Tapering (medicine)

In medicine, tapering is the practice of gradually reducing the dosage of a medication to reduce or discontinue it. Generally, tapering is done is to avoid or minimize withdrawal symptoms that arise from neurobiological adaptation to the drug.[1][2]

Prescribed psychotropic drugs that may require tapering due to this physical dependence include opioids,[3][4][5] selective serotonin reuptake inhibitors,[6] antipsychotics,[7] anticonvulsants,[8] and benzodiazepines.[9][10]

Cross-tapering

Cross-tapering refers to the practice of a reducing one drug, while introducing a new medication that is titrated to an effective dose. This can be used, for example, when changing antipsychotic medications.[11]: 156 

Peer support groups

Peer support groups, such as survivingantidepressants.org, provide a medium where those tapering medication can discuss approaches and withdrawal symptoms.[12] Surviving antidepressants advocate for a slower rate of tapering than that used in standard medical practice.[13]: 4  Many such groups exist on Facebook and other social media platforms.[14] Along with sharing tapering tips, members of the groups discuss the risks of prescription cascade, where withdrawal symptoms or the side effects of a psychotropic medication result in further medication, and the risk of neurobiological "kindling" effects where repeated unsuccessful withdrawal attempts yield progressively poor results upon drug reinstatement or, later, may increase the risk of withdrawal symptoms.[15][16][13]: 5 

See also

References
  1. Reidenberg, Marcus M. (2011-11-01). "Drug Discontinuation Effects Are Part of the Pharmacology of a Drug". Journal of Pharmacology and Experimental Therapeutics. 339 (2): 324–328. doi:10.1124/jpet.111.183285. ISSN 0022-3565. PMC 3200000. PMID 21849624.
  2. Lerner, Alicja; Klein, Michael (2019-01-01). "Dependence, withdrawal and rebound of CNS drugs: an update and regulatory considerations for new drugs development". Brain Communications. 1 (1): fcz025. doi:10.1093/braincomms/fcz025. ISSN 2632-1297. PMC 7425303. PMID 32954266.
  3. Dowell, Deborah; Haegerich, Tamara M.; Chou, Roger (2016). "CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016". MMWR. Recommendations and Reports. 65 (15): 1624–1645. doi:10.15585/mmwr.rr6501e1er. ISSN 1057-5987. PMC 6390846. PMID 26977696.
  4. Centers for Disease Control and Prevention. Pocket guide: tapering opioids for chronic pain. https://www.cdc.gov/drugoverdose/pdf/clinical_pocket_guide_tapering-a.pdf. Accessed July 30, 2023.
  5. Davis, Mellar P.; Digwood, Glen; Mehta, Zankhana; McPherson, Mary Lynn (2020). "Tapering opioids: a comprehensive qualitative review". Annals of Palliative Medicine. 9 (2): 586–610. doi:10.21037/apm.2019.12.10. PMID 32008341.
  6. Horowitz, Mark Abie; Taylor, David (2019). "Tapering of SSRI treatment to mitigate withdrawal symptoms". The Lancet Psychiatry. 6 (6): 538–546. doi:10.1016/s2215-0366(19)30032-x. ISSN 2215-0366. PMID 30850328. S2CID 73507008.
  7. Potla, Shanthi; Al Qabandi, Yousif; Nandula, Savitri Aninditha; Boddepalli, Chinmayi Sree; Gutlapalli, Sai Dheeraj; Lavu, Vamsi Krishna; Abdelwahab Mohamed Abdelwahab, Rana; Huang, Ruimin; Hamid, Pousette (2023-02-07). "A Systematic Review of the Need for Guideline Recommendations; Slow Tapering vs. Maintenance Dose in Long-Term Antipsychotic Treatment: 2022". Cureus. 15 (2): e34746. doi:10.7759/cureus.34746. ISSN 2168-8184. PMC 9904861. PMID 36777974.
  8. Schachter, Steven C. (2018). "Determining when to stop antiepileptic drug treatment". Current Opinion in Neurology. 31 (2): 211–215. doi:10.1097/WCO.0000000000000530. ISSN 1350-7540. PMID 29324507. S2CID 206124004.
  9. FDA. (2020). U.S. Food and Drug Administration FDA Requiring Boxed Warning Updated to Improve Safe Use of Benzodiazepine Drug Class Includes Potential for Abuse, Addiction, and Other Serious Risks.https://www.fda.gov/media/142368/download
  10. Baandrup, Lone; Ebdrup, Bjørn H; Rasmussen, Jesper Ø; Lindschou, Jane; Gluud, Christian; Glenthøj, Birte Y (2018-03-15). Cochrane Drugs and Alcohol Group (ed.). "Pharmacological interventions for benzodiazepine discontinuation in chronic benzodiazepine users". Cochrane Database of Systematic Reviews. 2018 (3): CD011481. doi:10.1002/14651858.CD011481.pub2. PMC 6513394. PMID 29543325.
  11. Keks, Nicholas; Schwartz, Darren; Hope, Judy (2019-10-01). "Stopping and switching antipsychotic drugs". Australian Prescriber. 42 (5): 152–157. doi:10.18773/austprescr.2019.052. PMC 6787301. PMID 31631928.
  12. Hengartner, Michael P.; Schulthess, Lukas; Sorensen, Anders; Framer, Adele (2020). "Protracted withdrawal syndrome after stopping antidepressants: a descriptive quantitative analysis of consumer narratives from a large internet forum". Therapeutic Advances in Psychopharmacology. 10: 204512532098057. doi:10.1177/2045125320980573. ISSN 2045-1253. PMC 7768871. PMID 33489088.
  13. Framer, Adele (2021). "What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications". Therapeutic Advances in Psychopharmacology. 11: 204512532199127. doi:10.1177/2045125321991274. ISSN 2045-1253. PMC 7970174. PMID 33796265.
  14. White, Edward; Read, John; Julo, Sherry (2021). "The role of Facebook groups in the management and raising of awareness of antidepressant withdrawal: is social media filling the void left by health services?". Therapeutic Advances in Psychopharmacology. 11: 204512532098117. doi:10.1177/2045125320981174. ISSN 2045-1253. PMC 7816538. PMID 33520155.
  15. Amsterdam, Jay D.; Lorenzo-Luaces, Lorenzo; DeRubeis, Robert J. (2016). "Step-wise loss of antidepressant effectiveness with repeated antidepressant trials in bipolar II depression". Bipolar Disorders. 18 (7): 563–570. doi:10.1111/bdi.12442. ISSN 1399-5618. PMC 5123793. PMID 27805299.
  16. Fava, Giovanni A. (2020). "May antidepressant drugs worsen the conditions they are supposed to treat? The clinical foundations of the oppositional model of tolerance". Therapeutic Advances in Psychopharmacology. 10: 204512532097032. doi:10.1177/2045125320970325. ISSN 2045-1253. PMC 7649913. PMID 33224471.
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