Better Thinking

In this episode of Better Thinking, Nesh Nikolic speaks with Dr Mark Horowitz about exploring expert strategies for tapering off SSRIs and managing withdrawal symptoms.
Dr Mark Horowitz MBBS PhD is a Clinical Research Fellow in Psychiatry in the National Health Service (NHS) in England and an Honorary Research Fellow at University College London (UCL) and a trainee psychiatrist. He runs a deprescribing clinic in the NHS helping people to stop psychiatric medications.
He co-authored the Royal College of Psychiatry guidance on “Stopping Antidepressants”, and his work informed the recent National Institute for Clinical Excellence (NICE) guidelines on safe discontinuation of psychiatric medications. He also published work on how to safely taper antipsychotics in JAMA Psychiatry and Schizophrenia Bulletin.
He has authored chapters of the Maudsley Prescribing Guidelines on how to stop mood stabilisers, antidepressants, antipsychotics, benzodiazepines, z-drugs and gabapentinoids. He is currently writing the Maudsley Deprescribing Guidelines in Psychiatry which will be published in 2023. He is Co-Investigator on the RELEASE trial in Australia evaluating the effect of gradual, hyperbolic tapering of antidepressants compared to care as usual.
He has an interest in rational psychopharmacology and deprescribing psychiatric medication. He has experienced the difficulty of coming off psychiatric medications first-hand which has informed much of his work. His work can be found at markhorowitz.org/
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[@celestepiccolo6586]

Lexapro of 10 years, my emotions are significantly numbed, I have sexual dysfunction 😢 I’m happy to hear that my sexual dysfunction will possibly improve and that I can have my emotions fully back to their normal state. I’m a young mother with 3 kids and a supportive husband. I’m on the liquid for my taper. Thank you Mark for being a HUGE help.

[@shan4145]

💎🦋Dr.Mark Horowitz 💖👏

[@kmkeenan]

Hopefully someday US doctors will get the message as well. Most of them are so far behind in their thinking and practice.

[@celestepiccolo6586]

Yes, hopefully medical schools can start teaching this if they haven’t already because they are going to need it TREMENDOUSLY in the future. 😢

[@amarahmed3112]

For about 33 years, I have been taking prescription medications through legal prescriptions, taking various antidepressants and benzodiazepine medications. For the past 15 years, I have been regularly taking Zoloft 50mg and Bromazepam (Lexotanil) 6mg, half a pill in the morning and half a pill in the evening. I am now 55 years old and a teacher In Third World countries, doctors still consider that there is no danger in continuing to take the drug and no danger in stopping it after a few weeks. I've recently started cutting back on my benzo medication, from what I've heard from you. Question: Should I taper both medications together or start with one? Thank you for what you are doing to educate people

[@NejBk]

Start with Zoloft, 10% of the previous dose every x weeks (depending on the symptoms you have). They used to say the benzo should be tapered first but nowadays it seems starting with the AD is better.

[@celestepiccolo6586]

Not together. Benzodiazepines are harder to come off. I’ve heard it stated multiple times that start tapering from the easiest drug to come off of first. The Benzo is the harder of the two. Best wishes!

[@samanthapowers8868]

Thank you for the timing of this post! I was on Day 15 of brain zaps, etc. after tapering from 50 mg sertraline over 3 weeks to nothing. Went back on the last dose of 12.5 mg daily after watching this last night and will be discussing with my NP next week how to taper in much more smaller mg increments (or using fluoxitine as a bridge to taper off from) from here.

[@kennethromano806]

I’ve been on 100mg for the last 25 yrs. I’m getting ready for the long journey of withdrawing. Good move by going back on for the time being. You got this!

[@celestepiccolo6586]

I own his wonderful book on Deprescribing.

[@vikasgupta1828]

Thanks