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Horowitz, 2021: A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse


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Schizophrenia Bulletin 2021, March 23, https://doi.org/10.1093/schbul/sbab017

 

 

A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse

 

Mark Abie Horowitz, Sameer Jauhar, Sridhar Natesan, Robin M Murray, David Taylor

 

 

Full text PDF: https://academic.oup.com/schizophreniabulletin/advance-article-pdf/doi/10.1093/schbul/sbab017/36645212/sbab017.pdf

 

 

News article with additional comments from Dr. Mark Horowitz, Prof. David Taylor and others regarding this paper:  https://metro.co.uk/2021/03/23/new-paper-on-how-to-stop-antipsychotic-drugs-deemed-historic-breakthrough-14287804/

 

 

Open letter from Chairman Prof. John Read of IIPDW to the National Institute for Health and Care Excellence (NICE) in the UK regarding this paper: https://iipdw.org/open-letter-to-nice/

 

 

Abstract:

 

"The process of stopping antipsychotics may be causally related to relapse, potentially linked to neuroadaptations that persist after cessation, including dopaminergic hypersensitivity. Therefore, the risk of relapse on cessation of antipsychotics may be minimized by more gradual tapering. There is converging evidence that suggests that adaptations to antipsychotic exposure can persist for months or years after stopping the medication—from animal studies, observation of tardive dyskinesia in patients, and the clustering of relapses in this time period after the cessation of antipsychotics.

 

Furthermore, PET imaging demonstrates a hyperbolic relationship between doses of antipsychotic and D2 receptor blockade. We, therefore, suggest that when antipsychotics are reduced, it should be done gradually (over months or years) and in a hyperbolic manner (to reduce D2 blockade “evenly”): ie, reducing by one quarter (or one half) of the most recent dose of antipsychotic, equivalent approximately to a reduction of 5 (or 10) percentage points of its D2 blockade, sequentially (so that reductions become smaller and smaller in size as total dose decreases), at intervals of 3–6 months, titrated to individual tolerance. Some patients may prefer to taper at 10% or less of their most recent dose each month.

 

This process might allow underlying adaptations time to resolve, possibly reducing the risk of relapse on discontinuation. Final doses before complete cessation may need to be as small as 1/40th a therapeutic dose to prevent a large decrease in D2 blockade when stopped. This proposal should be tested in randomized controlled trials."

 

 

 

 

2022 IMPORTANT WITHDRAWAL SURVEY, PLEASE PARTICIPATE: https://uelpsych.eu.qualtrics.com/jfe/form/SV_0AR9IsQ61jsiXBk

 

non-native speaker of english

2020: 3-March -> started Mirtazapine 15mg;

3-March to 6-April -> approx. cutting to 0 mg; 6-April to 20-April -> ~ 7,5 mg; 21-April to 31-April -> 15 mg; 1-May to 13-May -> ~ 10 mg (approx.); 15-May to 19-July -> 15 mg (psychosomatic clinic) 19-July -> started taper (scale and file) 14 mg (-6,6%); 08-August -> 12 mg (-14,3 %); 27-August -> 10 mg (-16,6 %); 15-September -> 8 mg (-20 %, bad idea, heavy WD); 23-September -> 10.2 mg (+20 %, 102 mgpw)

2021: 12-April to 12-May -> crossover from solid pill to DIY liquid (water only), 10.2 mg, not stable; 10-September -> back to crushing and weighing, still 10.2 mg (102 mgpw)

2022: 13-March -> changed to DIY liquid with suspension vehicle, 10.2 mg (dose feels much more consistent now)

 

Supplements: 1 x ~125 mg magnesiumbiglycinate before bed, low histamine diet

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