PROTECT PSP (Priorities for Future Research on Reducing and Stopping Psychiatric Medicines)

Top 10 priorities

The most important questions

1. What is the most effective way to safely reduce and stop psychiatric medicines in terms of tapering approach, rate of taper and duration of taper? What individual service user characteristics (e.g., age, gender, pregnancy, other medical conditions/diseases) and drug characteristics (e.g., medication type, duration of treatment, use of other medication) determine these?
    
2. What are the most effective ways to provide support to individuals who are reducing and stopping psychiatric medicines? These may include, but are not limited to, family/peer support, educational support, financial support, psychological support, and healthcare support.
    
3. What are the best ways to educate current and future healthcare professionals about reducing and stopping psychiatric medicines in terms of the tapering process, associated risks/difficulties, withdrawal symptoms, and supporting shared decision making? What is the impact of education on clinical practice?
    
4. What are the views and experiences of individuals who have reduced/stopped psychiatric medicines or are currently reducing/stopping psychiatric medicines on the tapering process and accessing tapering support?
    
5. What are the views and experiences of service users, family members/carers, and healthcare professionals around shared decision making in relation to starting and stopping psychiatric medicines? This includes informed consent. How can the process of implementing shared decision-making be improved when starting and stopping psychiatric medicines? What factors influence this process?
    
6. What are the positive and negative long-term consequences of reducing and stopping psychiatric medicines on an individual’s physical and mental health status? For individuals who experience negative consequences, what are the best ways to manage these difficulties? Negative consequences may include withdrawal symptoms, relapse, and protracted withdrawal syndromes.
    
7. What are the perspectives of key stakeholders on the professional, ethical, and legal responsibilities of healthcare professionals and/or the pharmaceutical industry in relation to reducing and stopping psychiatric medicines?  Stakeholders include service users, family members/carers and healthcare professionals. What are the best ways to enact these responsibilities?
    
8. Which factors influence the prevalence, duration and severity of withdrawal effects that appear during or after reducing and stopping psychiatric medicines? What is the best way to control these factors and reduce an individual's risk of developing withdrawal effects or relapsing?
    
9. How best can the withdrawal symptoms that appear during or after reducing and stopping psychiatric medicines be identified and differentiated from other causes (e.g., relapse/return of underlying condition, distress)?
    
10. What are the barriers and enablers to reducing and stopping psychiatric medicines? These may include, but are not limited to, the service user, the healthcare professional, family, and society.

The following questions were also discussed and put in order of priority at the workshop:

11. How can the availability of psychiatric medicines in formulations that facilitate the process of reducing and stopping psychiatric medicines be improved? These include tapering strips and liquid formulations.
     
12. Is there an optimum duration of use of psychiatric medicines after which reducing and stopping should be initiated that minimises the potential of physical dependency and/or relapse? Does this differ depending on the class/ type of medication?
     
13. What would make for an effective public health campaign about the potential risks associated with the use of psychiatric medicines, and the potential for challenges when reducing and stopping? These may include withdrawal symptoms and protracted withdrawal syndromes.
     
14. What effects does the tapering process (tapering approach, rate, and duration of taper) and associated outcomes (i.e., withdrawal symptoms, protracted withdrawal syndrome, quality of life) have on the individual’s health status and underlying neurobiology?
     
15. Is there a relationship between reducing and stopping psychiatric medicines and suicide/ suicidal ideation? If so, how best can this relationship be explained in terms of causation and prevalence?
     
16. What is the rate/likelihood of recovery from withdrawal effects after reducing and stopping psychiatric medicines? Which factors influence/predict an individual’s recovery outcomes?
     
17. What factors influence a service user’s decision to reduce and stop psychiatric medicines? These may include patient factors, social factors, and health system factors.
     
18. To what extent do healthcare professionals report and document the adverse effects associated with the use of psychiatric medicines and/or the difficulties associated with reducing and stopping psychiatric medicines? How does this align with reports from service users, family members and carers?
     
19. How best can the future health of individuals who have stopped psychiatric medicines and have current/previous experience of protracted withdrawal syndromes be managed and protected? This may include, but are not limited to, the use of similar drugs or class of drug during future medical encounters
     

Key documents

These documents set out the aims, objectives and commitments of the PSP.

PROTECT PSP (Priorities for Future Research on Reducing and Stopping Psychiatric Medicines) protocol

PROTECT PSP (Priorities for Future Research on Reducing and Stopping Psychiatric Medicines) Steering Group terms of reference