.

In a recent study, published in the journal Psychosis, Dr Groot, together with Jim van Os, reported on the results of their trial which recorded the experiences of people using Tapering Strips.

In this episode we discuss:

What motivated Peter to be interested in and study the effects of coming off antidepressants drugs.
That the observational study reported in Psychosis was based on questionnaires completed by users who had made use of tapering medication (Tapering Strips) to slowly reduce their medication dosage.
How the questionnaire asked about withdrawal symptoms and the ease of tapering using the strips and whether people had tried to withdraw previously using conventional methods.
That Tapering Strips offer a flexible and necessary addition to standard doses that have been registered by the pharmaceutical companies.
That current guidelines advise doctors to let patients start on the same recommended dose of an antidepressant, without taking into account large differences that exist between patients (weight, sex, etc).
How we would be surprised if, when we came to buy shoes or clothes, our choices were limited to only a few sizes, but we don't question this limitation with our medications.
How current guidelines are based on group averages and do not help a doctor to determine how a given individual patient should taper.
How shared decision making, in which the patient and the doctor work in a collaborative way, can make tapering easier.
How shared decision making has contributed to the success of the use of tapering medication and the availability of tapering medication makes shared decision making practically possible.
How shared decision and the availability of tapering medication makes life easier for the doctor as well as for the patient.
How working initially as a volunteer to develop Tapering Strips brought Peter into contact with Professor Jim van Os and the User Research Centre of Maastricht University.
That, in the study, 1,750 questionnaires were sent, with 1,164 received, a response rate of 68%.
Of those returned, 895 said their goal was to taper their antidepressant drug completely and 70% succeeded in this goal.
That the median time taken for people in the study to withdraw from Venlafaxine was 56 days or two Tapering Strips.
There were a variety of reasons reported for those who didn't reach their goal, including the fact that some of the patients were still tapering.
Other reasons reported for not withdrawing completely were due to the occurrence of withdrawal symptoms, relapse of an original condition or even issues related to reimbursement of the cost of the tapering medication by insurance companies.
That 692 patients reported that previous attempts to withdraw had failed in comparison to the successful use of Tapering Strips.
That people using multiple drugs should only ever taper one medication at a time and in discussion with a medical professional.
That Peter's goal for Tapering Strips is to make sure that people that want to withdrawal gradually can access Tapering Strips and have the cost reimbursed by health insurers.
That Tapering Strips were not developed to get everyone off their antidepressant drug but to enable patients to get to a dosage that provides benefit for them (which can be zero) while minimising adverse effects.
That people outside the Netherlands can get Tapering Medication, but only with a prescription signed by a certified doctor, instructions and receipt/order forms can be found at taperingstrip.org.
That Tapering Strips are also available for antipsychotics, sedatives (benzodiazepines), analgesics and for some drugs other than psychotropics, like some anti-epileptic drugs, which are currently being developed.
That Peter warns against tapering by taking doses on alternating days, particularly for drugs like paroxetine or venlafaxine that have a short metabolic half-life, because this will lead to more severe withdrawal symptoms.

Relevant Links:

Tapering Strips (website of the User Research Centre of Maastricht University)

Treatment guidelines for the use of tapering strips

Summary of the tapering study in the journal Psychosis (blog)

Tapering Strips study from the journal Psychosis

Peter Groot interviewed on Let's Talk Withdrawal

Claire shares her experience with Tapering Strips (YouTube)

Petition requesting use of Tapering Strips in the UK

Mad in America report on Tapering strips study

Prime Time for Shared Decision Making

Mandatory Shared Decision Making