Dr. Stephen Stahl, MD and Jeffery Strawn have published a new de prescribing guide. He is the author of Essential Psychopharmacology which is the current prescribing guide in the United States. 

 

From what little I know about this book so far I take serious issue with it. Part of what it advocates in addition to too short and too rapid tapers is that it also advocates addition of other medications such as anti psychotics, mood stabilizers, etc. to deal with any withdrawal symptoms. Here are 2 links that discuss this book. Thought everyone would want to know. The first link is to the Psychiatric De-prescribing Council founded by Adele Framer the founder of Surviving Antidepressants. The other link is to a thread on Benzo Buddies which has a pretty thorough review of the book. 

 

https://psychdeprescribing.org/stahl-deprescribinginterview/

 

https://benzobuddies.org/topic/289921-heads-up-stahls-deprescribers-guide-released/

 

 

If anyone finds critical reviews of this book or if you have read it, have screenshots from it, etc. please post them here. You can also register on the PDC website and leave comments on the book through the above link. I purchased the book and will post more of what I think about it as I read the book.

I posted my comment on Amazon and on PDC website 

 

https://psychdeprescribing.org/stahl-deprescribinginterview/
 

Strongly encourage others to do the same! 

On 3/4/2026 at 3:09 PM, Mao205 said:

I posted my comment on Amazon and on PDC website 

 

https://psychdeprescribing.org/stahl-deprescribinginterview/
 

Strongly encourage others to do the same! 

This is good news 

why is that even posted on deprescribing guidelines council ?

I do not undestand. 

Others are asking the same question. I don't know. However, if you look at the bottom of the article there is a footnote that says the author is an advisor to the Psychiatric De-prescribing Council (PDC). I have no explanation.

 

My copy of the book should be here today. I will go through it and post my own review based on my lived experience.

Edited March 10Mar 10 by Feralcatman

This is the review I posted on Amazon:

 

This book has already received a range of reviews, both favorable and critical, many from clinicians who either intend to incorporate it into practice or who disagree with its approach. I am not a doctor, scientist, therapist, or healthcare professional. I write solely from the perspective of 32 years of lived experience as a psychiatric patient.

During that time I have been prescribed 17 psychiatric medications and at least 29 additional medications used to manage their adverse effects. I experienced severe complications from psychotropic drugs including type 2 diabetes, metabolic syndrome, 100 pounds of weight gain, cardiac and thyroid issues, vision problems, circadian rhythm disruption, akathisia, tremors, cognitive impairment, and more. At one point I was admitted to the ICU after inpatient medication changes caused life-threatening metabolic, cardiac, and gastrointestinal symptoms. At the time these issues were attributed to dysfunction in various body systems. Looking back, it is clear they were the result of polypharmacy gone terribly wrong. Since discontinuing one medication and tapering another, many of these problems have improved or resolved.

The book does contain positive elements. The authors acknowledge that medications may outlast their usefulness and that deprescribing is an essential part of mental health care. They emphasize that how medications are tapered is just as important as how they are initiated, and that abrupt discontinuation can have serious consequences that are preventable through proper tapering strategies. They also highlight the importance of shared decision-making and recognize the value of patient lived experience in informing ethical prescribing and deprescribing practices. As someone who has experienced multiple provider-directed rapid tapers, abrupt withdrawals, and medication swaps, I am encouraged to see these issues addressed in a clinical text.

However, the book still contains serious concerns. It often fails to clearly distinguish withdrawal from relapse and gives little attention to protracted withdrawal syndromes. Taper recommendations are frequently linear and overly rapid compared with real-world patient experiences. Withdrawal management often involves adding additional medications, increasing the risk of further polypharmacy. The concept of neurological kindling from repeated medication changes is absent. Finally, medications are ranked by withdrawal severity despite strong evidence that individual physiology and medication history are far more predictive.

This book is a start in the right direction but a poor one at best and as such I recommend staying away from it. In its current form it is more of a potential danger to the patient than anything else. There are better references available for safe deprescribing.

This is the original non-condensed review that I wrote but it's too long to post anywhere other than here:

 

This book has already received several reviews, both favorable and critical. Many of these come from clinicians who either plan to incorporate the book into their practice or who disagree with its approach. I am not a doctor, scientist, therapist, or healthcare / mental healthcare worker. I am providing this review purely from the perspective of 32 years of lived experience as a patient. During this time, I have been on 17 different psychiatric medications and at least 29 other medications that were used to manage adverse effects of these medications. I have experienced severe side effects from psychotropics such as type 2 diabetes, metabolic syndrome, 100 pounds of weight gain, cardiac issues, thyroid issues, vision issues, circadian rhythm issues, akathisia, super sensitivity psychosis, severe tremors, loss of cognitive function, and more. At one point I ended up in the ICU due to severe and life threatening metabolic, cardiac, and gastrointestinal symptoms resulting from inpatient medication changes. At the time, most of these symptoms were attributed to dysfunction in body systems rather than medication effects. Knowing what I know now and looking back, it is obvious that I was suffering from the effects of poly-pharmacy gone horribly wrong. Now that I have succeeded in stopping one of the medications and am currently tapering another, much of this has improved or resolved completely.

I first want to address the positive aspects of the book. It acknowledges that treatments, though initially helpful, can outlast their usefulness and that deprescribing is an essential part of mental health care. This book makes clear that how a medication is tapered and stopped is equally as important as medication initiation, and that sudden discontinuation of medication can in some cases have disastrous consequences that are preventable through proper tapering strategies. The authors express the need for mitigating discontinuation syndromes and optimizing long term outcomes through shared decision making and that the tapering process be informed, strategic, and structured except in rare situations where discontinuation is initiated due to a life-threatening event such as Neuroleptic Malignant Syndrome. They go on to state that a patient-centered approach is the best path to successful cessation. Lastly, they acknowledge the importance of their patients whose lived experience has proven more valuable than academic instruction or controlled trials and express their thanks for those whose lived experience has contributed to their ongoing education in proper and ethical prescribing and deprescribing. Having been a patient for 32 years with multiple provider-initiated and monitored rapid tapers, cold turkey withdrawals, and rapid swaps I am very happy to see all of this in a publication that addresses the urgent need for deprescribing guidelines.

That said, there are serious problems with the techniques and recommendations presented in this book that, in my view and experience, will ultimately contribute to the proliferation of polypharmacy and continued patient harm and suffering. There are many issues that need to be addressed and throughout this book there are many contradictions that need to be reconciled.

I would first point out that early in the book there is an acknowledgement that psychiatry and psychopharmacology is:

“a field with limited evidence and few formal guidelines.”

I have read many studies over the years trying to understand my own issues and have found that the bulk of them are short (several weeks to only a few months at most), limited in scope (restrictive selection criteria and small patient pool), and contradictory, so I agree that their statement is a true statement. Evidence of any kind that is useful at the clinical level is very sparce and of poor quality due to study design. The bulk of studies do not address long term use and its effects over many years of use or the consequences of polypharmacy and multiple starts and stops. Studies quoted in this book fall more in line with following the current standard of care and the accepted narrative while other studies that provide alternative insights have been left out. While the authors acknowledge the importance of lived experience, the tapering methodologies they recommend suggest that the perspectives informing their conclusions were limited in scope and largely aligned with existing clinical practices.

There are 5 main drawbacks to this book that I feel are critical to point out and discuss.

1.     Failure to adequately distinguish between relapse and withdrawal as many symptoms overlap with little mention of the risk of protracted withdrawal syndrome or post-acute withdrawal syndrome (PAWS) as a risk across most of the medication classes aside for the concept being theoretical and controversial. The article about the book mentions the idea briefly, but is overall dismissive of the concept and of the vast amount of data in the lived experience of the withdrawal community.

 

2.     Taper strategies are largely linear and overly short which is not in line with what many patients have experienced, myself included. This forces many people to move away from the medical system for help in online forums and social media.

 

3.     Adjunct recommendations for coping with withdrawal symptoms includes the addition of other medications such as Z-drugs, mood stabilizers, benzodiazepines, and antipsychotics. Each of these carry their own risks of side effects and withdrawal, that may simply add to the burden the patient is already experiencing contributing to increased polypharmacy, possible kindling, and associated harms.

 

4.     There is no mention of the concept of neurological kindling as a risk of polypharmacy. This risk can be heightened by the addition of supportive medication, which in some patients leads to central sensitization, increased risks of side effects, and adverse reactions when adding in additional medications.

 

5.     Each medication is rated in terms of severity of withdrawal. However, in the real world it seems to be more about individual physiology and medication history that determines the severity of withdrawal, making this rating system misleading and potential harmful to the patient. In this text, Clonidine is rated as more difficult to taper than Quetiapine. The bulk of lived experience shows this to be untrue and a bad assumption. There are many examples and assumptions in this book that do not reflect lived experience.

 

To keep this from turning into more of a thesis paper, I will not address each one of these items individually or at length. I would suggest that those who read this review also read the following 2 studies, both of which fall in line with lived experience.

 

Kindling in psychopharmacology

 

Protracted withdrawal syndrome after stopping antidepressants

 

Through my own experience, kindling is a very real and disabling phenomenon. In the beginning making medication changes was uneventful and caused no long-term discomfort. However, as time went by and more medications were added and removed my sensitivity to their effects has increased dramatically, as has the severity of withdrawal. After 14 years of being on Tegretol I developed hyponatremia and had to start tapering. I can only tolerate drops of 2% of the current dose and have had to hold the last 3 months to allow for my body to catch up. Symptoms are resolving, so this is not relapse. Had I continued to try to medicate symptoms with additional medications I likely would have been made even worse given my already severe reactions to Benadryl and Ativan. This kindling effect is unfortunately common in the withdrawal community.

 

After my last hospitalization which resulted in being admitted to the ICU, I developed dopamine super sensitivity psychosis from a 200mg drop in my Seroquel dose, standard procedure at that hospital. This took 3 months to resolve, and I have had no further issues with psychosis. I tapered the Seroquel over 3 years and 4 months, but due to a rapid taper at the end I developed severe withdrawal and 6 months later my symptoms became severe and disabling. This was not relapse, this was the beginning of protracted withdrawal and featured many severe GI and autonomic symptoms, which are now slowly resolving 4.5 years later. I initially tried Ativan and Benadryl to help deal with symptoms, but developed severe paradoxical reactions to both. I had severe food sensitivities, a large spike in my IgE levels for 2 years, gastroparesis, and much more. I still suffer from sleep issues due to adrenaline awakenings at night. After my last hospitalization I developed an abnormal EKG and left bundle branch block which normalized within 2 years of medication cessation. My diabetes took about a year to normalize. Sleep and urinary issues seem to be my most enduring symptoms. There is much more I could add to this from years of experience, but there is just not enough room in a book review to do so

 

What I would like to point out is that in this text the authors state that the risk of physiological dependance on the drugs other than benzodiazepines is low, which is not true with many people. They also state that:

 

“Withdrawal from psychotropic medication is not merely a function of drug half-life or dose reduction (although they are very important) but rather a neurobiological process driven by both homeostatic and allostatic mechanisms. Chronic exposure to psychotropic agents perturbs neurobiological homeostasis, triggering allostatic adaptations – including compensatory changes in receptor density, synaptic transmission, intracellular signaling cascades, and neurotransmitter regulation.”

 

In many places they also discuss the multifaceted effects on multiple neurotransmitter systems as many of these drugs go beyond their stated effects such as SSRI’s on SERT receptors. SSRI’s and other drugs also affect dopamine, norepinephrine, etc. and abrupt discontinuation of these medications can lead to diffuse neurotransmitter disequilibrium. They also speak of neuroadaptive changes to nervous system structure itself. When you take this all into account, is it any wonder that those like myself have long-term enduring issues resulting from not just weeks or months of exposure, but decades of poly-pharmacy? I do not need to be a healthcare professional or researcher to answer that question, as the answer should be obvious.

 

This book is a start, but a poor one and given the recommendations will lead to more harm, more polypharmacy, more kindling, more protracted withdrawal, and more suffering.

 

 

 

 

 

 

thanks so much for your thorough and thoughtful book review, although I find it moderately triggering. It is a start, but as you say there are a lot of pitfalls.  It looks like we are still on our own. some of us have more resources to hand such as sound education, coming from medical backgrounds, good social/family supports and an ability to pay for services and things like compounded medicines. Others are not so fortunate.  Advocacy is badly needed to help people through and out the other side. We are very lucky indeed to have this forum where we can share our experiences and knowledge.

I'm saddened to read everything you have been through. No wonder you can write something so succinct that pulls together your experience and knowledge to make some sense. I have no desire to read the book at this stage, but thank you anyway.