Main content

Reducing medication using tapering strips is part of the new way of prescribing medication in the Dutch mental health care services.

This hasn’t always been the case. In the psychiatric field there’s been a long standing tradition of prescribing medications like antidepressants, benzodiazepines, antipsychotics, anti-epileptics, and lithium for long periods of time, sometimes even decades.

Reducing medication: Short-term use as a new model

These medications were used as the cornerstone of the treatment of several psychological problems. However, in recent years a shift has become visible in this approach. Long-term use of these medications is increasingly questioned. Short-term use of medication, combined with strengthening of long-term mental resilience is becoming the new norm.

Not everyone can/wants to reduce their medication. But even if completely stopping isn’t possible, you can always try to reduce to the minimal effective dose, which I have mentioned in a previous blog.

Reducing medication: Why this change?

The answer lies in our growing understanding of how these medications affect our brain. Long-term use can lead to significant changes in our brain’s chemistry – and structure, and they’re not all good ones. Furthermore we’re becoming more and more familiar with the notion that quitting these medications after long-term use can lead to serious withdrawal symptoms, and a phenomenon that is known as ‘rebound’. That means that symptoms of the original condition seem to return, but in reality it’s often a reaction of the brain to the loss of medication, after a long period of dampening these symptoms.

Medication for temporary support

These insights have resulted in the fact that a model in which psychiatric medications are used for a short time only is increasingly promoted, in tandem with development of the mental resilience in a person, to prevent a relapse. The idea is to see the medication as temporary support; whilst we’re working on more sustainable means of recovery.

Reducing medication: The challenges are significant

Many of people that want to quit, find out that this is a difficult process, fraught with withdrawal symptoms, the confrontation with emotions that are being experienced again, and traumas that have been suppressed by the medication for a long time.

There’s also a process regarding the identity going on: who am I really without these medications? Reducing medication is all in all an incredibly complex process that consists of so much more than just stopping taking a tablet. This is why doctors are often reluctant to wean their patients off: In practice, it is often an intensive process that requires much time, knowledge, and skill.

There is also a big practical problem

Reducing psychiatric medication has to happen in very small steps. The lower the dose gets in the reduction process, the smaller the steps need to be. The required small doses aren’t usually commercially available, which creates an obstacle to successful attempts to quit. Furthermore, there is a lack of knowledge among health care professionals, about how the process of quitting can be best supported.

There are guidelines, but they don’t provide practical instructions on how people can quit. The guidelines also distinguish between people with – and without risk of withdrawal symptoms, but that distinction doesn’t actually work. Therefore, patients that are being weaned off according to the guidelines run the risk of being unjustly classed as “low” or “high” risk, with all its consequences.

An important tool for reducing medication are tapering strips

These strips were developed based on the work of experience expert Peter Groot, who’s been recognised for his contribution to this method. These strips make it possible to lower the dose of medication gradually and in very small steps, which significantly reduces the chance of withdrawal symptoms. It is the only way of reducing medication that is scientifically proven to be effective.

And even of the people that had been taking medication for years, and that had unsuccessfully tried to quit in the past, 70% managed to successfully quit their medication using tapering strips. PsychosisNet is committed to making tapering strips more accessible and calls for these to be covered by healthcare insurers.

The aim is to develop a new model of prescribing medication

In this new model a balance will be found between the short-term use of medication and the development of long-term personal resilience and defensibility. This doesn’t just require changes in the field of prescribing medication, but also a broader social recognition of the complexity of mental health and the road to recovery.

In this transition it is crucial that we pay attention to the psychological aspects of reducing, like the difference between withdrawal and rebound, coping with re-emerging traumas, and re-discovering the own identity outside the context of use of medication. This process of changing and becoming aware isn’t easy, but necessary for a modern approach to mental health.

Translated from Dutch by SGM Taplin

Prof. dr. Jim van OsChair Division Neuroscience, Utrecht University Medical Centre. Jim is also Visiting Professor of Psychiatric Epidemiology at the Institute of Psychiatry in London. 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’. 

Want to read more?

Did you know that PsychosisNet regularly posts new content?


Leave a Reply

Your email address will not be published. Required fields are marked *