Safely stopping antidepressants and other psychiatric drugs in clinical practice

Wednesday 12 February 2025 | 7:00pm-8:45pm AEDT

How to safely stop antidepressants and other psychiatric drugs has been relatively neglected in psychiatric teaching and guidelines. Many patients report significant harm from the process of stopping in the form of severe and prolonged withdrawal effects. We have attempted to fill this gap in guidance with The Maudsley Deprescribing Guidelines.

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 mis-diagnosis 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.

There have been advances in the science of stopping antidepressants leading to updated guidelines in the UK outlining gradual, hyperbolic tapering.

Safely stopping antidepressants and other psychiatric drugs after long-term use in people who have difficulties involves three principles:

1. 1. stopping more slowly than previously recommended (months and sometimes years);
   2. reducing dose at a rate the individual can tolerate (involving some degree of controlled trial and error); and
   3. 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.

Objectives:

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

Includes 15 minutes for live Q&A.