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Read, Moncrieff, and Horowitz (2023), Designing withdrawal support services for antidepressant users: Patients’ views on existing services and what they really need


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Journal of Psychiatric Research. 2023: https://doi.org/10.1016/j.jpsychires.2023.03.013

 

Full article: Designing withdrawal support services for antidepressant users

 

Abstract

Background

Public Health England has recommended that services be put in place to support people who choose to withdraw from antidepressants because of a current gap. This study aims to explore the views of members of online withdrawal peer-support groups about existing healthcare and what additional support is needed.

Methods

The administrators of 15 online support groups for people stopping antidepressants were asked to advertise an online survey to their members. The survey, which was online from May 2021 to April 2022, was completed by 1276 people from 49 countries.

 

Results

71% of respondents found their doctors' advice unhelpful (57% ‘very unhelpful’) regarding stopping an antidepressant; the main reasons being ‘Recommended a reduction rate that was too quick for me’, ‘Not familiar enough with withdrawal symptoms to advise me’ and ‘Suggested stopping antidepressants would not cause withdrawal symptoms’. One in three did not seek advice from their prescriber when deciding whether to withdraw, with the main reasons being ‘I felt they would not be supportive’ (58%) and ‘I felt that they didn't have the expertise to help me’ (51%). The most common prescriber responses to those who did seek advice was ‘Suggested a quick withdrawal schedule’ (56%) and ‘Not supportive and offered no guidance' (27%). The most common discontinuation periods recommended by doctors were one month (23%) and two weeks (19%). A range of potential professional services were rated ‘very useful’, most frequently: ‘Access to smaller doses (e.g. tapering strips, liquid, smaller dose tablets) to ensure gradual reduction’ (88%) and ‘A health professional providing a personalised, flexible reduction plan’ (79%).

1988-2012: Prozac @ 60mg (with a few stops and starts)

Fall 2012: Returned to 40mg after discontinuing and horrid withdrawal 

Fall 2013: 40mg Fluoxetine, added 150mg Wellbutrin to treat fatigue 

Winter 2014: Attempting to taper both (too fast)

April 2014: 9mg Fluoxetine + 37.5 Wellbutrin 

Summer 2014: 8 mg Fluoxetine + 0 Wellbutrin (way too fast a drop)

Late summer/Early Fall 2014: Debilitating Withdrawal symptoms 

Fall 2014 - Wellbutrin successfully kicked to the curb but…

Oct- Dec 2014: Panicked reinstatement of Fluoxetine ->30mg - held for 5yrs

Jan 2021: taper to 20mg Fluoxetine  then tapering by 1mg every 2-3 months

Fall 2022 - held at 10mg->December 2022: 9mg->Feb 2023: 8mg ->March 2023: brassmonkey slide begins: 7.8mg -> 7.6 -> 7.4->2 week hold (April)->7.2->7mg->6.8->2 week hold->6.6-> 1-month hold ->(June)-6.5->4-week hold-> (July)-6.4 (discontinued brassmonkey slide and slowed taper)-> (Aug)-6.2->(Sept)-6.0->(Oct)-5.9->(Nov)-5.8->(Dec)-5.7->wave!->(Jan)-5.8->(Feb)-6mg and holding.

 

My 2014 withdrawal experience: https://rxisk.org/antidepressant-withdrawal-a-prozac-story/

 

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