So Dunedin’s Ashburn Clinic has established New Zealand’s first Deprescribing and Tapering Clinical Service to help patients avoid the unpleasant and potentially severe withdrawal effects by carefully and gradually reducing their medication dosage.
Service leader and clinical pharmacist prescriber Marleen van Oeveren said the service started "quite naturally", with people contacting doctors at Ashburn to see if they could get support with slowly tapering off their medications to avoid some of the side effects.
"Traditionally, like even in my training which was not that long ago, we were taught that things like antidepressants were very easy for people to stop — you could stop it over a few weeks with mild symptoms," Ms van Oeveren said.
"But once we started working with people here at Ashburn and learnt more about their lived experiences, we found that actually stopping antidepressants can be incredibly difficult for some people.
"It’s also difficult to come off antipsychotics and benzodiazepines [for anxiety] and other medications like gabapentin, which are used for a range of things, probably most commonly neuropathic pain."
Ms van Oeveren said people wanted to come off their medications for many reasons.
"Sometimes they just feel that they no longer need it and they want to see if they can manage without it.
"At other times it’s about side effects. Emotional numbing affects probably around 60% or 70% of people that take antidepressants.
"Often, they may have been started on an antidepressant for something acute going on in their life that’s caused depression or anxiety, and they have taken the medication for years or even decades.
"And then as they’ve come to understand their difficulties in a different way, they may want to actually focus on working on those things rather than having a medication.
Getting pregnant was also a reason for some people, she said.
The service is one of few in New Zealand and offers reviews for those wanting advice about how their medicines could be rationalised, or optimised to minimise side effects.
It also offers advice for those who have unusual side effects and would like to get more information about them or discuss suggestions for alternative treatments.
Whether it is safe or appropriate to stop or reduce medications is also assessed.
Those approved will be provided with individualised medication tapering plans to discontinue psychiatric medicines, including antidepressants, benzodiazepines, mood stabilisers and antipsychotics, and staff provide regular follow-ups to support the tapering process.
