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.
研究人員說，成功減停抗精神病藥物可能需要“幾年”
倫敦國王學(xué)院的研究人員表示，需要正式的指南來逐步減少抗精神病藥物的使用。
標簽：抗精神病藥?
2021年3月26日
作者：朱莉婭·羅賓遜
研究人員指出，“停止抗精神病藥物的過程可能與復(fù)發(fā)有因果關(guān)系，可能與停止后持續(xù)存在的神經(jīng)適應(yīng)有關(guān)?！?/i>
SHUTTERSTOCK.COM
根據(jù)倫敦國王學(xué)院研究人員進行的一項研究，抗精神病藥物的逐漸減量應(yīng)該在幾個月或幾年內(nèi)進行，并以三到六個月的間隔逐漸減少劑量。
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”.
根據(jù)研究人員的說法，目前還沒有關(guān)于如何使患者停用抗精神病藥物的公開指南，盡管這對開處方的人來說是一個挑戰(zhàn)。研究人員說，戒斷癥狀可能很嚴重，從失眠、抑郁到幻聽和妄想，但通過精心管理的戒斷（這些不良反應(yīng)）是可以避免的。
“停止抗精神病藥物的過程可能與復(fù)發(fā)有因果關(guān)系，可能與停止后持續(xù)存在的神經(jīng)適應(yīng)有關(guān)，包括多巴胺能超敏反應(yīng)，”作者說。
“因此，通過逐步減少抗精神病藥物的使用，可以將停止服用抗精神病藥物后復(fù)發(fā)的風(fēng)險降至最低。”
在研究了抗精神病藥物戒斷的現(xiàn)有證據(jù)和藥物本身的機制后，研究人員建議，抗精神病藥物的戒斷應(yīng)“逐步（數(shù)月或數(shù)年）并以雙曲線的方式進行”。
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，抗精神病藥物的最新劑量可以按順序減少四分之一或一半，這樣隨著總劑量的減少，減少的量會變小，間隔三到六個月，具體取決于個體的耐受性。
研究人員說：“一些患者可能傾向于每月減少其最近劑量的10%或更少。這一過程可能會讓潛在的適應(yīng)時間得以解決，可能會降低停藥后復(fù)發(fā)的風(fēng)險?！?，補充說，完全停止抗精神病藥物前的最終劑量可能需要小到治療劑量的40分之一。
倫敦國王學(xué)院精神藥理學(xué)教授、該研究的資深作者大衛(wèi)·泰勒說：“抗精神病藥物對開處方的人來說是如此熟悉，以至于人們很容易認為它們既有效又無害?！薄?/p>
“雖然它們可能是治療嚴重精神疾?。ㄈ缇穹至寻Y）最有效的方法，但它們的毒性使它們不適合于較不嚴重的情況。
“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.”
“抗精神病藥物會引起大腦神經(jīng)細胞的長期變化，需要非常緩慢地（以特定的方式）將其取出，以便有時間讓大腦重新啟動?！?/p>
皇家精神病醫(yī)生學(xué)院心理藥理學(xué)委員會主席奧利弗·豪斯說：“抗精神病藥物可以幫助治療精神疾病，包括精神病、嚴重抑郁癥和雙相情感障礙，許多人從長期服用中受益。
“想要停止治療的患者應(yīng)該考慮復(fù)發(fā)的風(fēng)險以及副作用，并從醫(yī)生那里得到支持和建議。
“這些指南有助于幫助醫(yī)生建議想要停止治療的患者采取最佳方法?！?/p>
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
根據(jù)NHS商業(yè)服務(wù)管理局2020年9月報告的統(tǒng)計數(shù)據(jù)，2019-2020年間英國共開出了1260萬種抗精神病藥物處方；從2015-2016年的1100萬件增加了14.3%。
研究人員還制定了關(guān)于停止抗抑郁藥的指導(dǎo)方針，他們說，他們論文中提出的假設(shè)應(yīng)該在進一步的抗精神病藥物逐漸減少的試驗中得到檢驗，需要正式的逐步減少抗精神病藥物的指導(dǎo)方針。
閱讀更多：抗抑郁藥處方在2020年最后三個月增長6%
最后更新2021年6月2日14:00
