Talk:Tapering (medicine)

What next?

So... I wanted to give a general discussion of best practices when tapering... but the literature wants to do everything "per drug", "per condition" or sometimes "per drug-conditions". Such empiricism is understandable, given that medicine is hard... but it means that to discuss best practice I sort of need to do so for a number of drugs (potentially interlacing material to allow for comparison) Talpedia 13:22, 22 April 2023 (UTC)

I agree that this material is best presented as a general overview of tapering prescribed psychotropics, as neurobiological adaptation is a commonality across drug classes that determines the necessity for gradual tapering in order to avoid withdrawal symptoms. (See Lerner and Klein, 2019).

If I might suggest, Tapering prescribed psychotropics (medicine) might be a better title for this article, as all these drugs are prescribed psychotropics: "opioids, selective serotonin reuptake inhibitors, antipsychotics,anticonvulsants, and benzodiazepines".

For example, non-psychotropic drugs might require tapering, such as proton pump inhibitors (PPIs) or blood pressure drugs, but they do not require the same type of gradual tapering to allow for receptor re-accommodation.

These generalizations about tapering might also apply apply to non-prescribed psychotropics, except that their societal context requires different discontinuation techniques, as applied by addiction medicine. Avoiding withdrawal symptoms is not as much of a priority as getting the person off the "addictive" drug fairly quickly.

I hope you don't mind, I expanded a few bits with additional references. Sobricatte (talk) 22:46, 30 July 2023 (UTC)

I'm happy with that change. It might be worth noting that the medication while a psychotropic might be being used for other purposes, e.g. pregabaline is used as a pain killer but is also a generalised anti-anxiety medication requiring tapering. Talpedia 08:09, 31 July 2023 (UTC)

On "prescribed". I presume the tapering process if you say, illicitly obtain ritalin is similar to if you were prescribed the drugs. So perhaps Tapering psychotropic medication? There are perhaps unique considerations to tapering illicit medication in that you might not be sure about the drugs or their concentration and they may not have been taken in a consistent manner. Talpedia 09:09, 31 July 2023 (UTC)

Yes, taken often enough, illicitly obtained psychotropics will incur neurobiological adaptation exactly like prescribed psychotropics and, as you point out, they may be identical. Reference Lerner & Klein, 2019

However, addressing tapering and withdrawal from "abused" drugs will get you into hot water with addiction medicine, which has its own guidelines for drug discontinuation. These are the "unique considerations to tapering illicit medication".

Addiction medicine would take issue with tapering methods to avoid withdrawal symptoms, as getting the "addict" off the drug ASAP is held to be a medical priority above making it comfortable for them -- even if the drugs are identical to those that are prescribed. (Addiction is distinguished by the psychological compulsion to take the drug, not by neurobiological dependence.)

I would disambiguate by titling the article Tapering prescribed psychotropics for exactly this reason, you will not want to wade into the muddy waters of "abused" or "addictive" drugs with Tapering psychotropic medication.

Although the distinction may be a cultural construct, discontinuing drugs in situations of abuse is another field altogether. Sobricatte (talk) 20:18, 31 July 2023 (UTC)

Yeah, I had the feeling there might be a bit of that in the distinction. I sometimes feel a bit like "it's not our job to mislead to enforce your morality and rules" regarding these sorts of distinctions (which is sometimes backed up with arguments for using plain language), but obviously WP:DUE. Regardless of the naming, I think it would be appropriately to prominently link to material on withdrawal of illicit drugs early in the article such that readers are aware of different opinions. Talpedia 10:58, 1 August 2023 (UTC)

Thank you. A psychotropic is a psychotropic, modifying the nervous system no matter how it's used.

E.g. Domperidone is a failed antipsychotic prescribed to stimulate lactation in new mothers. Nonetheless, it brings on neurobiological adaptation and requires tapering to avoid a withdrawal syndrome. Reference Majdinasab E, Haque S, Stark A, Krutsch K, Hale TW. Psychiatric Manifestations of Withdrawal Following Domperidone Used as a Galactagogue. Breastfeed Med. 2022 Dec;17(12):1018-1024. doi: 10.1089/bfm.2022.0190. Epub 2022 Nov 11. PMID: 36367713. Sobricatte (talk) 20:05, 31 July 2023 (UTC)