Stahl's Deprescriber's Guide

‘Deprescribing medications is a necessary skill for all clinical psychopharmacologists, and is not a trivial task. Drs. Strawn and Stahl impart their collective wisdom as they meld their own experiences with what the medical literature informs us, offering advice for implementing winning strategies. Sagely eliminating medications that interfere with others is essential to the practice of optimal, and personalized, care. The key concept is that gradual dose reduction is often required to avoid ‘rebound effects’ but there are others that can be safely stopped abruptly - the wise practitioner will know which is which. Organized alphabetically, together with an index by drug class, the book is user friendly and thus easy to consult. Profusely illustrated with the award-winning figures that have made Stahl’s series of books from Cambridge University Press famous, this book belongs on the shelves (and e-readers) of all clinicians involved in the care of people receiving psychotropic medications.’ Leslie Citrome, MD, MPH, Clinical Professor of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York; Adjunct Professor of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, Illinois‘In psychiatry, the role of deprescribing has been largely misunderstood and relatively neglected until fairly recently. Drs. Strawn and Stahl provide readers with a well-annotated, scholarly, comprehensive overview of the logistics for deprescribing psychotropic agents, paying careful attention to the context, circumstances, implications, and practical implementation of deprescribing protocols across all major elements of the modern pharmacopoeia. Readers will be enlightened by their comprehensive yet practical drug-by-drug approach that includes pharmacokinetics, logistics for switching strategies, managing withdrawal phenomena and differentiating them from relapses, use of rating scales, and considerations for special populations. Clinicians at all levels of training and expertise will benefit from the wisdom imparted in this critical text.’ Joseph F. Goldberg, M.D., Clinical Professor of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY; President, American Society of Clinical Psychopharmacology; Deputy Editor-in-Chief, The Journal of Clinical Psychiatry‘Deft pharmacologic prescription of psychiatric medications in the treatment of mental disorders involves integrating results from efficacy and effectiveness studies along with clinical experience. Initiating and optimizing pharmacologic treatments has been the priority of clinical research and knowledge transfer to practising clinicians. Deprescribing psychiatric medication, however, has received relatively less consideration, resulting in a knowledge gap predisposing heterogeneity in practice, quality of care, risk of harm and cost-ineffectiveness of treatment. Dr. Jeffrey Strawn and Dr. Steven Stahl have provided a scholarly, timely, ready for primetime implementation guide to practitioners on the appropriate deprescribing of medications in psychiatry. Their guide is a thoughtful integration of the science and art recognizing the fundamentals of psychopharmacology yet considering aspects of safety, utility, and acceptability of treatments, filling the knowledge gap that is so critically and urgently needed.’ Roger S. McIntyre, M.D., FRCPC, Professor of Psychiatry and Pharmacology, University of Toronto; Chairman and Executive Director, Brain and Cognition Discovery Foundation (BCDF), Toronto, Canada‘While considerable research, multiple guidelines and substantial clinical attention is paid to the question of which medication to prescribe, information and guidelines about when and how to discontinue medications scarcely get a mention. Until now. Stahl’s Deprescriber’s Guide authored by Dr Jeffrey R. Strawn and Dr Stephen M. Stahl provides the most authoritative guide on deprescribing psychotropic medications available. It covers 64 of the most widely used agents, managing the near impossible task of simultaneously being succinct and focused yet comprehensive and detailed. It is suffused with rare clinical wisdom answering the kinds of questions of greatest clinical relevance. It deserves pride of place on the bookshelf of every prescriber.’ Michael Berk, MBBCh, MMed(Psych), FF(Psych)SA, PhD, FRANZCP, FAAHMS, FASSA, Deakin Distinguished Professor of Psychiatry, School of Medicine, Deakin University and Barwon Health‘Psychiatric patients often receive several medications, some of which may no longer be needed, may be causing harmful side-effects, or adverse pharmacokinetic interactions. Thus, deprescribing is a critical and often necessary component of pharmacotherapy. This expertly written book by Dr. Strawn and Stahl contains comprehensive guidelines about the art of discontinuing, tapering or switching psychotropic medications to improve patients’ outcomes. It provides systematic details of the “what, why, when, and how” of optimizing a psychotropic drug regimen via judicious deprescribing to avert or minimize the risks of polypharmacy in all age groups. Beautifully illustrated and generously referenced, the authors provide rating scales and checklists of the withdrawal symptoms of 64 widely used psychotropic medications and differentiating them from relapse. I believe this book is destined to become an indispensable, must-have reference for all psychopharmacology prescribers.’ Henry A. Nasrallah, MD, University of Cincinnati College of Medicine, Cincinnati, OH

Jeffrey R. Strawn, MD is Professor of Psychiatry & Behavioral Neuroscience in the College of Medicine, University of Cincinnati, Cincinnati, Ohio. Stephen M. Stahl is Adjunct Professor of Psychiatry at the University of California, San Diego, Clinical Professor of Psychiatry and Neuroscience at the University of California, Riverside, and Honorary Visiting Senior Fellow in Psychiatry at the University of Cambridge.