Acceptability and optimisation of resources to support antidepressant cessation: A qualitative think-aloud study with patients

Suzanne McDonald; Katharine Ann Wallis; Mark Horowitz; Esther Mann; Vilany Le; Maria Donald

doi:10.3399/BJGP.2023.0269

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Tapering strips: a practical solution to implement personalized hyperbolic tapering trajectories
Peter C. Groot and Jim van Os

Published on: 05 September 2023

Published on: (5 September 2023)
Page navigation anchor for Tapering strips: a practical solution to implement personalized hyperbolic tapering trajectories
Tapering strips: a practical solution to implement personalized hyperbolic tapering trajectories
Peter C. Groot, researcher/person with lived experience, User Research Center, UMC Utrecht Brain Centre, University Medical Centre Utrecht, the Netherlands
Other Contributors:
Jim van Os, Psychiatrist, Charman Dept. Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, The Netherlands
McDonald et al. investigate resources to support safe discontinuation of antidepressants and developed a decision aid and a detailed protocol for step-by-step hyperbolic tapering of drug doses.¹ This is commendable but places an additional burden on doctors who often lack time, compensation and resources to do this.

To simplify the process, tapering strips were developed in the Netherlands which enable patients to gradually reduce the dose in unequal (daily) steps, with the steps becoming progressively smaller as the dose decreases - which is the hallmark of hyperbolic tapering.²

Tapering strips can be prescribed through shared decision-making, eliminating concerns about the feasibility of implementing a personalized tapering plan, which can be challenging or practically impossible when daily dosages are not available, or can only be obtained by e.g., splitting doses, or using liquid medications, which are difficult to dose accurately, especially during the crucial final stages of tapering, when doses are very low.

These challenges are overcome when tapering strips are used, in which all required daily dosages are available and individually packaged. Furthermore, patients and doctors can use self-monitoring forms included with the strips to take early action if and when withdrawal symptoms arise, by stabilizing first and then proceeding with a more gradual tapering strip or strips.

Four observat...
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McDonald et al. investigate resources to support safe discontinuation of antidepressants and developed a decision aid and a detailed protocol for step-by-step hyperbolic tapering of drug doses.¹ This is commendable but places an additional burden on doctors who often lack time, compensation and resources to do this.

To simplify the process, tapering strips were developed in the Netherlands which enable patients to gradually reduce the dose in unequal (daily) steps, with the steps becoming progressively smaller as the dose decreases - which is the hallmark of hyperbolic tapering.²

Tapering strips can be prescribed through shared decision-making, eliminating concerns about the feasibility of implementing a personalized tapering plan, which can be challenging or practically impossible when daily dosages are not available, or can only be obtained by e.g., splitting doses, or using liquid medications, which are difficult to dose accurately, especially during the crucial final stages of tapering, when doses are very low.

These challenges are overcome when tapering strips are used, in which all required daily dosages are available and individually packaged. Furthermore, patients and doctors can use self-monitoring forms included with the strips to take early action if and when withdrawal symptoms arise, by stabilizing first and then proceeding with a more gradual tapering strip or strips.

Four observational studies involving over 2700 participants have demonstrated the effectiveness of using tapering strips.^3-6 More than 60% of participants, many of whom had been using antidepressants for extended durations and had previously struggled to discontinue due to severe withdrawal symptoms, found relief when they attempted discontinuation again using tapering strips. Their withdrawal symptoms were significantly reduced, and 70% of them now successfully managed to discontinue their medication.

References

1. McDonald S, Wallis KA, Horowitz M et al. Acceptability and optimisation of resources to support antidepressant cessation: A qualitative think-aloud study with patients. Br J Gen Pract. BJGP.2023.0269. https://doi.org/10.3399/bjgp.2023.0269.

2. Groot PC, van Os J. How user knowledge of psychotropic drug withdrawal resulted in the development of person-specific tapering medication. Ther Adv Psychopharm 2020;10. https://doi.org/10.1177/2045125320932452.

3. Groot PC, van Os J. Antidepressant tapering strips to help people come off medication more safely. Psychosis 2018;10. https://doi.org/10.1080/17522439.2018.1469163.

4. Groot PC, van Os J. Outcome of Antidepressant Drug Discontinuation with Taperingstrips after 1-5 Years. Ther Adv Psychopharmacol 2020;10. https://doi.org/10.1177/2045125320954609.

5. Groot PC, van Os J. Successful use of tapering strips for hyperbolic reduction of antidepressant dose - a cohort study. Ther Adv Psychopharmacol2021;11. https://doi.org/10.1177/20451253211039327.

6. van Os J, Groot PC. Outcomes of hyperbolic tapering of antidepressants. Ther Adv Psychopharm 2023;13. https://doi.org/10.1177/20451253231171518.

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Competing Interests: PCG was involved in the development of tapering strips. PCG and JvO investigate the use of tapering strips but are not involved in any way in their production or sales. In the Netherlands, tapering medications are made, at the specific request of the not-for-profit foundation Cinderella Therapeutics, by the Regenboog pharmacy in Bavel, The Netherlands, against a nationally pre-set, regulated reimbursement. Other pharmacies in the Netherlands do not produce tapering strips as the pre-set reimbursement is considered too low. The User Research Centre at UMC Utrecht has benefitted from an educational grant provided by the Regenboog Pharmacy.