The Pharmaceutical Journal, Successful tapering of antipsychotics could take ‘years’
Successful tapering of antipsychotics could take ‘years’, say researchers
Researchers at King's College London said formal guidelines for tapering antipsychotics were needed.
Antipsychotics
26 March 2021
By Julia Robinson
Citation
The Pharmaceutical Journal, PJ, March 2021, Vol 306, No 7947;306(7947)::DOI:10.1211/PJ.2021.1.72216
THE OFFICIAL JOURNAL OF THE ROYAL PHARMACEUTICAL SOCIETY
The researchers noted that "the process of stopping antipsychotics may be causally related to relapse, potentially linked to neuroadaptations that persist after cessation"
SHUTTERSTOCK.COM
Tapering of antipsychotics should be carried out over a period of months or years, and by reducing the dose gradually at intervals of three to six months, according to a major review carried out by researchers at King’s College London.
研究人员说，成功减停抗精神病药物可能需要“几年”
伦敦国王学院的研究人员表示，需要正式的指南来逐步减少抗精神病药物的使用。
标签：抗精神病药
2021年3月26日
作者：朱莉娅·罗宾逊
研究人员指出，“停止抗精神病药物的过程可能与复发有因果关系，可能与停止后持续存在的神经适应有关。”
SHUTTERSTOCK.COM
根据伦敦国王学院研究人员进行的一项研究，抗精神病药物的逐渐减量应该在几个月或几年内进行，并以三到六个月的间隔逐渐减少剂量。
According to the researchers, there are currently no published guidelines on how to wean patients off antipsychotics, despite the challenge it presents for prescribers. Symptoms of withdrawal can be severe, ranging from insomnia and depression to auditory hallucinations and delusions, but are avoidable with a carefully managed withdrawal, the researchers said.
“The process of stopping antipsychotics may be causally related to relapse, potentially linked to neuroadaptations that persist after cessation, including dopaminergic hypersensitivity,” the authors said.
“Therefore, the risk of relapse on cessation of antipsychotics may be minimised by more gradual tapering.”
After examining existing evidence into antipsychotic withdrawal and the mechanisms of the drugs themselves, the researchers recommended that withdrawal of antipsychotics should be “done gradually (over months or years) and in a hyperbolic manner”.
根据研究人员的说法，目前还没有关于如何使患者停用抗精神病药物的公开指南，尽管这对开处方的人来说是一个挑战。研究人员说，戒断症状可能很严重，从失眠、抑郁到幻听和妄想，但通过精心管理的戒断（这些不良反应）是可以避免的。
“停止抗精神病药物的过程可能与复发有因果关系，可能与停止后持续存在的神经适应有关，包括多巴胺能超敏反应，”作者说。
“因此，通过逐步减少抗精神病药物的使用，可以将停止服用抗精神病药物后复发的风险降至最低。”
在研究了抗精神病药物戒断的现有证据和药物本身的机制后，研究人员建议，抗精神病药物的戒断应“逐步（数月或数年）并以双曲线的方式进行”。
For example, the most recent dose of antipsychotic could be reduced by one quarter, or one half, in a sequential manner so that reductions become smaller in size as the total dose decreases, at intervals of three to six months, depending on the tolerance of the individual.
“Some patients may prefer to taper at 10% or less of their most recent dose each month. This process might allow underlying adaptations time to resolve, possibly reducing the risk of relapse on discontinuation,” the researchers said, adding that the final dose before complete cessation of the antipsychotic may need to be as small as one 40th of a therapeutic dose.
“Antipsychotics are so familiar to prescribers that it is tempting to assume that they are both effective and innocuous,” said David Taylor, professor of psychopharmacology at King’s College London and senior author of the study.
“While they are perhaps the most useful treatment for serious mental illness such as schizophrenia, their toxic nature makes them unsuitable for less severe conditions.
例如，抗精神病药物的最新剂量可以按顺序减少四分之一或一半，这样随着总剂量的减少，减少的量会变小，间隔三到六个月，具体取决于个体的耐受性。
研究人员说：“一些患者可能倾向于每月减少其最近剂量的10%或更少。这一过程可能会让潜在的适应时间得以解决，可能会降低停药后复发的风险。”，补充说，完全停止抗精神病药物前的最终剂量可能需要小到治疗剂量的40分之一。
伦敦国王学院精神药理学教授、该研究的资深作者大卫·泰勒说：“抗精神病药物对开处方的人来说是如此熟悉，以至于人们很容易认为它们既有效又无害。”。
“虽然它们可能是治疗严重精神疾病（如精神分裂症）最有效的方法，但它们的毒性使它们不适合于较不严重的情况。
“Antipsychotics induce long-lasting changes to nerve cells in the brain and they need to be withdrawn very slowly (and in a particular way) to allow time for the brain to reset.”
Oliver Howes, chair of the Psychopharmacology Committee at the Royal College of Psychiatrists, said: “Antipsychotic medication can help treat mental illnesses including psychosis, severe depression and bipolar disorder, and many people benefit from taking them long-term.
“Patients who want to stop treatment should consider the risk of relapse as well as side-effects and get support and advice from their doctor.
“These guidelines are useful to help doctors advise patients who want to stop treatment on the best way to do this.”
“抗精神病药物会引起大脑神经细胞的长期变化，需要非常缓慢地（以特定的方式）将其取出，以便有时间让大脑重新启动。”
皇家精神病医生学院心理药理学委员会主席奥利弗·豪斯说：“抗精神病药物可以帮助治疗精神疾病，包括精神病、严重抑郁症和双相情感障碍，许多人从长期服用中受益。
“想要停止治疗的患者应该考虑复发的风险以及副作用，并从医生那里得到支持和建议。
“这些指南有助于帮助医生建议想要停止治疗的患者采取最佳方法。”
According to statistics reported by the NHS Business Services Authority in September 2020, 12.6 million items of antipsychotics were prescribed in 2019–2020; a 14.3% increase from 11.0 million items in 2015–2016.
The researchers, who have also produced aligning guidelines on stopping antidepressants, said that the hypothesis put forward in their paper should be tested in further tapering trials of antipsychotics, and that formal guidelines for tapering antipsychotics were required.
READ MORE: Antidepressant prescribing up 6% in last three months of 2020
Last updated 2 June 2021 14:00
根据NHS商业服务管理局2020年9月报告的统计数据，2019-2020年间英国共开出了1260万种抗精神病药物处方；从2015-2016年的1100万件增加了14.3%。
研究人员还制定了关于停止抗抑郁药的指导方针，他们说，他们论文中提出的假设应该在进一步的抗精神病药物逐渐减少的试验中得到检验，需要正式的逐步减少抗精神病药物的指导方针。
阅读更多：抗抑郁药处方在2020年最后三个月增长6%
最后更新2021年6月2日14:00
