“Comprehensive Manual for Safely Reducing Antidepressants: Guidelines for Doctors, Pharmacists and Patients”

• Sander Zurhake

  health care editor

As of today, doctors, pharmacists and patients have access to a comprehensive manual to safely reduce the use of all antidepressants. Many doctors lack the knowledge to guide people in this, although these drugs are widely prescribed.

The scientific professional associations of psychiatrists, general practitioners, pharmacists and patient umbrella organization Mind have now formulated guidelines for this. In 2018, they already compiled tapering guidelines for commonly used antidepressants. The new manual also includes a clear step-by-step plan for the other antidepressants.

The need to improve the tapering process is great because many people use antidepressants. For example, 250,000 people take them for a long time. In addition to people with depression, this also concerns people with anxiety disorders, PTSD or neuropathic pain.

Many people want to stop at some point. Sometimes because people have not had depression for years and want to try whether they can do without medication. Other reasons could be the side effects such as sluggishness or decreased libido.

However, tapering off is not always easy. If the tapering goes too fast, people can relapse into depression or psychosis. But there are also withdrawal symptoms such as flu, sleeping problems and heart palpitations. These are not necessarily a precursor to a relapse, but they can arouse anxiety in patients. Sometimes the dosages therefore have to be reduced gradually over a longer period of time.

Psychological complaints can also occur. If they persist for a week after the tapering period, there is a chance of a relapse. A doctor should be aware of that.

“So in addition to guidelines on the dosage, this manual also explains which signals doctors should pay attention to in order to see in time whether there is a risk of a relapse during tapering,” says Eric Ruhe. As a psychiatrist at Radboudumc and on behalf of the professional association of psychiatrists, he co-wrote the document.

“In this way, we hope that more doctors will dare to guide people. Because if you follow the steps, you will go a long way. And if you can’t figure it out, you can consult a psychiatrist or pharmacist. That’s also the beautiful of this multidisciplinary manual, it really is a joint venture of the different disciplines.”

Psychiatrist and professor Christiaan Vinkers of Amsterdam UMC, who was not involved in compiling the manual, is also enthusiastic. “This can really be an important step in making the possibility of phasing out widely accessible, provided that it is sensible. It will not be possible for everyone.”

As co-founder of one of the few specialized outpatient clinics for tapering off, his voice matters. “You have seen a change in thinking about phasing out for the past ten years. And this manual is a concrete example of that”, says Vinkers. “In the past, doctors were mainly happy that there was a well-functioning medicine. There was hardly any thought about tapering back then. Those days are over.”