Discontinuation of psychotropic medication: a synthesis of evidence across medication classes.

Autor: Vinkers CH; Department of Psychiatry and Anatomy & Neurosciences, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands. c.vinkers@amsterdamumc.nl.; Amsterdam Public Health, Mental Health Program and Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, The Netherlands. c.vinkers@amsterdamumc.nl.; GGZ inGeest Mental Health Care, Amsterdam, The Netherlands. c.vinkers@amsterdamumc.nl., Kupka RW; Department of Psychiatry, Amsterdam Neuroscience and Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Penninx BW; Department of Psychiatry, Amsterdam Neuroscience and Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Ruhé HG; Department of Psychiatry, Radboudumc, Radboud University, Nijmegen, The Netherlands.; Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands., van Gaalen JM; GGZ inGeest Mental Health Care, Amsterdam, The Netherlands.; Department of Psychiatry, Amsterdam Neuroscience and Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., van Haaren PCF; Department of Psychiatry, Radboudumc, Radboud University, Nijmegen, The Netherlands.; Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands., Schellekens AFA; Department of Psychiatry, Radboudumc, Radboud University, Nijmegen, The Netherlands.; Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands.; Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, The Netherlands., Jauhar S; Centre for Affective Disorders, Psychological Medicine, IoPPN, King's College, London, UK., Ramos-Quiroga JA; Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain.; Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain.; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain., Vieta E; Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain., Tiihonen J; Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.; Department of Clinical Neuroscience, Karolinska Institutet, 11364, Stockholm, Sweden.; Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden.; Neuroscience Center, University of Helsinki, Helsinki, Finland., Veldman SE; Department of Psychiatry, Radboudumc, Radboud University, Nijmegen, The Netherlands.; Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands.; Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, The Netherlands.; Novadic-Kentron Addiction Care, Vught, The Netherlands., Veling W; Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands., Vis R; Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands., de Wit LE; Department of Psychiatry, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands., Luykx JJ; GGZ inGeest Mental Health Care, Amsterdam, The Netherlands.; Department of Psychiatry, Amsterdam Neuroscience and Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands.
Jazyk: angličtina
Zdroj: Molecular psychiatry [Mol Psychiatry] 2024 Aug; Vol. 29 (8), pp. 2575-2586. Date of Electronic Publication: 2024 Mar 19.
DOI: 10.1038/s41380-024-02445-4
Abstrakt: Pharmacotherapy is an effective treatment modality across psychiatric disorders. Nevertheless, many patients discontinue their medication at some point. Evidence-based guidance for patients, clinicians, and policymakers on rational discontinuation strategies is vital to enable the best, personalized treatment for any given patient. Nonetheless, there is a scarcity of guidelines on discontinuation strategies. In this perspective, we therefore summarize and critically appraise the evidence on discontinuation of six major psychotropic medication classes: antidepressants, antipsychotics, benzodiazepines, mood stabilizers, opioids, and stimulants. For each medication class, a wide range of topics pertaining to each of the following questions are discussed: (1) Who can discontinue (e.g., what are risk factors for relapse?); (2) When to discontinue (e.g., after 1 year or several years of antidepressant use?); and (3) How to discontinue (e.g., what's the efficacy of dose reduction compared to full cessation and interventions to mitigate relapse risk?). We thus highlight how comparing the evidence across medication classes can identify knowledge gaps, which may pave the way for more integrated research on discontinuation.
(© 2024. The Author(s).)
Databáze: MEDLINE
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