Shorter use as the new model
These medicines were seen as the cornerstone of treatment for various mental health problems. In recent years this approach has been shifting. Long-term use of psychiatric medication is questioned more and more often. Shorter use of medication, combined with strengthening mental resilience for the longer term, seems to be becoming the new model.
Why this change?
The answer lies in our growing understanding of how these medicines act on the brain. Long-term use can lead to significant changes in brain chemistry and structure, and not always for the better. It is also becoming better known that stopping these medicines after long-term use can lead to serious withdrawal symptoms and to a phenomenon known as ‘rebound’. Symptoms of the original problem seem to come back, but in reality this is often a reaction of the brain to the medication falling away after long dampening.
Medication as temporary support
These insights have led to a growing call for a model in which psychiatric medication is used for a shorter time, alongside the development of mental resilience to prevent a relapse. The idea is to see medication as temporary support, while working at the same time on more lasting forms of recovery.
The challenges of tapering off are considerable
Many people who want to stop find out that this is a hard process, loaded with withdrawal symptoms and with the confrontation with emotions that are felt again, or with trauma that was suppressed by the medication for a long time.
A process around identity plays a part too: who am I without this medication? All in all, tapering off is a very complex process that involves much more than stopping a pill. This is why doctors are often reluctant: in practice it is an intensive process that takes a lot of time, knowledge and skill.
There is also a big practical problem
Psychiatric medication has to be tapered off in very small steps. The lower the dose gets, the smaller the steps have to be. The small doses needed for responsible tapering are usually not commercially available. This seriously limits the possibility of tapering off safely. There is also a lack of knowledge among care providers about how best to support this process.
There are guidelines, but they give no practical guidance on how people can taper off. The guidelines also distinguish between people with and without ‘risk factors’ for withdrawal, but that distinction does not work in practice: these risk factors do not predict whether people will get withdrawal. People who are tapered off according to the guidelines therefore run the risk of being wrongly classed as ‘low’ or ‘high’ risk, with all the consequences.
Tapering strips are an important aid
Tapering strips were developed on the basis of the work of the expert by experience Peter Groot, who is recognised for his contributions to this method. The strips make it possible to lower the dose gradually and in very small steps, which considerably reduces the chance of withdrawal symptoms. It is the only way of tapering off that has been scientifically shown to be effective.
You can find more information about tapering strips, and about how to order them, on taperingstrip.com.
Even of the people who have used medication for years, and who tried to stop before without success, about 70% can stop successfully with the help of tapering strips. In the Netherlands, PsychoseNet works for the availability of tapering strips and argues with health insurers for reimbursement.
The aim is a new model of prescribing
In this new model a balance is found between the use of medication in the short term and the development of personal resilience in the longer term. This asks for changes in the practice of prescribing, and also for wider recognition in society of how complex mental health and the road to recovery are.
In this transition it is crucial that we also keep an eye on the psychological aspects of tapering off, such as the difference between withdrawal and rebound, dealing with emotions and trauma that come up again, and rediscovering your own identity outside the context of medication use. This process of change is not simple, but it is necessary for a modern approach to mental health.
Read more: Tips for tapering off your medication.
Prof. dr. Jim van Os, Chair Division Neuroscience, Utrecht University Medical Centre. Jim works at the interface of ‘hard’ brain science, health services research, art and subjective experiences of people with ‘lived experience’ in mental healthcare.
Jim has been appearing on the Thomson-Reuter Web of Science list of ‘most influential scientific minds of our time’ since 2014. In 2014 he published his book ‘Beyond DSM-5‘, and in 2016 the book ‘Good Mental Health Care’. In 2026 he published 'Wat psychisch lijden is'.
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Blogs by Jim van Os can be read here
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