Book review: The Maudsley Deprescribing Guidelines

It is heartening to see a book review of The Maudsley Deprescribing Guidelines being published in the BJGP.¹

Having contributed to the ‘patient experience evidence’ cited in the book (through our own work locally and nationally via our Petition to the Scottish Parliament PE01651, 2017–2021,² and our petition evidence published internationally, ‘The “patient voice”: patients who experience antidepressant withdrawal symptoms are often dismissed, or misdiagnosed with relapse, or a new medical condition’),³ it is interesting to see this now being used formally to educate and inform prescribers of the issues that patients have been encountering, not least that of being disbelieved by their doctors, resulting in serious damage to trust and doctor–patient relationships — as well as other harms sustained due to misdiagnosis of now known symptoms of ‘withdrawal’.

The introductory sections of the book provide a wide-ranging overview of the dependence-forming drug classes included. It goes on to explain, as mentioned by Sian Gordon, ‘The importance of gradual hyperbolic reduction regimes, of which many GPs may still be unaware’.¹

One has to wonder how it is that GPs have not learned from their own experience of seeing what happens to all too many patients when changes to medications are made. Gordon says, ‘I also cannot help but reflect on the medical profession’s reluctance to accept what their patients were telling them about drug effects, preferring to listen to false reassurance often originating from the producers of the drugs involved.’ ¹

The new Maudsley guidebook contains a wealth of background information and evidence, then step-by-step detailed ‘tapering’ options for each individual drug. It will do much to assist prescribers, patients, and the public to learn the all-important difference between ‘relapse’ and ‘withdrawal’, and to more safely navigate what seems to have been a serious void in understanding of the optimal use of these medicines.

My own sincere hope is that The Maudsley Deprescribing Guidelines will be widely used — by doctors, pharmacists, and patients all working together — to enable far safer use of these medicines, all commonly prescribed in primary care settings.