{"product_id":"the-maudsley-deprescribing-guidelines-isbn-9781119822981","title":"The Maudsley Deprescribing Guidelines","description":"\u003cb\u003eThe Maudsley® Deprescribing Guidelines\u003c\/b\u003e \u003cp\u003e\u003cb\u003eComprehensive resource describing guidelines for safely reducing or stopping (deprescribing) antidepressants, benzodiazepines, gabapentinoids and z-drugs for patients, including step-by-step guidance for all commonly used medications, covering common pitfalls, troubleshooting, supportive strategies, and more.\u003c\/b\u003e\u003c\/p\u003e \u003cp\u003eMost formal guidance on psychiatric medication relates to starting or switching medications with minimal guidance on deprescribing medication. In 2023, the World Health Organisation and the United Nations called for patients, as a human right, to be informed of their right to discontinue treatment and to receive support to do so.\u003c\/p\u003e \u003cp\u003e\u003ci\u003eThe Maudsley Deprescribing Guidelines \u003c\/i\u003efills a significant gap in guidance for clinicians by providing comprehensive and authoritative information on this important aspect of treatment.\u003c\/p\u003e \u003cp\u003eThis evidence-based handbook provides an overview of principles to be used in deprescribing. This is derived from fundamental scientific principles and the latest research on this topic, combined with emerging insights from clinical practice (including from patient experts).\u003c\/p\u003e \u003cp\u003eBuilding on the recognised brand of \u003ci\u003eThe Maudsley Prescribing Guidelines\u003c\/i\u003e, and the prominence of the authors’ work, including in \u003ci\u003eThe Lancet Psychiatry \u003c\/i\u003eon tapering antidepressants (the most read article across all Lancet titles when it was released). \u003ci\u003eThe Maudsley Deprescribing Guidelines \u003c\/i\u003ecovers topics such as:\u003c\/p\u003e \u003cul\u003e \u003cli\u003eWhy and when to deprescribe antidepressants, benzodiazepines, gabapentinoids and z-drugs\u003c\/li\u003e \u003cli\u003eBarriers and enablers to deprescribing including physical dependence, social circumstances, and knowledge about the discontinuation process\u003c\/li\u003e \u003cli\u003eDistinguishing withdrawal symptoms, such as poor mood, anxiety, insomnia, and a variety of physical symptoms from symptoms of the underlying disorder that medication was intended to treat\u003c\/li\u003e \u003cli\u003eThe difference between physical dependence and addiction\/substance use disorder\u003c\/li\u003e \u003cli\u003eExplanation of why and how to implement hyperbolic tapering in clinical practice\u003c\/li\u003e \u003cli\u003eSpecific guidance on formulations of medication and techniques for making gradual reductions, including using liquid forms of medication, and other approaches\u003c\/li\u003e \u003cli\u003eStep-by-step guidance for safely stopping all commonly used antidepressants, benzodiazepines, gabapentinoids and z-drugs, including fast, moderate and slow tapering regimens or schedules for each drug, and guidance on how to tailor these to an individual\u003c\/li\u003e \u003cli\u003eTroubleshooting issues which can arise on stopping these medications, including akathisia, withdrawal symptoms, acute or protracted, and relapse.\u003c\/li\u003e \u003c\/ul\u003e \u003cp\u003eWritten for anyone interested in safe deprescribing of psychiatric medications including psychiatrists, GPs, pharmacists, nurses, medical trainees, and interested members of the public. \u003ci\u003eThe Maudsley Deprescribing Guidelines \u003c\/i\u003eis an essential resource on the subject that provides practical guidance on how to improve patient outcomes in this field of medicine.\u003c\/p\u003e \u003cp\u003ePreface ix\u003c\/p\u003e \u003cp\u003eAcknowledgements xii\u003c\/p\u003e \u003cp\u003eNotes on Using the Maudsley® Deprescribing Guidelines xiii\u003c\/p\u003e \u003cp\u003eAbbreviations List xv\u003c\/p\u003e \u003cp\u003e\u003cb\u003eChapter 1 Introduction to Deprescribing Psychiatric Medications 1\u003c\/b\u003e\u003c\/p\u003e \u003cp\u003eDeprescribing as an Intervention 1\u003c\/p\u003e \u003cp\u003eThe context for deprescribing 2\u003c\/p\u003e \u003cp\u003eWhy deprescribe? 7\u003c\/p\u003e \u003cp\u003eBarriers and facilitators to deprescribing 11\u003c\/p\u003e \u003cp\u003eWithdrawal Effects from Psychiatric Medications 13\u003c\/p\u003e \u003cp\u003eMis-diagnosis of withdrawal effects as relapse 13\u003c\/p\u003e \u003cp\u003ePathophysiology of psychiatric drug withdrawal symptoms 16\u003c\/p\u003e \u003cp\u003eClinical aspects of psychiatric drug withdrawal 19\u003c\/p\u003e \u003cp\u003eSpecific issues in psychiatric drug withdrawal 23\u003c\/p\u003e \u003cp\u003eHow to Deprescribe Psychiatric Medications Safely 27\u003c\/p\u003e \u003cp\u003eThe neurobiology of tapering 28\u003c\/p\u003e \u003cp\u003ePractical options for prescribing gradually tapering doses 36\u003c\/p\u003e \u003cp\u003ePsychological aspects of tapering 43\u003c\/p\u003e \u003cp\u003eTapering psychiatric drugs in practice 45\u003c\/p\u003e \u003cp\u003eFurther topics 52\u003c\/p\u003e \u003cp\u003e\u003cb\u003eChapter 2 Safe Deprescribing of Antidepressants 57\u003c\/b\u003e\u003c\/p\u003e \u003cp\u003eWhen and Why to Stop Antidepressants 57\u003c\/p\u003e \u003cp\u003eAdverse effects of antidepressants 66\u003c\/p\u003e \u003cp\u003eDiscussing deprescribing antidepressants with patients 72\u003c\/p\u003e \u003cp\u003eWithdrawal Effects from Antidepressants 76\u003c\/p\u003e \u003cp\u003eRecent developments in the understanding of antidepressant withdrawal 76\u003c\/p\u003e \u003cp\u003ePathophysiology of antidepressant withdrawal symptoms 80\u003c\/p\u003e \u003cp\u003eClinical aspects of antidepressant withdrawal 87\u003c\/p\u003e \u003cp\u003eHow common, severe and long‐ lasting are withdrawal symptoms from antidepressants? 92\u003c\/p\u003e \u003cp\u003eProtracted antidepressant withdrawal syndrome 96\u003c\/p\u003e \u003cp\u003ePost‐ SSRI sexual dysfunction 98\u003c\/p\u003e \u003cp\u003eFactors influencing development of withdrawal effects 99\u003c\/p\u003e \u003cp\u003eStratfiying risk of antidepressant withdrawal 105\u003c\/p\u003e \u003cp\u003eDistinguishing antidepressant withdrawal symptoms from relapse 107\u003c\/p\u003e \u003cp\u003eDistinguishing antidepressant withdrawal symptoms from new onset of a physical or mental health condition 111\u003c\/p\u003e \u003cp\u003eWithdrawal symptoms during antidepressant maintenance treatment or switching medication 113\u003c\/p\u003e \u003cp\u003eHow to Deprescribe Antidepressants Safely 115\u003c\/p\u003e \u003cp\u003eTapering antidepressants gradually 119\u003c\/p\u003e \u003cp\u003eHyperbolic tapering of antidepressants 125\u003c\/p\u003e \u003cp\u003ePractical options in prescribing gradually tapering doses of antidepressants 131\u003c\/p\u003e \u003cp\u003ePsychological aspects of antidepressant tapering 140\u003c\/p\u003e \u003cp\u003eTapering antidepressants in practice 143\u003c\/p\u003e \u003cp\u003eManaging complications of antidepressant discontinuation 153\u003c\/p\u003e \u003cp\u003eTapering Guidance for Specific Antidepressants 158\u003c\/p\u003e \u003cp\u003eAgomelatine 159\u003c\/p\u003e \u003cp\u003eAmitriptyline 163\u003c\/p\u003e \u003cp\u003eBupropion 168\u003c\/p\u003e \u003cp\u003eCitalopram 174\u003c\/p\u003e \u003cp\u003eClomipramine 183\u003c\/p\u003e \u003cp\u003eDesvenlafaxine 188\u003c\/p\u003e \u003cp\u003eDosulepin 193\u003c\/p\u003e \u003cp\u003eDoxepin 198\u003c\/p\u003e \u003cp\u003eDuloxetine 203\u003c\/p\u003e \u003cp\u003eEscitalopram 209\u003c\/p\u003e \u003cp\u003eFluoxetine 216\u003c\/p\u003e \u003cp\u003eFluvoxamine 223\u003c\/p\u003e \u003cp\u003eImipramine 228\u003c\/p\u003e \u003cp\u003eLofepramine 233\u003c\/p\u003e \u003cp\u003eMirtazapine 238\u003c\/p\u003e \u003cp\u003eMoclobemide 243\u003c\/p\u003e \u003cp\u003eNortriptyline 248\u003c\/p\u003e \u003cp\u003eParoxetine 253\u003c\/p\u003e \u003cp\u003ePhenelzine 259\u003c\/p\u003e \u003cp\u003eSertraline 264\u003c\/p\u003e \u003cp\u003eTranylcypromine 270\u003c\/p\u003e \u003cp\u003eTrazodone 275\u003c\/p\u003e \u003cp\u003eVenlafaxine 280\u003c\/p\u003e \u003cp\u003eVilazodone 288\u003c\/p\u003e \u003cp\u003eVortioxetine 292\u003c\/p\u003e \u003cp\u003e\u003cb\u003eChapter 3 Safe Deprescribing of Benzodiazepines and Z-drugs 297\u003c\/b\u003e\u003c\/p\u003e \u003cp\u003eWhen and Why to Stop Benzodiazepines and Z-drugs 297\u003c\/p\u003e \u003cp\u003eDiscussing deprescribing benzodiazepines and z-drugs 304\u003c\/p\u003e \u003cp\u003eWithdrawal Symptoms from Benzodiazepines and Z-drugs 309\u003c\/p\u003e \u003cp\u003ePhysical dependence vs addiction in use of benzodiazepines and z-drugs 311\u003c\/p\u003e \u003cp\u003ePathophysiology of benzodiazepine withdrawal syndrome 313\u003c\/p\u003e \u003cp\u003eVariety of withdrawal symptoms from benzodiazepines and z-drugs 316\u003c\/p\u003e \u003cp\u003eProtracted benzodiazepine withdrawal syndrome 320\u003c\/p\u003e \u003cp\u003eDistinguishing benzodiazepine withdrawal symptoms from return of an underlying condition 323\u003c\/p\u003e \u003cp\u003eWithdrawal symptoms during benzodiazepine maintenance treatment 326\u003c\/p\u003e \u003cp\u003eHow to Deprescribe Benzodiazepines and Z-drugs Safely 327\u003c\/p\u003e \u003cp\u003eTapering benzodiazepines and z-drugs gradually 330\u003c\/p\u003e \u003cp\u003eHyperbolic tapering of benzodiazepines and z-drugs 332\u003c\/p\u003e \u003cp\u003eSwitching to longer-acting benzodiazepines to taper 335\u003c\/p\u003e \u003cp\u003eMaking up smaller doses of benzodiazepines and z-drugs practically 338\u003c\/p\u003e \u003cp\u003eOther considerations in tapering benzodiazepines and z-drugs 342\u003c\/p\u003e \u003cp\u003ePsychological aspects of tapering benzodiazepines and z-drugs 345\u003c\/p\u003e \u003cp\u003eTapering benzodiazepines and z-drugs in practice 348\u003c\/p\u003e \u003cp\u003eManagement of complications of benzodiazepine and z-drug discontinuation 358\u003c\/p\u003e \u003cp\u003eTapering Guidance for Specific Benzodiazepines and Z-drugs 362\u003c\/p\u003e \u003cp\u003eAlprazolam 364\u003c\/p\u003e \u003cp\u003eBuspirone 375\u003c\/p\u003e \u003cp\u003eChlordiazepoxide 380\u003c\/p\u003e \u003cp\u003eClonazepam 388\u003c\/p\u003e \u003cp\u003eClorazepate 396\u003c\/p\u003e \u003cp\u003eDiazepam 404\u003c\/p\u003e \u003cp\u003eEstazolam 412\u003c\/p\u003e \u003cp\u003eEszopiclone 418\u003c\/p\u003e \u003cp\u003eFlurazepam 423\u003c\/p\u003e \u003cp\u003eLorazepam 429\u003c\/p\u003e \u003cp\u003eLormetazepam 440\u003c\/p\u003e \u003cp\u003eNitrazepam 446\u003c\/p\u003e \u003cp\u003eOxazepam 452\u003c\/p\u003e \u003cp\u003eQuazepam 461\u003c\/p\u003e \u003cp\u003eTemazepam 467\u003c\/p\u003e \u003cp\u003eTriazolam 474\u003c\/p\u003e \u003cp\u003eZaleplon 480\u003c\/p\u003e \u003cp\u003eZolpidem 485\u003c\/p\u003e \u003cp\u003eZopiclone 490\u003c\/p\u003e \u003cp\u003e\u003cb\u003eChapter 4 Safe Deprescribing of Gabapentinoids 495\u003c\/b\u003e\u003c\/p\u003e \u003cp\u003eWhen and Why to Stop Gabapentinoids 495\u003c\/p\u003e \u003cp\u003eDiscussing deprescribing gabapentinoids 504\u003c\/p\u003e \u003cp\u003eOverview of Gabapentinoid Withdrawal Effects 507\u003c\/p\u003e \u003cp\u003ePhysical dependence vs addiction in use of gabapentinoids 510\u003c\/p\u003e \u003cp\u003eHow to Deprescribe Gabapentinoids Safely 512\u003c\/p\u003e \u003cp\u003ePrinciples for tapering gabapentinoids 512\u003c\/p\u003e \u003cp\u003eMaking up smaller doses of gabapentinoids practically 516\u003c\/p\u003e \u003cp\u003eOther considerations in tapering gabapentinoids 520\u003c\/p\u003e \u003cp\u003ePsychological aspects of tapering gabapentinoids 523\u003c\/p\u003e \u003cp\u003eTapering gabapentinoids in practice 525\u003c\/p\u003e \u003cp\u003eManagement of complications of gabapentinoid discontinuation 532\u003c\/p\u003e \u003cp\u003eTapering Guidance for Specific Gabapentinoids 537\u003c\/p\u003e \u003cp\u003eGabapentin 538\u003c\/p\u003e \u003cp\u003ePregabalin 546\u003c\/p\u003e \u003cp\u003eIndex 553\u003c\/p\u003e \u003cp\u003e\u003cb\u003eMark Horowitz, BA, BSc(Med), MBBS(Hons), MSc, GDipPsych, PhD,\u003c\/b\u003e is a trainee psychiatrist and Clinical Research Fellow at North East London NHS Trust, where he runs a psychiatric drug deprescribing clinic. He is an Honorary Research Fellow at University College London and he co-authored the Royal College of Psychiatrists guide on 'Stopping antidepressants'. He has authored multiple academic papers on how to safely stop psychiatric drugs in high impact journals, and lectured on this topic around the world to doctors, pharmacists and the public. He was commissioned by Health Education England to prepare a module on safe deprescribing of antidepressants for prescribers in the National Health Service (NHS). He has lived experience of stopping psychiatric drugs which informs most of his work.\u003c\/p\u003e \u003cp\u003e\u003cb\u003eDavid Taylor, PhD, FFRPS, FRPharmS, FRCP\u003csmall\u003eEdin\u003c\/small\u003e, FRCPsych(Hon),\u003c\/b\u003e is Director of Pharmacy and Pathology at the South London and Maudsley NHS Trust and Professor of Psychopharmacology at King's College, London. He is the lead author of the Maudsley Prescribing Guidelines in Psychiatry and Editor-in-Chief of Therapeutic Advances in Psychopharmacology. He co-authored the Royal College of Psychiatrists guide on 'Stopping antidepressants'. His pharmacy department ran a medication help-line for a decade which fielded queries largely related to withdrawal from psychiatric drugs. He has personal experience of stopping psychiatric drugs.\u003c\/p\u003e  \u003cp\u003e \u003cb\u003eComprehensive resource describing guidelines for safely reducing or stopping (deprescribing) antidepressants, benzodiazepines, gabapentinoids and z-drugs for patients, including step-by-step guidance for all commonly used medications, covering common pitfalls, troubleshooting, supportive strategies, and more.\u003c\/b\u003e \u003c\/p\u003e\u003cp\u003eMost formal guidance on psychiatric medication relates to starting or switching medications with minimal guidance on deprescribing medication. In 2023, the World Health Organisation and the United Nations called for patients, as a human right, to be informed of their right to discontinue treatment and to receive support to do so.  \u003c\/p\u003e\u003cp\u003e\u003ci\u003eThe Maudsley Deprescribing Guidelines \u003c\/i\u003efills a significant gap in guidance for clinicians by providing comprehensive and authoritative information on this important aspect of treatment.  \u003c\/p\u003e\u003cp\u003eThis evidence-based handbook provides an overview of principles to be used in deprescribing. This is derived from fundamental scientific principles and the latest research on this topic, combined with emerging insights from clinical practice (including from patient experts). \u003c\/p\u003e\u003cp\u003eBuilding on the recognised brand of \u003ci\u003eThe Maudsley Prescribing Guidelines\u003c\/i\u003e, and the prominence of the authors’ work, including in \u003ci\u003eThe Lancet Psychiatry \u003c\/i\u003eon tapering antidepressants (the most read article across all Lancet titles when it was released). \u003ci\u003eThe Maudsley Deprescribing Guidelines \u003c\/i\u003ecovers topics such as:  \u003c\/p\u003e\u003cul\u003e\n\u003cli\u003eWhy and when to deprescribe antidepressants, benzodiazepines, gabapentinoids and z-drugs \u003c\/li\u003e \u003cli\u003eBarriers and enablers to deprescribing including physical dependence, social circumstances, and knowledge about the discontinuation process \u003c\/li\u003e \u003cli\u003eDistinguishing withdrawal symptoms, such as poor mood, anxiety, insomnia, and a variety of physical symptoms from symptoms of the underlying disorder that medication was intended to treat \u003c\/li\u003e \u003cli\u003eThe difference between physical dependence and addiction\/substance use disorder \u003c\/li\u003e \u003cli\u003eExplanation of why and how to implement hyperbolic tapering in clinical practice \u003c\/li\u003e \u003cli\u003eSpecific guidance on formulations of medication and techniques for making gradual reductions, including using liquid forms of medication, and other approaches\u003c\/li\u003e \u003cli\u003eStep-by-step guidance for safely stopping all commonly used antidepressants, benzodiazepines, gabapentinoids and z-drugs, including fast, moderate and slow tapering regimens or schedules for each drug, and guidance on how to tailor these to an individual \u003c\/li\u003e \u003cli\u003eTroubleshooting issues which can arise on stopping these medications, including akathisia, withdrawal symptoms, acute or protracted, and relapse.\u003c\/li\u003e\n\u003c\/ul\u003e \u003cp\u003eWritten for anyone interested in safe deprescribing of psychiatric medications including psychiatrists, GPs, pharmacists, nurses, medical trainees, and interested members of the public. \u003ci\u003eThe Maudsley Deprescribing Guidelines \u003c\/i\u003eis an essential resource on the subject that provides practical guidance on how to improve patient outcomes in this field of medicine.  \u003c\/p\u003e\u003cp\u003e\"This book provides a unique and detailed guide to deprescribing psychiatric medication. It is a welcome companion volume to the Maudsley Prescribing Guidelines in Psychiatry which have been essential and highly valued reading for psychiatrists for the past 30 years.\"\u003cbr\u003e—\u003cb\u003eProfessor Wendy Burn, Past President Royal College of Psychiatrists\u003c\/b\u003e\u003c\/p\u003e \u003cp\u003e\"Psychiatrists are bombarded with information on how to start and continue medications for their patients. However, they receive little or no information on how and when to decrease or stop medications. These guidelines fill that gap.\"\u003cbr\u003e—\u003cb\u003eSir Professor Robin Murray, Professor of Psychiatric Research\u003c\/b\u003e\u003c\/p\u003e \u003cp\u003e\"Since we began using psychiatric medications 60 years ago, the focus has been on prescribing- with almost no attention to withdrawal symptoms \u0026amp; how often they're confused with relapse. Any clinician can prescribe drugs; it takes art, science, and people skills to deprescribe them.\"\u003cbr\u003e—\u003cb\u003eProfessor Allen Frances, Professor Emeritus of psychiatry at Duke University and head of the DSM-IV committee\u003c\/b\u003e\u003c\/p\u003e","brand":"Wiley-Blackwell","offers":[{"title":"Default Title","offer_id":47990286057701,"sku":"NP9781119822981","price":47.0,"currency_code":"USD","in_stock":false}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/1842\/7735\/files\/9781119822981.jpg?v=1761787205","url":"https:\/\/k12savings.com\/es\/products\/the-maudsley-deprescribing-guidelines-isbn-9781119822981","provider":"K12savings","version":"1.0","type":"link"}