56 - References

References

382 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Unfortunately, most current tablet formulations of antidepressants do not permit hyperbolic tapering regimens, so patients will require the use of liquid formulations, as recommended by NICE18 (or compounded smaller dose formulations, e.g. tapering strips).15 Off-­label options for making up smaller doses also exist, including crushing and suspending tablets, opening up capsules to count or weigh beads or diluting manufacturers’ liquid preparations, all of which are permissible according to various pharmaceutical authorities.27 Again, further details are provided for licensed and off-­label options for hyperbolic tapering in the Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-­drugs.9 For many drugs, the final dose before complete stopping will need to be much less than 1mg so that the reduction in effect on target receptors is not greater than the changes previously tolerated. References

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18. National Institute for Health and Care Excellence. Depression in adults: treatment and management. NICE guideline [NG222]. 2022 (last reviewed September 2024, last checked September 2024); https://www.nice.org.uk/guidance/ng222.
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Depression and anxiety disorders CHAPTER 3 24. Guy A, et al. The ‘patient voice’: patients who experience antidepressant withdrawal symptoms are often dismissed, or misdiagnosed with relapse, or a new medical condition. Ther Adv Psychopharmacol 2020; 10:2045125320967183. 25. Rosenbaum JF, et al. Selective serotonin reuptake inhibitor discontinuation syndrome: a randomized clinical trial. Biol Psychiatry 1998; 44:77–87. 26. Sørensen A, et al. The relationship between dose and serotonin transporter occupancy of antidepressants-­a systematic review. Mol Psychiatry 2022; 27:192–201. 27. Specialist Pharmacy Service. SSRI suggestions for adults with swallowing difficulties 2021 (last updated July 2024, accessed September 2024); https://www.sps.nhs.uk/articles/selective-­serotonin-­reuptake-­inhibitor-­ssri-­formulations-­suggested-­for-­adults-­with-­swallowing-­difficulties.