UVA Health offers guidance on stopping psychiatric medications

CHARLOTTESVILLE, Va. (WVIR) - A new effort at UVA Health is tackling a question many patients ask: when is it safe to stop taking psychiatric medications?

A UVA psychiatrist says the answer depends on the person.

New national guidelines suggest some patients who have recovered from a first episode of depression may be able to gradually come off antidepressants after about a year of treatment.

Deprescribing is a systematic review of psychiatric medications to identify those that are unnecessary, not working or causing significant adverse effects, said Dr. Anita Clayton, a UVA Health psychiatrist and co-author of the new national guidelines.

The process may involve stopping medications, switching to something else or adding treatments for patients who have not responded adequately.

About 15% of all U.S. adults will have a major depressive episode at some time in their lives, and about 8.5% have a major depression in a single year, Clayton said. Women are twice as likely as men to have a major depressive episode.

The problem is that 50% of people with major depressive disorder never get treatment. Of those who do get treatment, about 50% respond to the initial treatment, which is usually an SSRI or SNRI antidepressant.

UVA Health recently launched a deprescribing clinic that looks to see if any medications are unnecessary, duplicative or risky.

The clinic focuses on patient safety, checking if people are dosed too high, if a drug is inappropriate for them or if it interacts with other medications they are taking for medical conditions.

“We need to make a plan, and the patient needs to be in agreement with that. And then we proceed with that plan over a period of time. And hopefully, they will be able to benefit from a decrease in the number of medications or an improvement in the type of medications,” Clayton said.

Patients who have been adequately treated for their first episode of depression could attempt to have their medication deprescribed about a year into their treatment, Clayton said. However, with recurrent episodes of depression, the likelihood of needing to stay on an antidepressant indefinitely is usually discussed after the third episode.

Doctors stress patients should never stop medication on their own.

Patients who stop medications on their own often become symptomatic. Some experience discontinuation symptoms, which can include sensations people describe as “brain zaps.”

Deprescribing can reduce side effects such as cognitive problems, sexual dysfunction and weight gain. It can also eliminate the burden of taking duplicate medications that work the same way.

The biggest risk of deprescribing is recurrence of depression or anxiety disorder, which often does not take long to happen, especially in someone who has had chronic depression.

The deprescribing process varies by patient. For someone at the lowest dose of a medicine, it might take two to four weeks. For someone on a very high dose or a medication that lasts a long time in the system, the process takes longer.

Any decision to reduce or stop medication should be made with a healthcare provider and tailored to each patient’s needs.

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