Tapering Strips Help People Discontinue Antidepressants

Peter Simons
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A new study by Peter Groot and Jim van Os has found that tapering strips help people successfully discontinue antidepressant medications. The study, published in the journal Psychosis, found that 71% were able to finally succeed using the new tapering strip process. This was especially important since 62% of the participants had made unsuccessful attempts to discontinue their antidepressants in the past, failing due to severe withdrawal symptoms.

“In many parts of the world, prescribing numbers for psychiatric drugs continue to climb and yet we have invested little time and effort into helping people who have come to the end of treatment and wish to stop,” Dr. Groot writes. “Our latest observational study clearly highlights that antidepressant drugs are difficult to stop, and also demonstrates the efficacy of using gradually reducing dosages in Tapering Strips to help people withdraw, while minimizing or avoiding unpleasant symptoms. Tapering Strips can provide a reliable, safe and easy method for patients to work with doctors to reduce their medication burden.”

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Tapering strips have been pioneered by a Dutch non-profit, Cinderella Therapeutics. Tapering strips are personalized medication packages in which each pill has either the same or a slightly smaller dose than the last. Users can use these tapering strips over the course of months to slowly wean themselves off of drugs such as antidepressants. This enables users to have more control over how long their discontinuation process lasts.

Without using tapering strips, there are only two options for discontinuing (besides cold turkey). Users can make large jumps between the doses provided by pharmaceutical companies, which increases the likelihood of severe withdrawal. The other option is to crush or open pills to take only part of the dose. This is problematic because it does not necessarily provide the same dosage—the active medication may not be evenly spread throughout the pill, for instance.

Users have many reasons to discontinue taking antidepressants. In previous studies, adverse effects (such as sexual side effects, weight gain, and emotional blunting) were reported by up to 72% of participants. Participants also expressed concerns about the possible long-term effects of the medications. Additionally, some participants simply felt that they had improved enough that they wanted to determine if they still needed to continue taking the drug.

Unfortunately, many individuals who attempt to discontinue their medication regimen have difficulty doing so. Often, this can be due to withdrawal symptoms, which can be severe and last for months—or even years. These symptoms are described as different from the resurgence of depressive symptoms (for instance, flu-like symptoms, dizziness, or “brain zaps”).

In the current study, 895 users in the Netherlands were attempting to discontinue their antidepressant medication using tapering strips. The median amount of time these users had been on antidepressants was 2-5 years. Sixty-two percent had attempted to stop before—most had tried multiple times.

Almost all (97%) of them had experienced withdrawal symptoms during previous attempts. Half of those (49%) had experienced severe withdrawal, rating their symptoms at the maximum level allowed by the scale used (7 on a scale of 1–7). After using tapering strips, 71% were able to successfully discontinue their medication, which is especially notable since two-thirds had tried and failed to do so previously. Those who succeeded used a median of 2 tapering strips over 56 days.

The length of time needed to taper medication successfully appeared to be correlated with the period of time the person had been taking the drug. Users who had been on antidepressants longer needed significantly more time to taper off the medication successfully.

At the end of the study, an additional 8% of the participants were still trying to taper their antidepressants. Four percent of participants had stopped trying to do so due to severe withdrawal effects, even with the tapering strips. Another 6% had stopped trying to discontinue due to a reemergence of depressive symptoms. Most of the participants were taking either paroxetine (Paxil; 47%) or venlafaxine (Effexor; 43%).

“The finding that 97% of over 600 people who had tried to come off antidepressants had experienced withdrawal effects is alarming,” Dr. Jim Van Os of Masstrict University wrote following the release of the study. “The fact that 49% of them ticked the most extreme level on the severity scale shows that it is unforgivable for professionals to continue to minimize or ignore this issue. It is significantly impacting the lives of millions of people.”

Last month, many people were introduced to the withdrawal effects of antidepressants through a New York Times article entitled “Many People Taking Antidepressants Discover They Cannot Quit.” That article featured the stories of individuals who had tried to discontinue their antidepressant medications, only to discover severe withdrawal symptoms, including dizziness, confusion, and insomnia, as well as nausea and “brain zaps.” Worse, many of the individuals interviewed received little to no help from their prescribers and were not warned that withdrawal effects could occur or be so severe.

Unfortunately, withdrawal effects from antidepressants are not news to the scientific community—although they are rarely so publicly acknowledged. In a 2016 study cited by the New York Times article, researchers surveyed people on antidepressants and found that 73.5% had experienced withdrawal effects. The participants also expressed wanting more and better information on long-term outcomes, discontinuation effects, and support for discontinuation of antidepressants.  Half of the participants in this study stated that they felt “addicted” to antidepressants.

The New York Times article also cited another recent study that found that about half of its participants were unable to discontinue antidepressants due to the severity of withdrawal. That study also found that prescribers were generally unhelpful in the discontinuation process. That same study reported that 86% of those who successfully discontinued were happy with that decision.

 

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Groot, P. C., & van Os, J. (2018). Antidepressant tapering strips to help people come off medication more safely. Psychosis. https://doi.org/10.1080/17522439.2018.1469163

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Peter Simons
MIA-UMB News Team: Peter Simons comes from a background in the humanities where he studied English, philosophy, and art. Now working on his PhD in Counseling Psychology, his recent research has focused on conflicts of interest in the psychopharmaceutical research literature, the use of antipsychotic medications in the treatment of depression, and the general philosophical and sociopolitical implications of psychiatric taxonomy in diagnosis and treatment.

17 COMMENTS

    • It does seem surprisingly, fast. I sent Cinderella Therapeutics an email to ask if they have any 3 month or 6 month follow up data, particularly as it relates to tardive akathisia.

      Despite the points that can be criticized, there is a lot to love in this article. The data they present addresses the enormous scope of the antidepressant withdrawal problems.

      • Here is the email reply:

        Dear Dr. Stuart Shipko,

        It seems to me that withdrawal symptoms are (by definition) unlikely if people start experiencing the symptoms you describe months after they tapered their antidepressant. The most likely explanation would then be relapse, but perhaps there are long term effects of (long term) antidepressant use we do not know enough about yet.

        I think that this issue is important and should be investigated. However,our study was focussed on the taper itself (which was enough work to get it right) and we do therefore not know how people fared after they finished their taper. Hopefully we will be able to follow up people for much longer times in the future.
        with kind regards,
        Peter Groot

        Dr. P.C. Groot
        User Research Centre
        Maastricht Universitair Medical Centre

  1. What I saw in the UK was that they taper you according to the pill size, which means going from a 75% dose to nothing in 3 weeks. They didn’t even suggest cutting the tablets to go slower and said there would be no problem.

    Looking at the dose response of an SSRI (according to the graphic by psychopharmacologist Sheldon Preskorn), that means going from 75% re-uptake inhibition to nothing. Even if you cut the tablets, you are going from 12.5% to nothing, which means dropping from 60% re-uptake inhibition to nothing overnight. You are going to get problems, which is why we need ready access to smaller tablets or tapering strips.

    I actually don’t think they know the basic dose response curve.

  2. Is the Royal College of Psychiatrists going to be sued for ignoring and denying that withdrawing from antidepressants is serious business? There was a complaint because the RCP had deleted the results of their own research on their website, but I don’t know what happened after that.

  3. There is another option for tapering, at least with paxil, and that’s the liquid form. There is some difficulty with a margin of error, due to air bubbles or an extra drop clinging to the dropper, but it does allow for a very tiny taper.

    I was on Paxil some thirteen years, the last four years or so of that was a liquid taper. I had spent 3 years already halving the pills; that’s all that was available then. For about two or two and half years after I took my last dose, I still had the neurological adverse effects like brain zaps. Now those are very infrequent.

    Even tapering over *years*, I still had disabling withdrawal and suicidality. Those of us harmed by these drugs against our knowledge deserve disability coverage during withdrawal, and a new rehab model (for lack of a better word) that can provide a safe, quiet place to stick out the worst times of withdrawal.

      • I don’t use the term disability lightly. I would not call several years of unnecessary drugging, then several years of suicidal withdrawal, years of lost work, sexual dysfunction, and diabetes, etc “lucky”…no one who goes through that is “lucky”.

        But yes I am aware how thin of a line it is to tardive dyskinesia and suicide. I was young when this happened to me, and I worry very much about the effects on children specifically.

        • I have been really well off in my withdrawal. After 22 years on various SSRIs I tapered off Effexor over the course of a year. Was pretty sick with symptoms like Chronic Fatigue Syndrome. Been off for more than 8 months now. Clear headed and the physical pain is bearable. Looking for at home employment.

          Many who have taken these drugs for years become bed ridden when withdrawing. Monica who wrote the blog BeyondMeds barely left her bed for 2 years at the end of her taper. She was lucky enough to have a spouse and alternative healer around. If I had been that bad off I would have been sent to a home!

          • I believe it. I was often bedridden when withdrawing too, and at the very least confined to the house. If not for my family I’m sure I would have been sent off somewhere.

            Did you find the CFS symptoms seemed to kick in during withdrawal? Or were they there before? Physically and neurologically I seemed to feel more fragile as I approached 0 dose, and recovery from each decrease was harder. But it’s tricky for me to disentangle that from other health problems I had at the time.