More about ‘tapering kits’

On this page I have tried to cover some of the main questions you may have about tapering kits. If you have other questions that you think would be useful please contact me and I'll gladly add them.

Why would someone want to stop taking their antidepressant?

There are actually a number of reasons that someone may want to stop:
  • The person may feel better and wish to stop.
  • They may want to try an alternative form of therapy or drug.
  • They may be prescribed a second medication for a different issue that is incompatible with an antidepressant.
  • The drug manufacturer may have stopped manufacturing the drug in question.
  • The side effects of the drug in question may be too much to tolerate.
  • Or they may simply feel that there was no benefit to being on the drug.
Who would benefit?

The user
  • The user can safely and confidently reduce their dosage over time.
  • The user can minimise the unpleasant effects of withdrawal.
  • Stopping the drug is likely to significantly reduce the unintended long-term consequences of the drug compared to someone who were to take it for life.
  • If a drug is stopped by the manufacturer there is a safe way of coming off the drug for the user.
  • When starting a new drug there is the reassurance of knowing that there is an accepted method of stopping at the end of treatment.
The GP/Psychiatrist
  • The GP/Psychiatrist can prescribe with the confidence of knowing that the risks of withdrawal are minimised.
  • The GP/Psychiatrist can focus on the patients recovery rather than the effects of withdrawal.
  • The patient is likely to need less time compared to someone attempting to stop without structured support.
The NHS
  • A significant and ongoing reduction in antidepressant prescription costs (£780,000 per day in 2015).
  • Less treatment required for the unintended long-term consequences of the drug compared to someone who were to take it for life.
Pharmaceutical manufacturers
  • A huge boost in public confidence and a positive good news story.
  • The opportunity to phase out older drugs with less risk of extensive and expensive litigation.

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What is the ‘right’ way to taper?

This is an area that needs more research, preferably some high quality randomised controlled trials to demonstrate that tapering is the most effective way to minimise withdrawal effects and to determine the best approach.

In his book, Coming off Antidepressants, Joseph Glenmullen M.D. proposes a number of tapering regimes based on a study of patients and that differ by individual drug half-life. If you want to understand the details that need to be considered when tapering, this book is a great place to start
amazon uk link amazon us link

As an example, let’s assume that a patient is taking a tablet which, at 10mg, is the lowest dosage available in pill form. The tapering kit would get the patient from 10mg to 0mg over a period of 14 months using the following reductions.

table

In the above table, while the percentage reduction increases, the amount of reduction in milligrams decreases over time. Please note that this is just an example, the details would have to be worked out by people much cleverer than me!

Are there any drawbacks with this method?

This approach is not meant for everyone, some users will be able to reduce more quickly while others may want to reduce more slowly. Good quality randomised controlled trials are the best way to determine the most effective approach.

There is a cost to factor in for the drug manufacturers to produce tablets in decreasing dosages, but this has to be weighed against the potential costs of litigation and the costs of reversing the negative public perception that surrounds the prescribing of these drugs.

Please note that you should never make changes to your psychoactive medications without the agreement and support of your Doctor or Psychiatrist.