Wiley-Blackwell The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs

From the desk of a Canadian MD/academic-clinical psychiatrist/concerned family member/patient. Arriving at my door this week, Deprescribing Guidelines was the first medical textbook where upon opening the cover, I read the first 50 pages straight through. In writing my first ever Amazon review, I would be honoured to be considered by Drs. Horowitz and Taylor to be their peer. There is not enough space here to express the potential benefit of this essential desk reference. A hard copy will be gifted to members of my team. My own busy pharmacist distractedly quipped, “they still make textbooks?” and then lit up at the prospect of the guidance therein. I find it HOPEFUL. Let me explain. This volume deals with Antidepressants, Benzodiazepines, Gabapentinoids and Z-Drugs. Simply put, they are used to suppress feelings and sensations. Notwithstanding several good, humane reasons for temporarily doing so, it turns out that taking them long-term changes the brain so we eventually must rely on the drug. It hurts if we don’t take it, from a little to a lot. I came of age in psychiatry training with the hype of the “decade of the brain” when mental disorders were being thought of as genetic diseases and cures were around the corner. Novel medications were heavily marketed and prescribing for even more DSM disorders took off. Since before PROZAC, we have been far too influenced by the profit driven global pharmaceutical industrial complex focused on starting, switching, substituting, and adding more medication to deal with side effects. This has yielded profits for corporations and tenured careers for academics. In my opinion, it has not improved our lot collectively. Now we have more distressed people taking medication for "treatment resistant" conditions and finance a perennial quest for the next pharmaceutical fix. Misdiagnosis of relapse or the addition of a 2nd and 3rd disorder likewise has resulted from drug company propaganda shaping medical education. Very few prescribers know how to support people finish a course of medication treatment well. Many are afraid or unwilling to supervise tapers and have no capacity to interpret the reactive feelings and sensations arising correctly. Unwittingly, in the absence of a HOW-TO MANNUAL like this one, I will admit I have dismissed my own body’s intuition, my patient’s self-reports and so-called unsanctioned internet forums that quietly whispered, “there must be another way”. Product monographs and the medical orthodoxy has it wrong, including the experts whose consensus we rely upon daily (CANMET Guideline psychiatry panelists included). “Expect a possible brief and mild discontinuation syndrome (for SSRI/SNRIs)" is simply untrue for too many situations. With this resource, I can more deftly refute standard medical advice without fear of censure. I can offer students and colleagues tangible direction to assist them in preventing needless suffering or perpetuating iatrogenic neurological injury. I know who to reach out to for a consult in the UK! After the COVID 19 years further aggravated my therapeutic nihilism, disenchantment and burnout, finding the works of critical psychiatrists and learning from champion deprescribers while on sabbatical has been a game changer. I add my voice to the first author speaking from lived experience, as I too have been swept up in the escalation of prescription drug reliance of our own profession. Mark Horowitz is plain speaking in key academic journals and several youtube/podcast interviews. I am circling back to read his mentor, Dr. Joanna Moncrieff's work now. Not since Hungarian Canadian, Dr. Gabor Mate won my respect in a Physician, Heal Thyself sort of way has someone come along and impressed me as much. Pharmacists, Prescribers of all kinds and Citizen Scientists with a personal stake in the safe handling of psychotropic drugs and moreover, the people taking them- all of us can breathe easier now with this resource to hand. Respect is earned by the publisher for throwing the weight of their name behind the project. Since adding a decent chapter on deprescribing to their last Prescribing Guidelines edition in 2021, this new Title was needed. May it begin to remedy the imbalance of credible, accessible solutions for navigating the stopping of neurologically adaptive drugs, that have harmed as many souls (or more) as they have helped. There is a companion Deprescribing Guide in the works covering mood stabilisers, stimulants, antipsychotics and opioids. My only disappointment is that we will have to wait until Volume 2 is released in 2025. Join me in appreciating the authors and their many collaborators for their hard-fought personal and professional journeys to bring this book forward. Like me, they have skin in the game and have shown courage and perseverance to deliver this work on behalf of the common good. Bravo.

The best guidelines for deprescribing. Should be taught to all doctors, nurses and psychologists, regardless of their field (especially ER doctors, psychiatrists, GPs, neurologists, etc.), so they can recognize withdrawal symptoms or guide safely patients to taper off these medications.

Best book in its field currently. Found out about this from Taperclinic Youtube. Best how to taper guide. I used this instead of my doctor's advice (General Practitioner) to safely taper my medication.

If you are taking certain prescribed medications and you have decided to come off of them for whatever reason, and you want to minimise possible discomfort, this is a great tool for safe guidance to achieve your goal. Unfortunately, many healthcare providers can prescribe certain medications, but in my opinion, they have no real idea how to get you off of them. The guidelines provided to them are often outdated and can cause unnecessary discomfort; however, those guidelines are gradually being reviewed and amended to align with those included in this amazing book. If you want to educate yourself and your prescriber, this is exactly what you need.

Un apport intéressant pour rationaliser la deprescription, qu'en tant que psychiatres, nous pouvions faire de manière empirique. À lire !