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Onmyway

Ruhe, 2019 Comment on Horowitz, 2019 Tapering of SSRI treatment to mitigate withdrawal symptoms

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Onmyway

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30182-8/fulltext

 

This just came out as a response to the Horrowitz paper. It is proposing a much more aggressive path to discontinuation than the 10%  rule and has tapering schedules for a number of drugs. Seems like they call their version mini tapering and the 10% reduction micro-tapering. They also seem to be against long holds between tapering. 

 

"This Taskforce does not consider prolonged use of any dosage of these discontinuation steps without further attempts of discontinuation as being rational pharmacotherapy. SNRI=serotonin–norepinephrine reuptake inhibitor."

 

Here is the abstract: 

"In their excellent manuscript, published in The Lancet Psychiatry, Mark Horowitz and David Taylor 1  share their personal view on tapering of SSRI treatment to mitigate antidepressant withdrawal symptoms. In the Netherlands, this topic has been raising debate as well, 2 which urged representatives of the Dutch college of General Practitioners, the Royal Dutch Pharmacists Association, the Dutch Association for Psychiatry, and the patient organisation MIND to develop multidisciplinary recommendations for the discontinuation of SSRIs and serotonin–norepinephrine reuptake inhibitors (SNRIs; appendix pp 1–15). Independent of Horowitz and Taylor,1  but with identical reasoning, we proposed reducing doses of SSRIs or SNRIs hyperbolically, and we also advocated the strategy of mini-tapering (tableappendix pp 3–6)."

 

On a positive note, there seems to be a long term trial of discontinuation of SSRIs in the Netherlands. Details here: https://opera-project.nl/

 

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kayjaydee

The details are there......but they're in Dutch!

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Onmyway
1 minute ago, kayjaydee said:

The details are there......but they're in Dutch!

Google translate was decent (it gave me the option on the page as I opened!) 

 

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kayjaydee

I'm failing to find the translation....but never mind, it was only an idle thought to see what it said rather than rely on summaries. I plan to continue with 10% reduction anyway.

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Onmyway

Hi Kayjaydee, I think I misunderstood.

The article itself is in English and the full text is available incl. their proposed tapering schedules. It's just a letter. The Dutch study description is in Dutch but there are no results from it yet, it just talks about the task force and the study design. I think the study will be 2 years+.  This is with Google Translate: 

https://opera-project.nl/

Target

With the OPERA study we want to get more clarity about the reduction of antidepressants. The central question is: does it matter whether you stop taking antidepressants sooner or later after recovery from depression?

Study design

Approximately 2,000 people with depression who have recently started taking antidepressants identify who is recovering. Four hundred recovered patients will be phasing out their antidepressants within a one-year period. Participants are randomly divided into two groups by means of a draw: the early or the later finishing group. After the withdrawal period, the antidepressants are replaced by a placebo pill. Both the doctor and the patient do not know at what time the reduction will start. During and after dismantling, a check is made to see whether symptoms remain away, and how it is going to affect the quality of life, the functioning and the severity of psychological and physical symptoms (side effects, withdrawal symptoms). These outcome measures are (largely online) measured at 10 moments during 2 years after the draw.

Performance

This national research is carried out at general practice and mental healthcare institutions from a consortium of university medical centers throughout the Netherlands (Amsterdam UMC, UMCG, Radboud UMC, Erasmus MC, LUMC). It is also supported by patient organizations and professional organizations (Depression Association, NHG, NVvP, NEDKAD, KNMP, NIVEL). The knowledge and the results of this study about phasing out with antidepressants can be applied in practice.

Read here  the press release about the OPERA project. For more information you can contact the project coordinators Dr. Karlijn Joling (k.joling@vumc.nl) or Dr. Mariska Bot (m.bot@vumc.nl).

 

 

 

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kayjaydee

Interesting that they're doing the study double-blind - that would reduce effects like worrying about feeling worse because you know you're on a lower dose.

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kayjaydee

Thanks, Altostrata, I'll check that out.

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