Latest news with #tapering
Medscape
2 days ago
- Health
- Medscape
Guideline Outlines How to Taper Benzodiazepines Safely
Long-term, regular use of benzodiazepines is common and can lead to physical dependence and withdrawal when the dose is reduced or the medication is abruptly stopped. However, evidence has been lacking on the best tapering methods for the medications commonly prescribed for uses including sleep disorders and anxiety. Additionally, patients have different reactions to the withdrawal process. In light of the clinical concerns, the American Society of Addiction Medicine has partnered with nine other medical societies and professional associations and on Tuesday published the Joint Clinical Practice Guideline on Benzodiazepine Tapering, in the Journal of General Internal Medicine . The guideline outlines evidence-informed and consensus-based strategies to help clinicians, particularly primary care physicians, and patients work together to safely taper the medications while minimizing withdrawal symptoms, which can be severe and potentially life-threatening. Primary care physicians prescribe most benzodiazepines. The guideline is not meant for palliative care and end-of-life physicians, the authors noted. Tapering Can Take More Than a Year The guideline, with lead author and Chair Emily Brunner, MD, with the Hazelden Betty Ford Foundation in Minneapolis recommends a slow tapering process, adjusted according to each patient's response. For those who have been using the medication for years, tapering can take a year or more, the authors noted. Among the key recommendations: Never abruptly stop benzodiazepines when patients are likely to be physically dependent on the medication and at risk for withdrawal. Consider tapering long-term use in older adults, unless there are compelling reasons for continuation. Regularly assess patients to weigh the risks and benefits of continuing benzodiazepine therapy compared with tapering. That calculation can change over time. Consider tapering when risks outweigh benefits of continued therapy. Begin tapering slowly and with small dose reductions (perhaps a 5%-10% reduction in total daily dose every 2-4 weeks). Routinely monitor patients and adjust the tapering as needed. Patients List Their Hopes for Physicians Aleksandra E. Zgierska, MD, PhD, with Penn State College of Medicine in Hershey, Pennsylvania, pointed out in an accompanying editorial that patients who experienced tapering helped develop the guideline at each step. Patient-advisers said they hoped physicians would: Be aware of the broad range of potential withdrawal symptoms and the risk for symptoms lasting months and years after stoppage. Know how to support patients who need very slow tapers, for example, by using 'micro tapering' strategies with liquid benzodiazepine formulations when needed. Understand, and help patients understand, the time needed for the brain's gamma-aminobutyric acid receptors to return to homeostasis (eg, avoiding alcohol and sedatives, including other benzodiazepine-like z-drugs such as zolpidem, zopiclone, and zaleplon). Prioritize Those at Highest Risk of Harm Zgierska and colleagues offer help on thinking about which patients most need tapering. 'As we saw after the release of the CDC Guideline for Prescribing Opioids for Chronic Pain in 2016, guidelines can have unintended consequences,' they wrote. 'There may be a large population of patients for whom benzodiazepine tapering is indicated. Clinicians should prioritize those who are at the highest risk of harm.' In a related Viewpoint in JAMA , published simultaneously, the guideline's lead author, Brunner, and co-editorialists, explained that after the CDC's 2016 guideline on opioid use was published, misapplication 'led some prescribers to abruptly discontinue pain medications without first developing a plan for safe tapering, putting patients at risk of withdrawal and transition to illegally obtained opioids while also failing to address pain symptoms.' They explained that benzodiazepines are effective in managing conditions including anxiety, seizures, agitation, insomnia, and alcohol withdrawal. In 2023, they wrote, '9% of US adults received a benzodiazepine prescription.' Treatment guidelines have generally advised against use for more than 4 weeks because of the accompanying risk of falls, vehicle crashes, cognitive impairment, delirium, and overdose. Despite that, in an analysis of prescribing to US adults, 'one quarter of those prescribed a benzodiazepine were prescribed a supply exceeding 120 days,' they wrote. 'Many patients are currently prescribed long-term benzodiazepines for conditions that could be managed with lower-risk interventions.' In some cases — such as those with treatment-resistant generalized anxiety disorder or sleep disorders with abnormal movements — long-term use of benzodiazepines may be warranted, they explained. While clinicians may read the guideline and decide large numbers of their patients may need tapering, the authors of the Viewpoint wrote, 'It is critical that the guideline not be used to justify abrupt discontinuation of benzodiazepines in patients who may have developed physical dependence.' Resources for Implementation A number of resources have been developed to help clinicians implement the recommendations in the guideline, including continuing medical education, pocket guides, and handouts, and downloadable tools such as benzodiazepine dose equivalents and decision flow charts. Report authors and the Viewpoint authors declared no relevant financial relationships. Zgierska, lead author of the editorial, is a member of the board of directors for the American Society of Addiction Medicine. Marcia Frellick is a Chicago-based healthcare journalist and a regular contributor to Medscape . Routinely monitor patients and adjust the tapering as needed.
Bloomberg
4 days ago
- Business
- Bloomberg
Japan Bond Futures Drop After BOJ Plans Slower Bond Buying Cuts
Japanese bond futures dropped after the central bank held rates steady and said it would slow its tapering of government bond buying from the start of the next fiscal year. The yen rose slightly against the dollar to 144.72 as 12:36 p.m. Tokyo time, while JGB futures dropped 0.1%. The BOJ eased the tempo at which it will decrease its monthly bond purchases from next fiscal year to a quarterly reduction of ¥200 billion ($1.4 billion), from the current pace of ¥400 billion.
WIRED
10-06-2025
- Health
- WIRED
‘Uber for Getting Off Antidepressants' Launches in the US
Jun 10, 2025 6:00 AM Outro, which is now available in seven states, wants to help people taper off antidepressants without experiencing debilitating side effects. Ariella Sharf was first prescribed antidepressants when she was a college student more than a decade ago. When she decided to stop taking them last year, Sharf says she wasn't sure how to do it safely. She was disappointed when her longtime psychiatrist didn't help her find a new doctor after she moved across the country, and she thought her primary care physician wasn't equipped for the task. Sharf decided instead to try Outro Health, a telehealth startup that CEO and cofounder Brandon Goode describes as 'Uber for getting off antidepressants.' Outro officially launched in the US last month and is currently available in seven states, including California and New York. The startup is betting that many of the growing number of Americans taking antidepressants will eventually want help coming off them. Over 11 percent of US adults took medication for depression in 2023, according to the US Centers for Disease Control and Prevention's National Health Interview Survey, which found women were more than twice as likely as men to use the drugs. About one in six people who stop taking antidepressants experience side effects like nausea and dizziness, especially if they do so abruptly, according to one study. Other research has found the prevalence of adverse withdrawal symptoms may be much higher, particularly among patients who have been on them for long periods. For a monthly fee starting at $125, Outro pairs patients with a clinician who meets with them on a custom schedule—often weekly or monthly—and guides them through a tailored tapering program. Outro currently employs a small group of medical contractors, including nurse practitioners specializing in psychiatry and general nurse practitioners, who are supervised by psychiatrists. For now, patients pay for the service entirely out of pocket, but Goode says Outro plans to start accepting insurance soon. Outro's program is currently focused specifically on drugs often prescribed for depression, including selective serotonin reuptake inhibitors (SSRIs) like Lexapro and Prozac, and serotonin–norepinephrine reuptake inhibitors (SNRIs) like Pristiq and Cymbalta. In the next year, Goode says, the company is planning to expand beyond antidepressants and begin offering tapering programs for stimulants and benzodiazepines, two classes of drug that are commonly prescribed in the US for issues like anxiety and ADHD and are known to cause intense withdrawal symptoms. 'I was kind of waiting for something like Outro to exist,' says Sharf, who became one of the company's first patients in the United States last June as part of a pilot program in California. 'Everything was tailored around how I wanted to do it.' Twelve months later, Sharf says she is still tapering off her medication with help from Outro at a pace that works for her. When customers sign up for Outro and get matched with clinicians, they then typically follow a tapering method endorsed by one of Outro's other cofounders, the British academic psychiatrist Mark Horowitz. Known as 'hyperbolic tapering,' it's a substantially more drawn-out process than other methods used to help people get off meds. Unlike a linear taper, which involves reducing the dose of a medication by the same amount each time, a hyperbolic taper gradually slows the rate of reduction—cutting smaller and smaller amounts as it goes—so that the final doses are extremely small and spread out over a much longer period. To facilitate this, Outro partners with compounding pharmacies to produce custom versions of generic antidepressants in minuscule doses that are not available commercially. In other words, while Outro promotes itself as a service for getting off medication, part of its business model hinges on people continuing to take the compounded drugs its clinicians prescribe. Horowitz, who has become one of the UK's leading experts on medication tapering, known as de-prescribing, says his interest in the topic was driven by his own harrowing experience coming off antidepressants more than a decade ago when he was a psychiatry doctoral student. Horowitz crafted a gradual tapering plan for himself that involved using syringes from his research lab to dole out small liquid doses of escitalopram, known by the brand name Lexapro. But he couldn't prevent the misery induced by discontinuing the drug. 'My life exploded,' Horowitz says. His symptoms, which included severe insomnia and dizziness, were so debilitating that he moved back in with his parents. 'It took me years to come off, not weeks as guidelines recommended.' After he recovered, Horowitz began pushing for doctors to adopt new clinical guidelines for getting off antidepressants. He coauthored the Royal College of Psychiatry's guidance for psychiatric drug cessation and joined the UK's National Health Service as a clinical research fellow. His goal with Outro is to bring the guided tapering methods he has developed to a new patient base in North America. Goode, Outro's CEO, has a background working in pharmaceuticals and telehealth that includes stints at Novo Nordisk and the psychedelic therapy startup Field Trip Health, now known as Stella. 'People kept asking how to use psychedelics to get off antidepressants,' Goode says, which led him to suspect there might be a substantial swath of the population who wanted help quitting the drugs. Horowitz and Goode cofounded Outro in 2022 along with another Field Trip alum, Tyler Dyck. The company's small team also includes Adele Framer, the founder of Surviving Antidepressants, a long-running forum where people swap tips on how to taper off this class of medication. It's a fraught moment to be launching a health startup in the US focused on getting people off psychiatric drugs. The US secretary of health and human services, Robert F. Kennedy Jr., has questioned whether the medications are overprescribed, and has made false claims linking antidepressants to school shootings and increased violence. Similar views have been articulated by other Trumpworld figures, including DOGE architect Elon Musk, who told Tucker Carlson that SSRIs are 'the devil.' Horowitz says he shares some of Kennedy's concerns about whether antidepressants are overprescribed and how severe withdrawals can be. But he's disturbed that Outro's project could be seen as aligned with the health secretary's broader Make America Healthy Again movement, especially as he considers himself 'to the left of Bernie Sanders.' 'The fact that this has become a political football is really dangerous,' he says. 'These medications have benefits—and they have harms, and can be difficult to stop. My work is about helping people navigate those things in an informed way.' There is a small but growing group of mental health experts who say it's time to reevaluate how antidepressant withdrawal is understood and treated. Anders Sørenson, a clinical psychologist in Denmark specializing in psychiatric de-prescribing, says the status quo for most patients is 'not just inadequate, but often actively harmful.' He sees an urgent need for more doctors to craft hyperbolic tapering plans customized to each individual patient's needs. Some psychiatry experts push back on the idea that hyperbolic tapering programs are necessary for many patients. Jonathan E. Alpert, a psychiatrist and professor at Montefiore's Albert Einstein College of Medicine, agrees that taking a thoughtful approach to tapering is important and says hyperbolic tapering 'makes some sense neurobiologically.' But he thinks a large portion of people who want to quit psychiatric drugs can do so by using what he considers to be 'less fussy' methods, like gradually halving doses, rather than relying on 'an extremely precise, extremely elaborate and potentially resource-intensive approach to a problem that usually can be handled in a much more straightforward way.' Horowitz sees his work with Outro as part of a larger mission to shift the public conversation about the root causes of psychological problems. While he doesn't want to discourage people who need medication from taking it, he believes that the level of chronic SSRI use happening today should be carefully evaluated to ensure social factors contributing to mental health issues are not being overlooked. 'To me, it is actually a very leftist issue to de-medicalize the way we treat anxiety and depression,' he says, noting that such illnesses are often caused 'by social circumstances, by poverty, by loneliness.' Outro is making the opposite pitch of most online health startups, offering to help people stop drugs rather than start them. But its website doesn't look too different from that of other telehealth companies, featuring the same neutral colors and clean fonts that have come to define the world of direct-to-consumer millennial wellness brands. On its landing page, a chirpy pop-up appears advertising its introductory offer: 'Get started for $99.'
Bloomberg
09-06-2025
- Business
- Bloomberg
BOJ Likely to Ease Tapering Pace of Bond Buys, Ex-Official Says
The Bank of Japan is likely to slow the pace of tapering its government bond purchases next fiscal year at the board's upcoming meeting, according to a former BOJ executive director in charge of monetary policy. The central bank has reduced the monthly pace of bond buying by ¥400 billion ($2.8 billion) per quarter since last summer. Whether it'll maintain that tempo in fiscal 2026 is a key focus of the two-day gathering ending on June 17.
CNA
04-06-2025
- Business
- CNA
BOJ to consider slowing pace of bond tapering next year, sources say
TOKYO :The Bank of Japan is considering slowing the pace of tapering in its bond purchases from next fiscal year onward, said four sources familiar with its thinking, a move that would signal its focus on avoiding big bond market disruptions. The move would come in the wake of heightened volatility in the Japanese government bond (JGB) market, with super-long yields having spiked to record highs last month reflecting investors' concern over Japan's worsening public finances. There is no consensus yet within the BOJ, as some prefer to maintain the current pace on the view the bank should focus on reducing its presence in the bond market, the sources said. A final decision will be made at the BOJ's next policy meeting on June 16-17, when the board conducts a review of a current tapering plan that runs through March and comes up with a subsequent programme for April 2026 onward. The BOJ received a sizeable number of requests from bond market participants to cut its quarterly taper size to around 200 billion yen, minutes of its meeting on May 20-21 with bank and financial institutions showed on Monday. Some policymakers see such views as a reasonable ballpark figure, the sources said. That would be half the size of the reduction under the current plan laid out last year, at which the BOJ cuts bond buying by around 400 billion yen per quarter until March 2026. "The balance of opinions at the meeting will be a crucial factor in the BOJ's discussions on the taper plan," one of the sources said. The sources spoke on condition of anonymity as they were not authorised to speak publicly. The BOJ began tapering its huge bond buying last year to wean the economy off decades of massive stimulus, and breathe life back to a market made dormant by its huge presence. Though the BOJ still holds huge amounts of JGBs, some market players are now worrying that the steady reduction in the bank's bond buying could leave them vulnerable during heightened market volatility such as last month's sell-off in super-long bonds. While many market players expect the BOJ to maintain or slightly slow the pace of tapering beyond April 2026, the BOJ has been mum on what the new plan could look like. Having ditched a bond yield control policy last year, the BOJ is in no mood to ramp up bond buying in the wake of recent rises in super-long bond yields as medium and shorter-maturity bonds, as well as bank lending rates, remained stable. But the volatility seen in the super-long JGB market has heightened awareness within the BOJ of the need to ensure its bond tapering plans do not destabilise markets, the sources said. "The BOJ won't react directly to the rise in super-long yields, but is mindful of the risk the move could affect the entire yield curve," a second source said. The new programme is likely to cover a one-year period running through March 2027. MILDER TAPERING EYED The BOJ has lagged well behind its global counterparts in whittling down crisis-era stimulus, having only exited last year a decade-long, massive stimulus aimed at pulling the economy out of stagnation. It also ended negative interest rates last year, though short-term borrowing costs are still stuck at 0.5 per cent. While the BOJ also began tapering its huge bond buying last year, it still owns roughly half of outstanding JGBs. At its upcoming review, the BOJ is likely to roughly maintain its taper plan for this year, which would see monthly bond buying halved to 3 trillion yen by March 2026. If the BOJ were to cut bond buying by 200 billion yen per quarter from fiscal 2026, its monthly buying will fall to around 2 trillion yen by the March 2027 end of the business year. That would roughly mesh with requests made by some market participants for the BOJ to reduce its monthly bond buying to around 1 trillion to 2 trillion yen, according to the minutes of the meeting. Compiled by the BOJ's staff, the minutes of the bank's meetings with bond market participants is seen as reflecting its preferred approach on bond tapering, and thus offers clues on the bank's final decision, analysts say. ($1 = 144.0200 yen)
