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The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs

The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs

9781119822981
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Opis
The Maudsley® Deprescribing Guidelines

Comprehensive resource describing guidelines for safely reducing or stopping (deprescribing) antidepressants, benzodiazepines, gabapentinoids and z-drugs for patients, including step-by-step guidance for all commonly used medications, covering common pitfalls, troubleshooting, supportive strategies, and more.

Most formal guidance on psychiatric medication relates to starting or switching medications with minimal guidance on deprescribing medication. In 2023, the World Health Organisation and the United Nations called for patients, as a human right, to be informed of their right to discontinue treatment and to receive support to do so.

The Maudsley Deprescribing Guidelines fills a significant gap in guidance for clinicians by providing comprehensive and authoritative information on this important aspect of treatment.

This evidence-based handbook provides an overview of principles to be used in deprescribing. This is derived from fundamental scientific principles and the latest research on this topic, combined with emerging insights from clinical practice (including from patient experts).

Building on the recognised brand of The Maudsley Prescribing Guidelines, and the prominence of the authors’ work, including in The Lancet Psychiatry on tapering antidepressants (the most read article across all Lancet titles when it was released). The Maudsley Deprescribing Guidelines covers topics such as::

  • Why and when to deprescribe antidepressants, benzodiazepines, gabapentinoids and z-drugs
  • Barriers and enablers to deprescribing including physical dependence, social circumstances, and knowledge about the discontinuation process
  • Distinguishing withdrawal symptoms, such as poor mood, anxiety, insomnia, and a variety of physical symptoms from symptoms of the underlying disorder that medication was intended to treat
  • The difference between physical dependence and addiction/substance use disorder
  • Explanation of why and how to implement hyperbolic tapering in clinical practice
  • Specific guidance on formulations of medication and techniques for making gradual reductions, including using liquid forms of medication, and other approaches
  • Step-by-step guidance for safely stopping all commonly used antidepressants, benzodiazepines, gabapentinoids and z-drugs, including fast, moderate and slow tapering regimens or schedules for each drug, and guidance on how to tailor these to an individual
  • Troubleshooting issues which can arise on stopping these medications, including akathisia, withdrawal symptoms, acute or protracted, and relapse.

Written for anyone interested in safe deprescribing of psychiatric medications including psychiatrists, GPs, pharmacists, nurses, medical trainees, and interested members of the public. The Maudsley Deprescribing Guidelines is an essential resource on the subject that provides practical guidance on how to improve patient outcomes in this field of medicine.

Szczegóły produktu
Wiley-Blackwell
101321
9781119822981

Opis

Rok wydania
2024
Numer wydania
1
Oprawa
miękka foliowana
Liczba stron
592
Wymiary (mm)
168 x 241

  • Preface ix

    Acknowledgements xii

    Notes on Using the Maudsley® Deprescribing Guidelines xiii

    Abbreviations List xv

    Chapter 1 Introduction to Deprescribing Psychiatric Medications 1

    Deprescribing as an Intervention 1

    The context for deprescribing 2

    Why deprescribe? 7

    Barriers and facilitators to deprescribing 11

    Withdrawal Effects from Psychiatric Medications 13

    Mis-diagnosis of withdrawal effects as relapse 13

    Pathophysiology of psychiatric drug withdrawal symptoms 16

    Clinical aspects of psychiatric drug withdrawal 19

    Specific issues in psychiatric drug withdrawal 23

    How to Deprescribe Psychiatric Medications Safely 27

    The neurobiology of tapering 28

    Practical options for prescribing gradually tapering doses 36

    Psychological aspects of tapering 43

    Tapering psychiatric drugs in practice 45

    Further topics 52

    Chapter 2 Safe Deprescribing of Antidepressants 57

    When and Why to Stop Antidepressants 57

    Adverse effects of antidepressants 66

    Discussing deprescribing antidepressants with patients 72

    Withdrawal Effects from Antidepressants 76

    Recent developments in the understanding of antidepressant withdrawal 76

    Pathophysiology of antidepressant withdrawal symptoms 80

    Clinical aspects of antidepressant withdrawal 87

    How common, severe and long- lasting are withdrawal symptoms from antidepressants? 92

    Protracted antidepressant withdrawal syndrome 96

    Post- SSRI sexual dysfunction 98

    Factors influencing development of withdrawal effects 99

    Stratfiying risk of antidepressant withdrawal 105

    Distinguishing antidepressant withdrawal symptoms from relapse 107

    Distinguishing antidepressant withdrawal symptoms from new onset of a physical or mental health condition 111

    Withdrawal symptoms during antidepressant maintenance treatment or switching medication 113

    How to Deprescribe Antidepressants Safely 115

    Tapering antidepressants gradually 119

    Hyperbolic tapering of antidepressants 125

    Practical options in prescribing gradually tapering doses of antidepressants 131

    Psychological aspects of antidepressant tapering 140

    Tapering antidepressants in practice 143

    Managing complications of antidepressant discontinuation 153

    Tapering Guidance for Specific Antidepressants 158

    Agomelatine 159

    Amitriptyline 163

    Bupropion 168

    Citalopram 174

    Clomipramine 183

    Desvenlafaxine 188

    Dosulepin 193

    Doxepin 198

    Duloxetine 203

    Escitalopram 209

    Fluoxetine 216

    Fluvoxamine 223

    Imipramine 228

    Lofepramine 233

    Mirtazapine 238

    Moclobemide 243

    Nortriptyline 248

    Paroxetine 253

    Phenelzine 259

    Sertraline 264

    Tranylcypromine 270

    Trazodone 275

    Venlafaxine 280

    Vilazodone 288

    Vortioxetine 292

    Chapter 3 Safe Deprescribing of Benzodiazepines and Z-drugs 297

    When and Why to Stop Benzodiazepines and Z-drugs 297

    Discussing deprescribing benzodiazepines and z-drugs 304

    Withdrawal Symptoms from Benzodiazepines and Z-drugs 309

    Physical dependence vs addiction in use of benzodiazepines and z-drugs 311

    Pathophysiology of benzodiazepine withdrawal syndrome 313

    Variety of withdrawal symptoms from benzodiazepines and z-drugs 316

    Protracted benzodiazepine withdrawal syndrome 320

    Distinguishing benzodiazepine withdrawal symptoms from return of an underlying condition 323

    Withdrawal symptoms during benzodiazepine maintenance treatment 326

    How to Deprescribe Benzodiazepines and Z-drugs Safely 327

    Tapering benzodiazepines and z-drugs gradually 330

    Hyperbolic tapering of benzodiazepines and z-drugs 332

    Switching to longer-acting benzodiazepines to taper 335

    Making up smaller doses of benzodiazepines and z-drugs practically 338

    Other considerations in tapering benzodiazepines and z-drugs 342

    Psychological aspects of tapering benzodiazepines and z-drugs 345

    Tapering benzodiazepines and z-drugs in practice 348

    Management of complications of benzodiazepine and z-drug discontinuation 358

    Tapering Guidance for Specific Benzodiazepines and Z-drugs 362

    Alprazolam 364

    Buspirone 375

    Chlordiazepoxide 380

    Clonazepam 388

    Clorazepate 396

    Diazepam 404

    Estazolam 412

    Eszopiclone 418

    Flurazepam 423

    Lorazepam 429

    Lormetazepam 440

    Nitrazepam 446

    Oxazepam 452

    Quazepam 461

    Temazepam 467

    Triazolam 474

    Zaleplon 480

    Zolpidem 485

    Zopiclone 490

    Chapter 4 Safe Deprescribing of Gabapentinoids 495

    When and Why to Stop Gabapentinoids 495

    Discussing deprescribing gabapentinoids 504

    Overview of Gabapentinoid Withdrawal Effects 507

    Physical dependence vs addiction in use of gabapentinoids 510

    How to Deprescribe Gabapentinoids Safely 512

    Principles for tapering gabapentinoids 512

    Making up smaller doses of gabapentinoids practically 516

    Other considerations in tapering gabapentinoids 520

    Psychological aspects of tapering gabapentinoids 523

    Tapering gabapentinoids in practice 525

    Management of complications of gabapentinoid discontinuation 532

    Tapering Guidance for Specific Gabapentinoids 537

    Gabapentin 538

    Pregabalin 546

    Index 553

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