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

Akansha Vaswani
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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

© Mad in America 2018

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Akansha Vaswani
MIA-UMB News Team: Akansha Vaswani is a therapist and a researcher with a particular interest in the lived experiences of people’s lives. Her studies in marriage and family therapy strengthened her commitment to social justice, de-colonizing, feminist and social constructionist approaches to therapy. She is currently involved in research examining biases in psychiatric research, the psychosocial aspects of chronic illness, and the effects of structural violence on marginalized communities.

19 COMMENTS

  1. It’s also interesting, Peter only mentions antidepressants. That’s because in the Netherlands, antidepressants should only be taken for no longer than 2 years, and always accompanied by talk therapy. So, withdrawal becomes a real problem, and a way for someone to earn money by specializing in the withdrawal process.

  2. I love the advice. Always in discussion with a medical professional. My particular medical professional had me on klonopin for 8 years, told me it was just a muscle relaxant (where I lived it was called Rivotril). I trusted her and didn’t look into it. Stopped cold turkey, and subsequently had 3 seizures, hallucinations, ended up in hospital. She also tried to get me on Zoloft (I stopped after a month), telling me that people in my situation (taking antipsychotics for many years) tend to become depressed. I wasn’t depressed at the time.

      • Yeah this is typical and precisely why we need to totally cut free of ‘medical professionals’ They only have power and destroy us because we, did trust them. Water titration is THE way to come off these horrors. Get a pill crusher from Amazon/Ebay where ever else, dilute/mix with warm water and pull out small amounts with a syringe thereby precisely reducing the dose, hold on that dose for a week/two weeks what ever you have found you can tolerate before further reduction. You have to work out how long based on your own response and how long you have been on the drug(s) The longer on, the longer coming off, usually months into a year or more.

        If you go down this tapering strip root you need a medical professional to sign the form to prescribe the drugs in precisely reduced dose. And that’s the problem.

        Medical Professionals have destroyed our lives for considerable profit and status. We need to take control of our lifes and demand the hypocritical, selfish, greedy ‘medical professioanls’ significantly compensate us for disability, horrific pain an death.

  3. I stopped listening when he said his “original complaints” came back four months after he ended his taper and so he is back on antidepressants and quite happy with it. I appreciate that he is on the right path with providing people with a sane way to come off their meds, but he falls short in understanding withdrawal. People who were put on these meds for reasons unrelated to depression and anxiety have developed depression and anxiety in that time frame after coming off, so not the “original complaints.” Just because people feel ok coming off with 25% cuts doesn’t mean they still won’t get hit with withdrawal months out. How many of those people who seemed ok with faster tapers ended up back on meds because their original complaint came back in four or so months? I wager that they were hit with delayed withdrawal.

    I know people who did small cuts off mirtazapine with home-made liquids but at a more rapid pace than the recommended three to four weeks, and were fine during the taper; yet, they have been hit with withdrawal months out. Windows and waves.

    It is not helpful to have Groot promoting the relapse scenario and “ADs are helpful for some people” after the good work of developing a tapering system!