STOP THE

ANTIPSYCHIATRI
C MEDICATION
Done by Dr. Norah Al-shatiri R3
Supervised By Dr. Kahled Al-jaber
OVERVIEW:
• Definition of mental health ?
• How to stop the medications
• Antidepressant Discontinuation Syndrome
• Prevention and Management
MENTAL HEALTH DEFINITION ?
• Mental health is a state of well being in which the individual realises his
or her own abilities, can cope with the normal stresses of life, can work
productively and fruitfully and is able to contribute to his or her own
community.
HOW TO STOP THE MEDICATION :
• Patients should be advised that treatment is to be for a limited period
initially, continuing for 6 months after improvement to reduce the risk of
relapse, i.e. usually 9–12 months altogether in the first instance. After that,
prescribing should continue only if there have been two or more previous
episodes of depression, or the patient is at significant risk of relapse due to
ongoing symptoms, or ongoing significant life events and difficulties.

• Treatment should be actively reviewed again after 2 years of treatment, to

consider whether to attempt coming off treatment.
• A systematic review of interventions to support discontinuation of
antidepressants found :
• that the risk of withdrawal symptoms is higher with abrupt termination of
antidepressants. Until recently, NICE and other guidelines recommended
relatively rapid tapering, over 2–4 weeks, halving doses and perhaps halving
again before complete cessation, but such rapid tapering is not much better
than abruptly stopping treatment, and is often not tolerated by patients. 
• Withdrawal symptoms are also more likely when coming off drugs with
shorter half‐lives, particularly the SSRI paroxetine and the serotonin and nor ‐
adrenaline reuptake inhibitor (SNRI) venlafaxine.
The most important barriers to discontinuation with relevance to the
prescriber, as they may be amenable to intervention when considering how
inappropriate long‐term use can be addressed, are:
• patient fears of withdrawal symptoms and relapse of depression,
• a lack of consistent guidance for practitioners on tapering off
antidepressant doses, and
• time constraints in follow‐up appointments for depression treatment.
ANTIDEPRESSANT DISCONTINUATION
SYNDROME:
• The ADSs typically appear within a few days of stopping an antidepressant and
usually last 2 weeks or longer. Even though ADSs are mostly reported after
abrupt antidepressant suspension, they can also occur after gradual tapering or
after missed doses.
• Antidepressant discontinuation symptoms are more likely to occur after longer
duration of treatment and with antidepressants that have shorter half-lives for
elimination (eg, paroxetine). Symptoms can also vary markedly from one
individual to another depending on the drug class. For example, ADSs associated
with tricyclic antidepressants closely mimic those of SSRIs but can additionally
include profound balance problems and parkinsonian features. Certain SNRIs,
such as venlafaxine, can cause more severe ADSs than those caused by SSRIs.
PREVENTION AND MANAGEMENT:
• Gradual tapering of an SSRI does not completely prevent antidepressant
discontinuation syndrome but appears to be a reasonable strategy to reduce
ADSs. When mild symptoms emerge, reassurance is usually sufficient while the
syndrome runs its course. In more severe cases, ADSs may last significantly
longer. Severe cases can be treated symptomatically, or the antidepressant can be
reinstated for rapid resolution followed by careful tapering to prevent
reemergence. In cases where slow tapering is poorly tolerated, a medication with
a longer half-life (especially fluoxetine) may be substituted for the shorter-half-
life agent. In addition, cognitive behavioral therapy and mindfulness-based
therapies may be helpful in some patients
REFERENCES :
• https://jaoa.org/article.aspx?articleid=2761944
• https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.14475
• https://www.psychiatrictimes.com/view/8-reasons-psychotropic-medicati
on-may-be-discontinued?page=2
• aafp.org/afp/2018/1001/p462.html
Thank you