Groot Peter C, van Os Jim
User Research Centre NL, Utrecht University Medical Centre Postbus 85500, Utrecht 3508 GA, The Netherlands.
UMC Utrecht Brain Centre, Utrecht, The Netherlands.
Ther Adv Psychopharmacol. 2020 Jul 10;10:2045125320932452. doi: 10.1177/2045125320932452. eCollection 2020.
Coming off psychotropic drugs can cause physical as well as mental withdrawal, resulting in failed withdrawal attempts and unnecessary long-term drug use. The first reports about withdrawal appeared in the 1950s, but although patients have been complaining about psychotropic withdrawal problems for decades, the first tentative acknowledgement by psychiatry only came in 1997 with the introduction of the 'antidepressant-discontinuation syndrome'. It was not until 2019 that the UK Royal College of Psychiatrists, for the first time, acknowledged that withdrawal can be severe and persistent. Given the lack of a systematic professional response, over the years, patients who were experiencing withdrawal started to work out practical ways to safely come off medications themselves. This resulted in an experience-based knowledge base about withdrawal which ultimately, in The Netherlands, gave rise to the development of person-specific tapering medication (so-called tapering strips). Tapering medication enables doctors, for the first time, to flexibly prescribe and adapt the medication required for responsible and person-specific tapering, based on shared decision making and in full agreement with recommendations in existing guidelines. Looking back, it is obvious that the simple practical solution of tapering strips could have been introduced much earlier, and that the traditional academic strategy of comparisons from randomised trials is not the logical first step to help individual patients. While randomised controlled trials (RCTs) are the gold standard for evaluating interventions, they are unable to accommodate the heterogeneity of individual responses. Thus, a more individualised approach, building on RCT knowledge, is required. We propose a roadmap for a more productive way forward, in which patients and academic psychiatry work together to improve the recognition and person-specific management of psychotropic drug withdrawal.
停用精神药物会导致身体和精神上的戒断反应，从而导致戒断尝试失败和不必要的长期药物使用。关于戒断反应的首批报告出现在20世纪50年代，但尽管患者几十年来一直在抱怨精神药物戒断问题，但直到1997年“抗抑郁药停药综合征”的引入，精神病学才首次初步承认这一问题。直到2019年，英国皇家精神科医学院才首次承认戒断反应可能严重且持续。由于缺乏系统的专业应对措施，多年来，经历戒断反应的患者开始自行摸索安全停药的实用方法。这产生了一个基于经验的戒断知识库，最终在荷兰促成了针对个人的减药方案（所谓的减药条）的开发。减药方案首次使医生能够根据共同决策，并完全按照现有指南中的建议，灵活地开出并调整负责任的、针对个人的减药所需的药物。回顾过去，很明显，减药条这种简单的实用解决方案本可以更早引入，而且传统的通过随机试验进行比较的学术策略并非帮助个体患者的合理第一步。虽然随机对照试验（RCTs）是评估干预措施的金标准，但它们无法适应个体反应的异质性。因此，需要一种基于RCT知识的更个性化的方法。我们提出了一条更具成效的前进路线图，让患者和学术精神病学共同努力，以提高对精神药物戒断的认识和针对个人的管理。
