{"id":194315,"date":"2025-06-18T11:55:13","date_gmt":"2025-06-18T11:55:13","guid":{"rendered":"https:\/\/www.europesays.com\/uk\/194315\/"},"modified":"2025-06-18T11:55:13","modified_gmt":"2025-06-18T11:55:13","slug":"making-antidepressant-tapering-safer-and-easier","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/uk\/194315\/","title":{"rendered":"Making antidepressant tapering safer and easier"},"content":{"rendered":"

\"antidepressant<\/a><\/p>\n

In a significant advancement for patient-centred care, a team of pharmacists from the University of Tasmania is reshaping the landscape of antidepressant deprescribing.<\/strong><\/p>\n

Their latest research aims to close a long-standing clinical gap by making easy-to-prepare, cost-effective oral liquid formulations of commonly prescribed antidepressants accessible to every Australian pharmacist.<\/p>\n

\"antidepressantNatalie Cooper<\/p>\n

These new formulas will help to ensure that patients have options to access safe and effective medications when deprescribing antidepressants, said Natalie Cooper, Research Project Lead at the University of Tasmania\u2019s School of Pharmacy and Pharmacology.\u00a0<\/p>\n

\u2018Prescribers can also have confidence that when they are prescribing these formulas and suggesting a deprescribing regime, the patient is going to receive an accurate and effective dose,\u2019 she said.<\/p>\n

Long-term use with limited tapering options<\/p>\n

Each year, over 3.5 million Australians <\/a>are prescribed antidepressants. Half of these patients become long-term users, with average treatment durations reaching 4 years<\/a> \u2013 well beyond the recommended 6\u201312 month course<\/a> to treat a single depressive episode. While these medicines play a critical role in managing mental health, extended use can result in adverse effects<\/a>, particularly in older adults<\/a>. Yet safely discontinuing antidepressants remains a challenge.<\/p>\n

Key among the hurdles is dose inflexibility.<\/p>\n

\u2018With the lack of commercially available liquid antidepressant formulations available in Australia, there are limited dosing options for people to withdraw from antidepressant medications,\u2019 Ms Cooper said.<\/p>\n

The recently released Maudsley Deprescribing Guidelines recommend a hyperbolic tapering method<\/a> \u2013 small, incremental decreases in dose over time \u2013 to minimise withdrawal symptoms and support the body\u2019s physiological adjustment. However, this method often requires doses lower than commercially available tablet strengths.<\/p>\n

In Australia, the lowest available strength of citalopram \u2013 the most commonly prescribed antidepressant \u2013 is a 10 mg tablet, which can make safe and effective tapering difficult.<\/p>\n

Seeking safer deprescribing methods<\/p>\n

When tapering antidepressants<\/a>, current guidelines often suggest that low doses of certain formulations can be crushed up and dispersed in water<\/a>, Ms Cooper said.\u00a0<\/p>\n

\u2018Getting patients to do this imprecise method at home didn\u2019t sound safe to me,\u2019 she said. \u2018So I reached out to the Wilson Foundation and asked \u201cwhy don\u2019t we utilise liquid formulations to [deprescribe] in a safe and effective way?\u2019\u201d<\/p>\n

In response, the Wilson Foundation funded an 18-month project aimed at producing professional, evidence-based formulation alternatives that all registered pharmacists can readily compound.\u00a0<\/p>\n

\u2018By creating easy-to-prepare, cost-effective liquid antidepressant formulations that any pharmacy can compound, we\u2019re tackling a major barrier to antidepressant discontinuation,\u2019 Ms Cooper said.<\/p>\n

Choosing the right antidepressants for compounding<\/p>\n

The research team selected 11 antidepressants for development, targeting those most commonly prescribed in Australia, including mirtazapine, paroxetine and fluoxetine.<\/p>\n

\u2018There are some that aren\u2019t as commonly prescribed, but if there\u2019s a patient who needs to come off them, they have an option available,\u2019 Ms Cooper said.<\/p>\n

Out of 15 antidepressants listed in the Maudsley Deprescribing Guidelines, four were identified as controlled-release formulations \u2013 such as venlafaxine \u2013 that can\u2019t be easily transformed into liquid forms.<\/p>\n

\u2018We have gone with the antidepressants we know are immediate release and can be formulated into liquid formulations,\u2019 she said.\u00a0<\/p>\n

The formulations that have sustained-release properties will still require a compounding pharmacist\u2019s expertise to formulate alternate dosage forms.<\/p>\n

Developing evidence-based liquid formulations<\/p>\n

Designed for ease and accessibility, the proposed liquid formulations can be compounded using standard equipment and readily available ingredients.<\/p>\n

\u2018We\u2019re conducting stability testing on these liquid formulations using the commercially available tablets and accessible bases such as ORA-Sweet and ORA-Plus,\u2019 Ms Cooper said. \u2018So pharmacists can compound them when they get a prescription from a GP for individual patient supply.\u2019<\/p>\n

Once stability and microbial safety are confirmed, the formulations will be submitted to the Australian Pharmaceutical Formulary and Handbook (APF) to be considered for inclusion.<\/p>\n

If they are in the APF, they will be available to every single pharmacist and pharmacy in Australia to compound.<\/p>\n

The rollout will be incremental, with three formulations submitted each quarter until all 11 are included by the project\u2019s completion.<\/p>\n

Bridging gaps in access and affordability<\/p>\n

Compounded formulations of antidepressants have traditionally only been available through specialised pharmacies. For patients and prescribers alike, this has presented a barrier to optimal care.<\/p>\n

\u2018Some people may be getting specialised compounded fluoxetine capsules in a low dose through a compounding pharmacy, for example. But they can be quite expensive,\u2019 Ms Cooper said. \u2018Accessing a compounding pharmacy also can be quite difficult.\u2019<\/p>\n

Dr Anna Seth, a Tasmanian GP, echoed these concerns from the prescriber\u2019s perspective.<\/p>\n

\u2018Existing options for gradual discontinuation of antidepressants are very limited, creating a barrier for patients and the doctors who support them,\u2019 she said. \u2018The cost of compounding these medications is prohibitive for many of my patients who are then stuck with either trying to crush and disperse tablets at home or stopping medications more abruptly and risking unpleasant withdrawal effects.\u2019<\/p>\n

The new liquid formulations will allow prescribers to instruct patients in volume-based dosing, simplifying the regimen.<\/p>\n

Pharmacists\u2019 role in interdisciplinary care<\/p>\n

Beyond compounding, pharmacists will play a crucial role in patient and prescriber education.<\/p>\n

\u2018It\u2019s important to get it out through networks to let prescribers know that these formulas are available for pharmacists to compound,\u2019 Ms Cooper said. \u2018Communication between the doctor and the pharmacist will help patients be able to achieve effective withdrawal from antidepressants.\u2019<\/p>\n

Joanne Gross, President of PSA\u2019s Tasmania Branch, reinforced the importance of pharmacist leadership in deprescribing initiatives.<\/p>\n

\u2018Antidepressant deprescribing remains a challenge, particularly for long-term users experiencing withdrawal symptoms,\u2019 she said.<\/p>\n

\u2018PSA looks forward to continuing to work with the University to potentially make their findings accessible to all Australian pharmacists through the APF, supporting flexible, individualised tapering regimens and improving patient outcomes.\u2019<\/p>\n

To find out more about when and how pharmacists can compound and the compliance obligations required, attend the \u2018Compounding essentials for 2025\u2019 session at PSA25 held in Sydney from 1\u20133 August. Register here to attend<\/a>.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"In a significant advancement for patient-centred care, a team of pharmacists from the University of Tasmania is reshaping…\n","protected":false},"author":2,"featured_media":194316,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4317],"tags":[79227,39564,79228,79229,105,79230,218,79231,16,15],"class_list":{"0":"post-194315","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-mental-health","8":"tag-antidepressant-deprescribing","9":"tag-antidepressants","10":"tag-apf26","11":"tag-compounding","12":"tag-health","13":"tag-maudsley-deprescribing-guidelines","14":"tag-mental-health","15":"tag-psa25","16":"tag-uk","17":"tag-united-kingdom"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@uk\/114704241403843717","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/194315","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/comments?post=194315"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/194315\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media\/194316"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media?parent=194315"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/categories?post=194315"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/tags?post=194315"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}