2 results
General practitioners’ and psychiatrists’ attitudes towards antidepressant withdrawal
- Joanne McCabe, Mike Wilcock, Kate Atkinson, Richard Laugharne, Rohit Shankar
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- Journal:
- BJPsych Open / Volume 6 / Issue 4 / July 2020
- Published online by Cambridge University Press:
- 18 June 2020, e64
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- Article
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- You have access Access
- Open access
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Background
There has been a recent rise in antidepressant prescriptions. After the episode for which it was prescribed, the patient should ideally be supported in withdrawing the medication. There is increasing evidence for withdrawal symptoms (sometimes called discontinuation symptoms) occurring on ceasing treatment, sometimes having severe or prolonged effects.
AimsTo identify and compare current knowledge, attitudes and practices of general practitioners (GPs) and psychiatrists in Cornwall, UK, concerning antidepressant withdrawal symptoms.
MethodQuestions about withdrawal symptoms and management were asked of GPs and psychiatrists in a multiple-choice cross-sectional study co-designed with a lived experience expert.
ResultsPsychiatrists thought that withdrawal symptoms were more severe than GPs did (P = 0.003); 53% (22/42) of GPs and 69% (18/26) of psychiatrists thought that withdrawal symptoms typically last between 1 and 4 weeks, although there was a wide range of answers given; 35% (9/26) of psychiatrists but no GPs identified a pharmacist as someone they may use to help manage antidepressant withdrawal. About three-quarters of respondents claimed they usually or always informed patients of potential withdrawal symptoms when they started a patient on antidepressants, but patient surveys say only 1% are warned.
ConclusionsPsychiatrists and GPs need to effectively warn patients of potential withdrawal effects. Community pharmacists might be useful in supporting GP-managed antidepressant withdrawal. The wide variation in responses to most questions posed to participants reflects the variation in results of research on the topic. This highlights a need for more reproducible studies to be carried out on antidepressant withdrawal, which could inform future guidelines.
3 - From irresponsible knaves to responsible knights for just 5p: behavioural public policy and the environment
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- By Kate Disney, London School of Economics and Political Science, Julian Le Grand, London School of Economics and Political Science, Giles Atkinson, London School of Economics and Political Science
- Edited by Adam Oliver, London School of Economics and Political Science
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- Book:
- Behavioural Public Policy
- Published online:
- 05 June 2014
- Print publication:
- 24 October 2013, pp 69-93
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Summary
Introduction
How should individuals be encouraged to change their behaviour in order to reduce their impact on the environment? How can they be persuaded to curb the waste they make, to decrease the air and water pollution they generate, to throw away less waste or to reduce their carbon footprint? Should government policy-makers rely upon people’s sense of social responsibility or their feelings of public duty to behave appropriately? Should governments simply supply individuals and households with information about the environmental cost of their activities? Explicitly appeal to a sense of public duty through exhortation and entreaty? Or should they go in a different direction, give up on notions of social responsibility and public duty, and instead try to regulate in some way those activities with an adverse impact on the environment? If so, in what way? Through imposing bans or other forms of legal restrictions on those activities – or through creating a financial incentive to reduce the activities by imposing a charge or tax on them, or on the waste they generate?
The answer to these questions will in part depend upon the answers to a further set of questions concerning the structure of individual motivation. Should individuals be regarded as essentially public-spirited with respect to the environment, committed to promoting the welfare of their fellow citizens and the wider society through economizing on the damage they do: socially responsible ‘knights’, in terms of a metaphor one of us has used elsewhere (Le Grand, 2006)? In which case, the provision of the relevant information, perhaps coupled with some exhortation to remind people of their social duty, should be sufficient to change their environmentally damaging behaviour. Or should people be treated as primarily self-interested agents, indifferent to those negatively affected by their waste products and only responsive to incentives that directly affect (either positively or negatively) their own personal interests: not knights, but something closer to those whom David Hume (among others) termed ‘knaves’? In which case, the government will need to use policy methods that appeal to people’s sense of self-interest (or self-preservation), such as charges, taxation, subsidies or direct regulation.