Discontinuing Psychiatric Medications: A Survey of Long-Term Users

Ostrow, Laysha; Jessell, Lauren; Hurd, Manton; Darrow, Sabrina M.; Cohen, David

doi:10.1176/appi.ps.201700070

Cited by 46 publications

(33 citation statements)

References 32 publications

(32 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Compared with Western countries, the rates of ever being admitted to hospital and taking antipsychotic drugs in people with SMI are still very low in rural China. 32,33 Possible reasons may be related to the patients' poor family economic level, lack of knowledge of mental illness and health disparity between rural and urban areas in China (for example most available health resources and services are concentrated in urban-based psychiatric hospitals) . 3,7,21…”

Section: Discussionmentioning

confidence: 99%

Changes in treatment status of patients with severe mental illness in rural China, 1994–2015

et al. 2019

View full text Add to dashboard Cite

BackgroundAlthough it is crucial to improve the treatment status of people with severe mental illness (SMI), it is still unknown whether and how socioeconomic development influences their treatment status.AimsTo explore the change in treatment status in people with SMI from 1994 to 2015 in rural China and to examine the factors influencing treatment status in those with SMI.MethodTwo mental health surveys using identical methods and ICD-10 were conducted in 1994 and 2015 (population ≥15 years old, n = 152 776) in the same six townships of Xinjin County, Chengdu, China.ResultsCompared with 1994, individuals with SMI in 2015 had significantly higher rates of poor family economic status, fewer family caregivers, longer duration of illness, later age at first onset and poor mental status. Participants in 2015 had significantly higher rates of never being treated, taking antipsychotic drugs and ever being admitted to hospital, and lower rates of using traditional Chinese medicine or being treated by traditional/spiritual healers. The factors strongly associated with never being treated included worse mental status (symptoms/social functioning), older age, having no family caregivers and poor family economic status.ConclusionsSocioeconomic development influences the treatment status of people with SMI in contemporary rural China. Relative poverty, having no family caregivers and older age are important factors associated with a worse treatment status. Culture-specific, community-based interventions and targeted poverty-alleviation programmes should be developed to improve the early identification, treatment and recovery of individuals with SMI in rural China.Declaration of interestNone.

show abstract

Section: Discussionmentioning

confidence: 99%

Changes in treatment status of patients with severe mental illness in rural China, 1994–2015

et al. 2019

View full text Add to dashboard Cite

show abstract

“…These trials must educate participants and clinicians and assess motivational and environmental factors that may affect discontinuation. Unsupported drug discontinuations may explain an undetermined amount of distress seen in medicated individuals [51]. Therefore, it may be unethical to discontinue psychotropic drugs from participants in clinical trials unless one is testing explicitly justified, optimally supportive discontinuation methods for willing individuals.…”

Section: Resultsmentioning

confidence: 99%

Discontinuing Psychotropic Drugs from Participants in Randomized Controlled Trials: A Systematic Review

Cohen

Recalt

2019

Psychother Psychosom

Self Cite

View full text Add to dashboard Cite

Background and Objective: Methods and justifications for discontinuing psychotropic drugs in randomized controlled trials (RCTs), and RCTs’ acknowledgement of possible withdrawal symptoms following discontinuation, have not been examined systematically, which this review aims to do. Study Eligibility, Data Extraction, and Synthesis: Publications in MEDLINE, EMBASE, and PsycINFO (2000–2017) randomly assigning participants diagnosed with mental disorders to discontinue antipsychotic, antidepressant, anticonvulsant, antimanic, mood-stabilizing, benzodiazepine, or stimulant drugs. Authors independently extracted data, devised a typology of trials, and assessed trials’ recognition of withdrawal symptoms. Results: Eighty RCTs (70% with industry participation) discontinued drugs from 5,757 participants to investigate relapse prevention (44%), successful discontinuation (26%), architecture of withdrawal (14%), and practicality of discontinuation (10%). RCTs of stimulants, antidepressants, and antipsychotics mostly aimed to reach conclusions about relapse prevention by testing abrupt or rapid discontinuations; RCTs of benzodiazepines mostly aimed to reduce drug use by testing longer-lasting, supportive discontinuations. In 67% of RCTs, no justification was given for the specific discontinuation strategy, which lasted under 2 weeks in 60% of RCTs. Possible withdrawal confounding of trial outcomes was addressed in 14% of eligible RCTs. Limitations: Only the published literature was searched. Conclusions and Implications: RCTs use drug discontinuation to study several key issues in psychopharmacology but infrequently justify how they implement it or acknowledge that possible withdrawal symptoms may threaten internal validity. Reappraising the use of drug discontinuation and the recognition of withdrawal symptoms in RCTs is required.

show abstract

“…Not attending to the social environment Surveys and first-person accounts of withdrawal difficulties emphasize support from physicians, therapists, and other people in helping discontinue psychotropic drugs taken for years. 80 Looking only at non relapse-prevention RCTs (i.e., 29 RCTs testing strategies to help individuals discontinue from drugs and stay off them, or examining whether drug-free management of certain dependent or institutionalized individuals might be safe, see Table 1), we observed that 12 did acknowledge environmental, attitudinal, or interpersonal factors -but only two formally assessed them. 81,82 This deficit hints at the lack of relevance to real-world circumstances even of discontinuation trials that do not exploit withdrawal difficulties.…”

Section: Describe Withdrawal Symptoms and Syndromesmentioning

confidence: 99%

Withdrawal effects confounding in clinical trials: another sign of a needed paradigm shift in psychopharmacology research

Cohen

Recalt

2020

Therapeutic Advances in Psychopharmacology

Self Cite

View full text Add to dashboard Cite

Randomized controlled trials’ ability to produce evidence useful for people to decide whether to take, continue taking, or stop taking psychotropic drugs has been intensely critiqued, along with the trials’ commercial, ideological, and regulatory contexts. This article applies the critique to the topic of withdrawal effects confounding the outcomes of relapse-prevention trials where prescribed psychotropic drugs are discontinued. Until recently, the complexity and reach of withdrawal and post-withdrawal effects were neglected by mainstream psychiatry, but not by lay users of prescribed psychotropics. This article discusses withdrawal effects as part of the pharmacology of psychotropic drugs but shaped by psychosocial factors, and possibly shaping the presentation of psychological distress generally. It outlines biases and misconceptions in assumptions, design, and reporting of general efficacy trials and findings from a recent review of 80 discontinuation trials. In theory, relapse-prevention trials are tautological and exaggerate efficacy. In publications, they pay little attention to the central feature of their design, favor abrupt or rapid discontinuations, do not attend to environmental factors, and provide insufficient data to allow re-analyses. Thus, relapse-prevention RCTs likely confound the detection of their main outcome of interest: “relapse.” Using slower tapers, active placebo controls, and specific covariates in analyses would reduce the risk of withdrawal confounding, and better reporting would reduce the opaqueness of trials. The crisis in psychopharmacology is fueled partly by the disconnect between claims of therapeutic efficacy from so-called best-evidence methods despite unchanging population-level indicators of psychiatric sickness. Only by “stacking the deck” against trial sponsors’ hoped-for outcomes can psychopharmacology trials regain scientific credibility.

show abstract

Discontinuing Psychiatric Medications: A Survey of Long-Term Users

Cited by 46 publications

References 32 publications

Changes in treatment status of patients with severe mental illness in rural China, 1994–2015

Changes in treatment status of patients with severe mental illness in rural China, 1994–2015

Discontinuing Psychotropic Drugs from Participants in Randomized Controlled Trials: A Systematic Review

Withdrawal effects confounding in clinical trials: another sign of a needed paradigm shift in psychopharmacology research

Contact Info

Product

Resources

About