Podcasts about Deprescribing

Send BFTA a commentDr. H breaks down the complex task of deprescribing into six clear steps, starting with the most important and challenging question of all:   Who is the patient and why are they suffering?"Bringing Therapy into Med Management"-- a psychotherapy training intensive with Dr. H for psych NPs and PAs this October in Ft Collins https://www.craigheacockmd.com/training/BFTA on IG @backfromtheabysspodcasthttps://www.instagram.com/backfromtheabysspodcast/BFTA/ Dr. Hhttps://www.craigheacockmd.com/podcast-page/

Join Dr. Andy Cutler as he talks with Dr. Jeffrey Strawn about how clinicians can determine the appropriate scenarios for benzodiazepine deprescribing, best practices for benzodiazepine tapering, and how to balance patient preferences to ensure best outcomes.  Jeffrey R. Strawn, MD is a Professor and Associate Vice Chair of Research in the Department of Psychiatry and Behavioral Neuroscience at the University of Cincinnati (UC) College of Medicine, the Assistant Director of Clinical and Translational Research in the Center for Clinical & Translational Science and Training at UC, and an Associate Professor in the Department of Pediatrics at UC and Cincinnati Children's Hospital Medical Center.   Andrew J. Cutler, MD is a distinguished psychiatrist and researcher with extensive experience in clinical trials and psychopharmacology. He currently serves as the Chief Medical Officer of Neuroscience Education Institute and holds the position of Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University in Syracuse, New York.  Save $100 on registration for 2025 NEI Spring Congress with code NEIPOD25  Register today at nei.global/spcongress25p  Never miss an episode!

Dr. Jennifer Giordano, widely recognized as Dr. G, is a psychiatrist who uses a holistic approach to help those who want to take an active role in their health and avoid, decrease, or stop using psychiatric medications.  She saw the major gap in the medical community in the understanding of psych med tapering and wanted to help fill it, which grew into working one-on-one with hundreds of people to safely and successfully navigate the tapering terrain. SHOWNOTES:

It's another deprescribing super special on today's GeriPal Podcast, where we delve into the latest research on deprescribing medications prescribed to older adults. Today, we explore four fascinating studies highlighting innovative approaches to reducing medication use and improving patient outcomes. In our first segment, we discuss a study led by Constance Fung and her team, which investigated the use of a masked tapering method combined with augmented cognitive behavioral therapy for insomnia (CBTI) to help patients discontinue benzodiazepines. The study involved 188 middle-aged and older adults who had been using medications like lorazepam, alprazolam, clonazepam, temazepam, and zolpidem for insomnia. The results were impressive: 73% of participants in the masked tapering plus augmented CBTI group successfully discontinued their medication, compared to 59% in the open taper plus standard CBTI group. This significant difference highlights the potential of targeting placebo effect mechanisms to enhance deprescribing efforts. Next, we turn to Emily McDonald, the director of the Canadian Medication Appropriateness and Deprescribing Network, to discuss her study on the impact of direct-to-consumer educational brochures on gabapentin deprescribing. Patients received brochures detailing the risks of gabapentinoids, nonpharmacologic alternatives, and a proposed deprescribing regimen (see here for the brochure). Additionally, clinicians participated in monthly educational sessions. The intervention group saw a deprescribing rate of 21.1%, compared to 9.9% in the usual care group. This study underscores the power of patient education in promoting safer medication use. In our third segment, we explore Amy Linsky's study that examined the effect of patient-directed educational materials on clinician deprescribing of potentially low-benefit or high-risk medications, such as proton pump inhibitors, high-dose gabapentin, or risky diabetes medications. The intervention involved mailing medication-specific brochures to patients before their primary care appointments (click here for the brochure). The results showed a modest but significant increase in deprescribing rates among the intervention group. This approach demonstrates the potential of simple, low-cost interventions to improve medication safety. Finally, we discuss Michelle Odden's study, which used a target trial emulation approach to investigate the effects of deprescribing antihypertensive medications on cognitive function in nursing home residents. The study included 12,644 residents and found that deprescribing was associated with less cognitive decline, particularly among those with dementia4. These findings and the two studies Michelle mentions in the podcast (DANTE and OPTIMIZE) suggest that carefully reducing medication use in older adults may help preserve cognitive function. However, the DANTON study adds more questions to that conclusion. Join us as we dive deeper into these studies and discuss the implications for clinical practice and patient care. Don't miss this episode if you're interested in the latest advancements in deprescribing research!

What is Deprescribing? Why is it so important? And the big question... who invented it?! We present a masterclass in deprescribing from pharmacist Dr Emily Reeve from Monash University in Australia who is also Chair of the Australian Deprescribing Network.The need to review, reduce or stop medicines has been a regular topic of conversation here on the Aural Apothecary. But how do we do it? Deprescribing should be an integral component of appropriate prescribing and is defined as the systematic process of dose reduction or discontinuing a medicine under the supervision of a healthcare professional. We chat to Emily about the difficulties faced, advancements in practice and her research into the topic. What help is available for prescribers? Do patients actually want their medicines stopped? And who is the world leader in Deprescribing...?There is no one better with whom to discuss this topic. Dr Emily Reeve, as well as being Chair of the Australian Deprescribing Network, is a Senior Research Fellow and Deputy Theme Lead for the Centre for Medicines Use and Safety, in the Faculty of Pharmacy and Pharmaceutical Sciences at Monash University in Australia.Should information on how to stop a drug feature in guidance on how to start it? In our micro-discussion we delve deeper into the guidance available for prescribers when we look at one of Emily's papers 'What do clinical practice guidelines say about deprescribing' https://qualitysafety.bmj.com/content/34/1/28 As with all of our guests, Emily shares with us her Memory Evoking Medicine, a career anthem and book that has influenced her career or life. We learn that it is hard to dance with the devil on your back.Want to get your papers published? Jamie mentioned the site https://gettingpaperspublished.com/.You can listen to the Aural Apothecary playlist here;https://open.spotify.com/playlist/3OsWj4w8sxsvuwR9zMXgn5?si=tiHXrQI7QsGtSQw Pyz1KBgYou can view the Aural Apothecary Library here;https://litalist.com/shelf/view-bookcase?publicId=KN6E3OOur website is https://www.theauralapothecary.com/       To get in touch follow us on Twitter and Instagram @auralapothecary or email us at auralapothecarypod@gmail.com . Don't forget to rate us and comment wherever you have got this podcast from.

This episode of the Geriatric Pharmacy Focus discusses medications and supplements to deprescribe along with deprescribing resources.  Dr. DeLon shares insights into how to monetize deprescribing.  We end with gratitude and goals as we head into a new year! Dr. Tamara Ruggles:  www.linkedin.com/in/tamara-ruggles-491882251 Dr. DeLon Canterbury:  www.linkedin.com/in/geriatrx/

Jana Husemann folgt einem Hörer:innen-Wunsch und klärt, ob Wetter und Gesundheit bzw. Befinden in irgendeinem Zusammenhang stehen. Gibt es Wetterfühligkeit wirklich? Der Epidemiologe der Herzen, Hannes B. aus M., reitet sein Steckenpferd Schilddrüse. Ilja hat noch mal die Spur von Colchizin aufgenommen, und zwar die zur Sekundärprävention kardiovaskulärer Ereignisse. Außerdem: Plättchenhemmer PLUS DOAK oder nur DOAK bei KHK und VHF?

James Greenblatt, MD, joins Integrative Practitioner Content Specialist Avery St. Onge to discuss how to use integrative and functional medicine strategies to properly wean patients off antidepressants while avoiding withdrawal symptoms. This episode is brought to you by the Integrative Healthcare Symposium. Register for the Symposium and receive 15% off with promo code IP2025PODCAST: https://xpressreg.net/register/ihsy0225/landing.php?sc=IP2025PODCAST Learn more about the event by visiting the Symposium website: www.ihsymposium.com Contact the Integrative Healthcare Symposium team: info@ihsymposium.com Find us at integrativepractitioner.com or e-mail us at IPEditor@divcom.com. Theme music: "Upbeat Party" by Scott Holmes via freemusicarchive.org, "Carefree" by Kevin Mcleod via incompetech.com, and “Relaxing Light Background” by AudioCoffee. About the Expert A pioneer in the field of Functional, Nutritional, & Metabolic Psychiatry, dually board-certified Adult and Child & Adolescent psychiatrist Dr. James M. Greenblatt has been treating patients since 1988. After obtaining his medical degree and completing his psychiatry residency at George Washington University, Dr. Greenblatt completed a fellowship in Child & Adolescent psychiatry at Johns Hopkins Medical School. He has served as Chief Medical Officer at Walden Behavioral Care in Waltham, MA for nearly 22 years, and is a member of the clinical psychiatry faculty at the Tufts University School of Medicine and the Dartmouth College Geisel School of Medicine.  Dr. Greenblatt is the author of eight books, including the bestselling Finally Focused and the expert-acclaimed Answers to Anorexia (2021). His newest book, Functional & Integrative Medicine for Antidepressant Withdrawal, is available now.  A nationally and internationally recognized expert, author, and educator, as well as an inductee of the ISOM Orthomolecular Medicine Hall of Fame, Dr. Greenblatt is also the founder of Psychiatry Redefined – an online Continuing Medical Education platform dedicated to the advancement of evidence-based, personalized treatment models for mental illness.

Dr. Bret Scher interviews Dr. Josef Witt-Doerring, a board-certified psychiatrist who specializes in tapering and deprescribing psychiatric medications. Dr. Josef combines his expertise in pharmaceutical safety, clinical psychiatry, and metabolic therapies to help patients safely transition off long-term medications. Topics Covered Life-Changing Outcomes Discover how Dr. Josef's holistic methods have empowered individuals like Trudy, who transitioned from years of debilitating medications to pursuing a career in medical school through targeted dietary and metabolic interventions. Rethinking Psychiatric Medications Dr. Josef discusses the complex nature of antidepressants, antipsychotics, and mood stabilizers. Learn how their effects can mask symptoms without addressing root causes and the challenges of long-term use, including tolerance, side effects, and withdrawal. The Role of Metabolic Therapies Hear about the surprising success stories of patients who used dietary changes like ketogenic or gluten-free diets to overcome severe mental health conditions, reduce medication reliance, and regain their quality of life. Deprescribing in Practice Dr. Josef shares his patient-led approach to tapering medications, including practical tips on dosage reduction, liquid formulations, and the importance of balancing withdrawal risks with ongoing medication effects. Dr. Josef's message challenges conventional psychiatry by prioritizing patient-centered care and exploring innovative therapies that focus on the root causes of mental health challenges. This conversation provides hope and practical insights for individuals and clinicians navigating the complexities of psychiatric medication. Experts Featured Dr. Josef Witt-Doerring Taper Clinic https://taperclinic.com/dr-josef-witt-doerring/ X: @taperclinic Instagram: https://www.instagram.com/taperclinic/ Follow our channel for more information and education from Bret Scher, MD, FACC, including interviews with leading experts in Metabolic Psychiatry. Learn more about metabolic psychiatry and find helpful resources at https://metabolicmind.org/ About us: Metabolic Mind is a non-profit initiative of Baszucki Group working to transform the study and treatment of mental disorders by exploring the connection between metabolism and brain health. We leverage the science of metabolic psychiatry and personal stories to offer education, community, and hope to people struggling with mental health challenges and those who care for them. Our channel is for informational purposes only. We are not providing individual or group medical or healthcare advice nor establishing a provider-patient relationship. Many of the interventions we discuss can have dramatic or potentially dangerous effects if done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications. #MetabolicMind #MetabolicNeuroscience #MetabolicPsychiatry#KetogenicMetabolicTherapy #KetogenicTherapy#KetoForMentalHealth#Keto#TaperingMedications #Deprescribing

Mark Horowitz is a training psychiatrist, now working as a Clinical Research Fellow at UCL. He is an Associate Editor of the journal Therapeutic Advances in Psychopharmacology and has edited a collection of papers in the journal on Discontinuing PsychiatricMedication. He has a PhD in psychopharmacology and the neurobiology of depression from the Institute of Psychiatry, Psychology and Neuroscience at King's College London. He also co-wrote the Maudsley Deprescribing guidelines.Mark has his own blog https://markhorowitz.org/ and has written in the media about his own personal experiences with antidepressant withdrawal syndrome.Today we discuss:The problems with viewing depression primarily through a biomedical lens The causes of depressionThe limitations of anti-depressants, the risks of withdrawal symptoms when stopping them and Mark's own personal experiences with thisSome useful principles in how to wean off psychiatric medications safely if you are considering doing soInterviewed by Dr. Alex Curmi, consultant psychiatrist and a UKCP registered psychotherapist in-training. If you would like to invite Alex to speak at your organisation please email thinkingmindpodcast@gmail.com with "Speaking Enquiry" in the subject line. If you would like to enquire about an online psychotherapy appointment with Dr. Alex, you can email - alexcurmitherapy@gmail.com.Give feedback here - thinkingmindpodcast@gmail.com -  Follow us here: Twitter @thinkingmindpod Instagram @thinkingmindpodcast

This episode discusses the relevancy of the Beers Criteria in clinical practice, examining how recent changes impact medication safety and prescribing practices for older adults. Learn strategies for effective deprescribing and discover best practices for applying these criteria to improve patient outcomes. This essential episode equips healthcare professionals with the knowledge needed to navigate complex medication regimens and advocate for safer prescribing practices. HOSTJoshua Davis Kinsey, PharmDVP, EducationCEimpactGUESTKristin Meyer, PharmD, BCGP, FASCPProfessor of Pharmacy PracticeDrake University College of Pharmacy and Health SciencesREFERENCEAmerican Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adultsPharmacists, REDEEM YOUR CPE HERE!CPE is available to Health Mart franchise members onlyTo learn more about Health Mart, click here: https://join.healthmart.com/CPE INFORMATION Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Discuss recent updates to the Beers Criteria and their impact on medication safety for older adults.2. Describe evidence-based strategies to implement the Beers Criteria and manage complex medication regimens in clinical practice.0.05 CEU/0.5 HrUAN: 0107-0000-24-282-H01-PInitial release date: 10/28/2024Expiration date: 10/28/2025Additional CPE details can be found here.Looking for more? Check out our course on deprescribing in older adults: Less is More: A Patient-Centered Approach to Deprescribing for Older Adults1 hour  |  On DemandPolypharmacy in older adults leads to significant health risks and increased costs. Learn how to effectively engage in deprescribing, using patient-centered and evidence-based approaches to reduce unnecessary medications. Enroll in this course to enhance your skills in facilitating safer medication practices, become a leader in deprescribing, and improve patient outcomes!

This episode discusses the relevancy of the Beers Criteria in clinical practice, examining how recent changes impact medication safety and prescribing practices for older adults. Learn strategies for effective deprescribing and discover best practices for applying these criteria to improve patient outcomes. This essential episode equips healthcare professionals with the knowledge needed to navigate complex medication regimens and advocate for safer prescribing practices.HOSTJoshua Davis Kinsey, PharmDVP, EducationCEimpactGUESTKristin Meyer, PharmD, BCGP, FASCPProfessor of Pharmacy PracticeDrake University College of Pharmacy and Health SciencesREFERENCEAmerican Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adultsPharmacist Members, REDEEM YOUR CPE HERE! Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)CPE INFORMATIONLearning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Discuss recent updates to the Beers Criteria and their impact on medication safety for older adults.2. Describe evidence-based strategies to implement the Beers Criteria and manage complex medication regimens in clinical practice.0.05 CEU/0.5 HrUAN: 0107-0000-24-282-H01-PInitial release date: 10/28/2024Expiration date: 10/28/2025Additional CPE details can be found here.Looking for more? Check out our course on deprescribing in older adults:Less is More: A Patient-Centered Approach to Deprescribing for Older Adults1 hour  |  On DemandPolypharmacy in older adults leads to significant health risks and increased costs. Learn how to effectively engage in deprescribing, using patient-centered and evidence-based approaches to reduce unnecessary medications. Enroll in this course to enhance your skills in facilitating safer medication practices, become a leader in deprescribing, and improve patient outcomes!Follow CEimpact on Social Media:LinkedInInstagram

Following their presentation at the Royal College of Psychiatrists' International Congress 2024, Dr Mark Horowitz and Prof David Taylor sat down with CPD eLearning Editor Dr Howard Ryland. In this podcast, they discuss deprescribing psychotropic medications and the findings in their book, The Maudsley Deprescribing Guidelines (Horowitz and Taylor, 2024).

In the first episode of a special pediatric psychopharmacology series hosted by Dr. Jeffrey Strawn, Dr. John Walkup joins the podcast to discuss deprescribing in pediatric patients. The conversation delves into the situations that warrant deprescribing from antidepressants, selecting the right time to do so, and dealing with relapse, as well as much more!  Jeffrey R. Strawn, MD is a Professor and Associate Vice Chair of Research in the Department of Psychiatry and Behavioral Neuroscience at the University of Cincinnati (UC) College of Medicine, the Assistant Director of Clinical and Translational Research in the Center for Clinical & Translational Science and Training at UC, and an Associate Professor in the Department of Pediatrics at UC and Cincinnati Children's Hospital Medical Center.  John T. Walkup, MD is Head of the Pritzker Department of Psychiatry and Behavioral Health at Ann & Robert H. Lurie Children's Hospital of Chicago and a Margaret C. Osterman Professor of Psychiatry and Behavioral Science. He also serves as Director of the Division of Child and Adolescent Psychiatry in the Department of Psychiatry and Behavioral Sciences at Northwestern University Feinberg School of Medicine.  Never miss an episode!

An alarming number of individuals find themselves dependent on antidepressants and psychiatric medications, desperately seeking guidance on how to safely discontinue their use. The general medical community has failed to assist people in safely getting off these drugs. The dependency can create severe withdrawal symptoms. Most doctors have no clue how to get their patients off safely keeping them in a cycle of drug dependency. The worst of prescribers will frame the withdrawal symptoms as worsening "depression" and justification for staying on drugs. On Episode 154 of the Radically Genuine Podcast Dr. Roger McFillin dives into the topic of deprescribing and tapering off psychiatric drugs with a pharmacist. Dr. Shawn Gill, PharmD, is a pharmacist, writer, podcaster, and entrepreneur dedicated to sparking change in healthcare through deprescribing. He is the founder of Deprescribe Solutions, an independent consulting practice focused on reversing early-stage chronic conditions in mental health, hypertension, and type 2 diabetes. He hosts the "Deprescribe" podcast and writes the Substack newsletter "B.U.D.S," where he explores topics in health, deprescribing, parenting, and personal growth. Chapters00:00 The Silent Epidemic of Over-Prescription03:06 The Role of Pharmacists in Mental Health06:11 Understanding Compounding Pharmacy09:01 Polypharmacy: A Growing Concern11:58 The Dangers of SSRIs and SNRIs15:12 The Ethics of Prescribing Practices18:01 Navigating Withdrawal and Tapering20:57 Hyperbolic vs. Linear Tapering24:14 Protracted Withdrawal: Understanding the Risks26:49 Preventing Dependency: Education and Awareness29:58 The Future of Mental Health TreatmentResources: Systematic review detailing the relationship between SERT occupancy and SSRI dosing.- This is a great systematic review that breaks down the hyperbolic nature of SSRIs. It also elucidates on the potential pharmacology and mechanism behind protracted withdrawal, which we touched upon. RELEASE Clinical Trial - RCT which will be investigating hyperbolic tapering vs. linear tapering. The trial will begin in 2025.Outro Health - Fantastic organization trying to scale and make hyperbolic tapering accessible to the US. Dr. Sean Gill SubstackDeprescribe Podcast w/ Dr. Sean Gill RADICALLY GENUINE PODCASTDr. Roger McFillin / Radically Genuine WebsiteYouTube @RadicallyGenuineDr. Roger McFillin (@DrMcFillin) / XSubstack | Radically Genuine | Dr. Roger McFillinInstagram @radicallygenuineContact Radically GenuineConscious Clinician CollectivePLEASE SUPPORT OUR PARTNERS15% Off Pure Spectrum CBD (Code: RadicallyGenuine)10% off Lovetuner click here—-----------FREE DOWNLOAD! DISTRESS TOLERANCE SKILLS

When and how to deprescribe Some medications impact on cognition, health-related quality of life and mortality - polypharmacy can cause underprescribing of high priority medications Health assessments for those over 75 can initiate the process of deprescribing   Host: Dr Marita Long | Total Time: 22 mins Experts: Dr Peter Tenni, Clinical Pharmacist Register for our fortnightly FREE WEBCASTSEvery second Tuesday | 7:00pm-9:00pm AEDT Click here to register for the next oneSee omnystudio.com/listener for privacy information.

With the upcoming implementation of the new CMS age-friendly hospital measure, hospitals will be required to attest that they review medications to identify potentially inappropriate medications (PIMS) for older adults. Dr. Martin Casey, MD, MPH is an Assistant Professor in the Department of Emergency Medicine at UNC School of Medicine. Dr. Caseys' work has focused on the identifying PIMS and finding opportunities to reduce the use of, and deprescribe, potentially harmful medications in the emergency department. In this episode, Dr. Christina Shenvi and Dr. Martin Casey will discuss strategies for ED physicians who face unique challenges when assessing older patients' medications. Using case examples of deprescribing in practice, they illustrate how deprescribing is a nuanced skill and how to approach it.

Klinisch Relevant ist Dein Wissenspartner für das Gesundheitswesen. Drei mal pro Woche, nämlich dienstags, donnerstags und samstags, versorgen wir Dich mit unserem Podcast und liefern Dir Fachwissen für Deine klinische Praxis. Weitere Infos findest Du unter https://klinisch-relevant.de

In this interview for MIA Radio, Brooke Siem speaks with David Taylor and Mark Horowitz about their publication of the Maudsley Deprescribing Guidelines, which is of particular note since the Maudsley Prescribing Guidelines is a leading text in medicine worldwide. David Taylor is the Director of Pharmacy and Pathology at Maudsley Hospital and a Professor of Psychopharmacology at King's College in London. He is also the editor-in-chief of the journal Therapeutic Advances in Psychopharmacology. Beyond academia, he contributes significantly to public health policy as a member of the United Kingdom's Department of Transport expert panel that introduced drug-driving regulations. He is also a current member of the UK government's Advisory Council on the Misuse of Drugs and is the only pharmacist to have been made an honorary fellow of the Royal College of Psychiatrists. David is the lead author of the Maudsley Prescribing Guidelines, a role he has held since their inception in 1993. The Maudsley Prescribing Guidelines have achieved significant success, with over 300,000 copies sold across 14 editions and translations into 12 languages. David has also authored 450 clinical papers published in prominent journals such as The Lancet, BMJ, British Journal of Psychiatry, and Journal of Clinical Psychiatry. His work has been cited over 25,000 times. Mark Horowitz is a clinical research fellow in psychiatry at the National Health Service (NHS) in London. He is a Visiting Lecturer in Psychopharmacology at King's College London and an Honorary Clinical Research Fellow at University College London, in addition to being a trainee psychiatrist. Mark holds a PhD from the Institute of Psychiatry, Psychology, and Neuroscience at King's College London, specializing in the neurobiology of depression and antidepressant action. He is the lead author of the Maudsley Deprescribing Guidelines and an associate editor of Therapeutic Advances in Psychopharmacology. Mark co-authored the recent Royal College of Psychiatry's guidance on stopping antidepressants, and his work has informed the recent NICE guidelines on the safe tapering of psychiatric medications, including antidepressants, benzodiazepines, and z-drugs. He has collaborated with the NHS to develop national guidance for safe deprescribing for clinicians and has been commissioned by Health Education England to prepare a teaching module on how to safely stop antidepressants. Mark has published several papers on safe approaches to tapering psychiatric medications, with contributions in The Lancet Psychiatry, JAMA Psychiatry, and Schizophrenia Bulletin. His interest lies in rational psychopharmacology and the deprescribing of psychiatric medications, which is deeply informed by his personal experiences of the challenges associated with coming off psychiatric medications. *** Thank you for being with us to listen to the podcast and read our articles this year. MIA is funded entirely by reader donations. If you value MIA, please help us continue to survive and grow. https://www.madinamerica.com/donate/ To find the Mad in America podcast on your preferred podcast player, click here: https://pod.link/1212789850 © Mad in America 2024. Produced by James Moore https://www.jmaudio.org

DISCLAMER >>>>>>    The Ditch Lab Coat podcast serves solely for general informational purposes and does not serve as a substitute for professional medical services such as medicine or nursing. It does not establish a doctor/patient relationship, and the use of information from the podcast or linked materials is at the user's own risk. The content does not aim to replace professional medical advice, diagnosis, or treatment, and users should promptly seek guidance from healthcare professionals for any medical conditions.   >>>>>> The expressed opinions belong solely to the hosts and guests, and they do not necessarily reflect the views or opinions of the Hospitals, Clinics, Universities, or any other organization associated with the host or guests.       Disclosures: Ditch The Lab Coat podcast is produced by (Podkind.co) and is independent of Dr. Bonta's teaching and research roles at McMaster University, Temerty Faculty of Medicine and Queens University. Welcome to another enlightening episode of "Ditch the Lab Coat," the podcast where we critically examine health issues through a lens of scientific skepticism and practical wisdom. I'm your host, Dr. Mark Bonta, and today, we have a special guest, Dr. Shawn Gill, a clinical pharmacist and founder of Deprescribed Solutions. Dr. Gill collaborates closely with physicians and patients to create detailed taper plans for safely coming off medications like SSRIs. In this episode, we dive deep into the challenges of convincing physicians to adopt evidence-based tapering approaches, the importance of individualized patient care, and the hazards of over-relying on medication for minor ailments. Dr. Gill shares his practical, sustainable mental health-boosting practices and underscores the need to consider lifestyle interventions over long-term pharmaceutical treatments.Listen in as we explore the complexities of medication therapy in both acute and community settings, debate the appropriateness of prescribing SSRIs, and discuss the collaborative interprofessional model in healthcare. We also touch on the systemic challenges within a fee-for-service infrastructure and the significance of managing patient expectations during the transition off medications.Join us for an insightful discussion on how we can evolve as healthcare providers and implement holistic, non-pharmacological approaches to improve patient care. And remember, this podcast is aimed at fostering thoughtful discussion and is not a substitute for professional medical advice or treatment. Enjoy the episode, and stay tuned for more in-depth conversations on "Ditch the Lab Coat"!06:43 Limited access to specialists leads to disjointed care.10:31 Concern about medication adherence and deprescribing motivation.14:21 Navigating healthcare challenges and career self-reflection.16:53 Intervening with young patients to prevent complications.18:58 Emphasizing patient goals and identifying severity of symptoms.23:43 Antidepressant numbness, fear of stopping medication.26:22 Mental health treatment lacking options due to time.31:36 Pharmacist navigates patient dynamics without prescribing authority.32:59 Experienced doctor focuses on patient's mental health.37:31 Coordinate deep prescribing with physicians, share updates.39:19 Building trust, giving feedback, and fragile egos.42:33 Consider stopping antidepressants, it's possible and rewarding.47:07 Discontinuing medication requires careful adjustment and support.51:46 Reflection on medical practice, calls for diverse guests.53:48 Mother's nursing work inspired son's medical career.

In this episode, we discuss the approach to deprescribing for several drugs such as benzodiazepine receptor agonists, cholinesterase inhibitors, memantine, antipsychotics, and antihyperglycemics. Key Concepts Medication appropriateness including indication and risk vs. benefit should be evaluated for all stages of life; however, more importantly in older individuals to address polypharmacy. There is an emerging trend of deprescribing networks that conduct research and provide evidence-based recommendations for how to deprescribe certain medications used for specific indications. Evidence-based deprescribing guidelines for PPIs, benzodiazepines, benzodiazepine receptor agonists, opioids, antipsychotics, cholinesterase inhibitors, memantine, and antihyperglycemics are available for patient-provider shared decision making.  A general deprescribing approach is gradual tapering of the drug leading to discontinuation over several weeks while monitoring patients for withdrawal symptoms or benefits of discontinuation.  References http://deprescribing.org https://www.australiandeprescribingnetwork.com.au

Laura Beaton talks to pharmacist Aili Langford and geriatrician Sarah Hilmer about their article on deprescribing antihypertensive drugs in frail older adults. They discuss how the potential benefits and harms of lowering blood pressure may change with increasing age and frailty, the evidence for deprescribing, and how to deprescribe antihypertensive drugs. Read the full article by Aili, Sarah, and their co-authors, in Australian Prescriber.

A clinical debate about the benefits versus the risks of deprescribing statins in adults over the age of 75 in both primary and secondary preventionPresented by: Megan Gross, PharmD, PGY1 Pharmacy Resident, SSM Health Monroe ClinicStephanie Garvin, PharmD, PGY2 Ambulatory Care Resident, SSM Health Monroe Clinic

***SUMMER REWIND  - INITIALLY RELEASED ON 31ST JAN 2024*** To get in touch: primarycarepodcasts@gmail.com Doctors Lisa and Sara talk to Senior Pharmacist Sarah Hafeez about Polypharmacy. She explains the difference between inappropriate and appropriate polypharmacy before talking through some typical cases that illustrate several examples of common scenarios.  This leads to discussions on prioritising concerns, weaning/stopping medications, counselling patients on the effects of Opioids and Gabapentinoids and involving community teams aiming for successful reductions of addiction forming medications. Other gems include a discussion of the potential long term risks of Proton Pump Inhibitors and advice on weaning, remembering to consider anticholinergic burdens as well as handy resources for tackling Polypharmacy, Structured Medications Reviews and medication reductions. You can use these podcasts as part of your CPD - we don't do certificates but they still count :) Useful resources:  Greater Manchester Medicines Management Group: Inappropriate Polypharmacy Review and Treatment Optimisation: Resource Pack (from Dec 2022, accessed Dec 2023): https://gmmmg.nhs.uk/wp-content/uploads/2023/02/GMMMG-Polypharmacy-resource-pack-v3.0.pdf Scotland Polypharmacy Resources for Professionals and for Patients: https://www.polypharmacy.scot.nhs.uk/for-patients-and-carers/ Scottish Polypharmacy Guidance 2018: https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/04/Polypharmacy-Guidance-2018.pdf Lewis T. Using the NO TEARS tool for medication review. BMJ. 2004 Aug 21;329(7463):434. doi: 10.1136/bmj.329.7463.434. PMID: 15321901; PMCID: PMC514207 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC514207/ Toolkit for General Practice in Supporting Older People Living with Frailty (includes a great Appendix of the STOPP/START criteria (2017): https://www.england.nhs.uk/wp-content/uploads/2017/03/toolkit-general-practice-frailty-1.pdf An example of an Anticholinergic Burdon Resource from West Essex CCG 2020: https://westessexccg.nhs.uk/your-health/medicines-optimisation-and-pharmacy/clinical-guidelines-and-prescribing-formularies/04-central-nervous-system/61-anticholinergic-side-effects-and-prescribing-guidance/file Canadian Resource for Deprescribing including reducing medications and some patient information leaflets: https://deprescribing.org/ Resource for help reducing and stopping medications: https://medstopper.com/ Me and My Medicines Resource for Patients to look through their medications before reviews or for information: https://meandmymedicines.org.uk/ Anticholinergic Medications and Risks of Dementia Cochrane Editorial with Reports in Link (Sept 2021): https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000154/full Anticholinergic drugs and risk of dementia: Time for action? British Pharmacological Society. Bell B et al Jun 2021 (9:3). Accessed 15/1/2024:  https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1002/prp2.793 Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder. Clin Interv Aging. 2020; 15: 1493–1503: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457731/ Greater Manchester Medicines Management Group: Management of Overactive Bladder Including a simple Bladder Diary before and after stopping Medications (Jun 2019): https://gmmmg.nhs.uk/wp-content/uploads/2021/08/Management-of-OAB-in-adults-v3-0-approved-Aug-2019.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it's release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

In this compelling episode of "Twenty Seven Degrees," hosts Chris and Nancy engage in a thought-provoking conversation with Dr. Donna Bartlett, a distinguished Professor of Pharmacy Practice, about the vital topic of deprescribing. With her extensive expertise and passion for optimizing patient care, Dr. Bartlett sheds light on the often-overlooked practice of reducing or stopping medications that may no longer be necessary or beneficial.Join us as Dr. Bartlett discusses the principles and importance of deprescribing in modern healthcare. She explains how this practice can improve patient outcomes, reduce adverse drug reactions, and enhance overall quality of life, particularly for the elderly and those with chronic conditions. Through real-life examples and evidence-based insights, Dr. Bartlett illustrates the challenges and successes of implementing deprescribing protocols.Whether you're a healthcare professional, a patient, or someone interested in the evolving field of pharmacy practice, this episode offers valuable perspectives on the benefits and complexities of deprescribing. Tune in to "Twenty Seven Degrees" for an informative and engaging discussion with Dr. Donna Bartlett, and discover how mindful medication management can lead to healthier lives.

Michelle Keller is an assistant professor of gerontology and the Leonard and Sophie Davis Early Career Chair in Minority Aging at the USC Leonard Davis School. She spoke to us about her research focused on improving patient-clinician communication, medication management, and the identification of dementia in minority older adults. Here are highlights from our conversation. On polypharmacy “When it comes to older adults and medications, it's important to understand that while medications can be incredibly beneficial for treating various conditions, they can also present really unique risks in this population. Older adults often take multiple medications at the same time. This is what we call polypharmacy.” “Older adults can be more sensitive to certain medications, they might experience side effects more intensely or even at lower doses than younger individuals. … This is particularly true for medications that affect our central nervous system, our brain, right? So, thinking about medications that are sedating or that have some sort of psychoactive effect. These medications, especially when they're combined together, can lead to things like confusion, dizziness and an increased risk of falls.” On her study of interventions to address polypharmacy “What we found in this study was that interventions to address polypharmacy can do a great job of reducing medications which are potentially harmful, identifying which medications people should be taking, improving the appropriateness of the medications people are taking, and reducing the total number of medications. So thinking about outcomes related to medications, what we have found is that it is really hard to change more downstream clinical outcomes, things like mortality, falls, hospitalizations, and emergency department visits. We did find that interventions that had multiple components; in other words, where a clinician is meeting face to face with a patient, reviewing their medications, reviewing all the chronic diseases that they have, along with their full patient history of what has happened to them in the past, those interventions tend to have a greater effect on mortality. So in other words, those types of interventions are reducing the risk of that someone actually dies.” “We also found that falls decrease when patients fully stop potentially harmful medications. These may be medications where somebody is feeling very dizzy or that make people feel very dizzy or drowsy, medications that may control somebody's blood sugar a little bit too much… So, their blood pressure's a little too low and they may actually fall as a result of these medications. But what we found was that stopping medications such as benzodiazepines, which are often taken for sleep or anxiety, can take months. These types of medications can have withdrawal effects. And so it's really, really important for somebody to work very closely with a healthcare provider to slowly taper these medications down to try to reduce those withdrawal effects.” “What we have found in working with other researchers and clinicians is that when patients team up with a healthcare provider, such as their primary care physician or clinical pharmacist who's embedded in the healthcare system, they really are able to stop taking some of these medications, and they feel a lot better. They feel much more energy, they're able to do the things that they really enjoy. They have a greater quality of life. But it's something that just takes time.” On the Empower Intervention for benzodiazepines “The typical recommendation for benzodiazepines is that they really should be taken short-term. These are medications that physicians typically recommend somebody take for a maximum of four weeks. What we have found in some of our research is that people are actually taking these for years, if not decades. And so stopping these medications can be quite challenging, and sometimes patients aren't fully convinced about why they should be stopping these medications. So, we took an intervention that started in Canada. It was developed by researchers in Quebec, and this is called the Empower Intervention. And what we did is we tailored it to a health system here in the US. The Empower Intervention is a really great brochure that contains some pretty striking facts about benzodiazepines.” “To give you some examples of benzodiazepine, these are like your Xanax, your Ativan, your Klonopin; these are the medications that we're talking about here. These brochures highlighted some really interesting facts, such as the fact that they can be harmful or linked to hip fractures and car accidents, and they can make people feel very tired and weak. What we did for this intervention is we sent these brochures to about 300 people along with a letter from their primary care physician, emphasizing that these medications can be harmful if taken for too long and especially among older adults. So what we did for this study is we compared patients who had received these brochures to patients who did not receive them. So they're going on usual care. Their physicians may have mentioned something to them, this was our control group, right? We didn't send anything to this particular group.” “We reviewed the medical records for both groups, and we looked at what kinds of medications they had been prescribed. And what we found is that patients who received the brochures were really activated. You know, when they received this messaging they would send messages in the patient portal to their physicians saying, ‘I didn't know that there were these risks of these medications. I would really like to come in and talk to you about them.' They made appointments to start tapering down these medications. What we found was for every 10 brochures that we sent, one person completely stopped taking these medications, which is a really good return on investment. This is a simple intervention. It has now been done in some other health systems in the US, particularly the Veterans Affairs health system.” On challenges in de-prescribing “I think some of the challenges that physicians face in de-prescribing is that de-prescribing takes a lot of time. As we all know, our primary care visits are very short; physicians, particularly in the primary care setting, are really rushed through their visits. And so I think having some of these conversations can just be something that's challenging. I also think they're quite complex conversations to have. They may not have received the training, for example, on how to taper a medication in a safe way so that a patient does not feel withdrawal effects. And I do think that there is something about getting physician buy-in … they are concerned [that] if they bring it up, the patient may be angry with them; they may be upset. And so I think really showing physicians ways in which this can be brought up that are really framed around ‘how do we center the patient's health and quality of life' – I think those are still questions that we as researchers are working on.” On the role of caregivers “It's really important for caregivers to be aware of the medications their loved ones are taking for many reasons. I think they can be amazing advocates in helping bring up potential side effects during doctor's visits. So, for example, if a caregiver is noticing that someone is feeling drowsy or doesn't have that much energy or is feeling dizzy, any sort of cognitive impairments such as those that may be seen in dementia, [they] may actually be a result of medication side effects. So, I think really becoming an advocate for somebody when seeing the doctor is one really important thing that caregivers can do.”  “Another area where caregivers can play a really important role is among people with dementia. People with dementia can have really some challenges in managing their medications. They may miss doses, they may take several medications twice, so they may have an overdose, or they may take the wrong medication altogether. So, caregivers can play really pivotal roles in helping somebody manage medication changes. There have been some early interventions looking at how to engage caregivers and persons with dementia. And some of the challenges that those researchers have seen is that there [is] often more than one person actually caring for somebody with dementia. And so, engaging that whole group of people who may be working with that person has been a real challenge.” On challenges facing patients with language barriers  “There is research showing that patients with language barriers have a greater risk of being hospitalized or re-hospitalized because of some of the communication challenges that come with medication management. So, you can imagine that, for example, older adults and their caregivers with language barriers may have a difficult time understanding medication instructions, which can lead to improper use. So when and how to take medications, recognizing potential side effects, understanding the purpose of each medication. And on top of that, you can layer on things, like if somebody doesn't have a great understanding of the condition. We call that disease literacy, or they may have health literacy issues.” “Right now, a mentee and I are working on this review of interventions that have been done specifically for patients with language barriers focused on improving medication management. And what we found was that interventions that really engaged people from communities with language barriers have been some of the most effective ways to really help people learn about which medications are working really well for them, how to improve medication adherence and other important outcomes. So, for example, an intervention that we found was researchers engaged folks in the community, co-created videos about medications in the community and why it was important to take them. And then when they actually distributed these interventions, they made sure that both in terms of the videos and some of the other educational materials that were handed out to folks that these really were very tailored both language-wise, literacy-wise, and culturally tailored to the communities that they were serving.” On new dementia medications and disparities in the diagnosis of dementia  “We are learning that older Black and Latino adults tend to get diagnosed with dementia once the disease has progressed more. And what that means is that they may not have received some of the kind of services that may help them or their families. So, for example, they may not have received enough support to be able to plan for the rest of their lives, or their families may not necessarily have received caregiving support early on in disease progress.” “I think in regard to these particular dementia medications, for example, if older adults are diagnosed with dementia at a place where they're no longer eligible to receive these medications, I think that'll be a really pretty serious health equity issue. So, I am really interested in how we make sure that people are getting diagnosed in time to make them eligible for really potentially beneficial treatments that may help them down the road.” On effective strategies for de-prescribing  “The most effective strategies that we see de-prescribing these medications is offering something else. So, for example, some of the most evidence for insomnia really exists around the use of using cognitive behavioral therapy. There's also been well-done systematic reviews that have found evidence that music or acupuncture may help people with insomnia. … I think one thing that's very important to think about when we de-prescribe medications is what else can we offer people? We're not just leaving people in the lurch and saying, ‘We're taking this away and we're leaving you with nothing.' We're actually able to offer them some non-pharmacological options as well.” Transcript Speaker 1 (00:02): One thing that's very important to think about when we de-prescribe medications is: what else can we offer people? We're not just leaving people in the lurch and saying, we're taking this away and we're leaving you with nothing. We're actually able to offer them some non-pharmacological options as well Speaker 2 (00:17): From the USC Leonard Davis School of Gerontology, this is Lessons in Lifespan Health, a podcast about the science and scientists improving how we live and age. I'm Orli Belman, Chief Communications Officer. On today's episode: how Professor Michelle Keller is working with older adults, caregivers and clinicians to manage the use and potential overuse of high risk medications. Michelle Keller is an Assistant Professor of Gerontology and the Leonard and Sophie Davis Early Career Chair in Minority Aging at the USC Leonard Davis School. Her research is focused on improving patient-clinician communication, medication management, and the identification of dementia in minority older adults. Hi, Michelle. Welcome and thank you for joining us today. Speaker 1 (01:06): Thank you so much for having me. Speaker 2 (01:08): I wanna start by asking you to talk about older adults and medications. We can all understand why medications are beneficial, but when it comes to older adults, what are some of the ways they can be problematic? Speaker 1 (01:19): Absolutely. So when it comes to older adults and medications, it's important to understand that while medications can be incredibly beneficial for treating various conditions, they can also present really unique risks in this population. So older adults often take multiple medications at the same time. This is what we call polypharmacy. Polypharmacy can increase the risk of drug interactions, right? So I like to think of the example of a suitcase, right? So imagine that you are packing up, getting ready to go to a trip. You start putting one thing into the suitcase, gets a little heavy, but you can manage it, right? You're suddenly adding more and more things and the suitcase is getting heavier and heavier to the point where you actually throw out your back at the airport, right? This is really what I think of when our bodies are kind of processing multiple medications at once with the additional challenge that some of these drugs may actually interact with one another. Speaker 1 (02:15): This is why it's so important for patients to talk to their doctors about the medications they're taking and the potential risks of each medication as people get older. I think one thing that people don't often think about is that when clinical trials are being done, often many clinical trials have excluded older adults. So we don't always have a great sense of how these medications work in older adult populations. And on top of that, they may exclude people with chronic conditions who are already taking a variety of other medications. And so as a result, what is happening now is that we have many people who are taking these medications, and it hasn't been well tested in these populations. It hasn't really been, you know, we don't have a clear sense of what is happening when all of these medications are being taken together. So polypharmacy can really increase the risk of drug interactions. Speaker 1 (03:09): As I was saying, when one medication affects another, and this can lead to a variety of adverse effects. So for example, if someone is taking multiple medications that make you feel drowsy or sleepy when you stack them on top of each other–thinking again about that suitcase, that can lead someone to have an increased risk of falls, potentially a fracture resulting from those falls, car accidents if they're feeling very drowsy or dizzy and other medications can increase our risk of internal bleeding. Another thing that's really important to think about for older adults is that as we get older, our bodies undergo various changes that can alter how our medications are absorbed, distributed, and actually excreted from the body. So for example, kidney and liver function can really decline with age. And so that can actually affect how well we process the drugs through our body. Speaker 1 (04:05): What that means is that drugs may stay in our bodies for longer periods of time leading to more side effects or adverse effects. The last thing I really wanted to bring up is this idea of how things change as we get older. So we maybe have been taking a medication for many years, but as we get older because of the changes that are happening within our body, some medications, which were fine for us when we were younger, are now gonna lead to more serious adverse effects now that we're older. So older adults can be more sensitive to certain medications, so they might experience side effects more intensely or even at lower doses than younger individuals. They might feel the effects. So this is particularly true for medications that affect our central nervous system, our brain, right? So thinking about medications that are sedating or that have some sort of psychoactive effect. Speaker 1 (05:04): These medications, especially when they're combined together, can lead to things like confusion, dizziness, and an increased risk of falls. One medication which people often take to help them sleep is Benadryl or Tylenol PM. This medication is actually a drug that's really recommended to avoid in older adults because it can be very sedating, making people feel very drowsy throughout the day. And it actually also has the effects on the brain and has been associated with a higher increased risk of dementia. So these are medications that again, we don't think of as generally harmful, but again, in an older person might really be an issue. Speaker 2 (05:46): That's a really helpful example 'cause that's just an over the counter medication that anyone can get, even without a doctor. You recently published two papers looking at interventions for addressing polypharmacy. The first one was a review of several studies. What did you learn in that review about the effectiveness or not of programs that are designed to reduce harmful polypharmacy? Speaker 1 (06:08): So we reviewed several systematic reviews. These are collections, as you mentioned, of numerous studies to understand how well interventions to address polypharmacy are working. Many of these interventions include a process called de-prescribing, which is the process of systematically reducing or stopping medications that may no longer be beneficial or might be causing harm, particularly in older adults. The goal of deprescribing is to optimize an individual's medication regimen to improve their overall health and quality of life. What we found in this study was that interventions to address polypharmacy can do a great job of reducing medications which are potentially harmful, identifying which medications people should be taking, improving the appropriateness of the medications people are taking, and reducing the total number of medications. So thinking about outcomes related to medications, what we have found is that it is really hard to change more downstream clinical outcomes. Speaker 1 (07:11): Things like mortality falls, hospitalizations, and emergency department visits. We did find that interventions that had multiple components, in other words where a clinician is meeting face-to-face with a patient, reviewing their medications, reviewing all the chronic diseases that they have along with their full patient history of what has happened to them in the past, those interventions tend to have a greater effect on mortality. So in other words, those types of interventions are reducing the risk that someone actually dies. We also found that falls decrease when patients fully stop potentially harmful medications. So these may be medications that make people feel very dizzy or drowsy medications that may control somebody's blood sugar a little bit too much and so they're actually feeling very low blood sugar or medications where their blood pressure is overly controlled. So their blood pressure's a little too low, and they may actually fall as a result of these medications. Speaker 1 (08:12): But what we found was that stopping medications such as benzodiazepines, which are often taken for sleep or anxiety, can take months. These types of medications can have withdrawal effects. And so it's really, really important for somebody to work very closely with a healthcare provider to slowly taper these medications down, to try to reduce those withdrawal effects. And because it takes so long to fully stop these medications, it's hard for studies to really find an effect unless they're following that person for a long period of time, which studies often don't. And so that's one of the challenges that we've seen in the research is that studies haven't followed people for enough time. Or at the time that they're measuring some of these clinical outcomes, not enough time has gone by to really see the full effects. So what we have found in working with other researchers and clinicians is that when patients team up with a healthcare provider such as their primary care physician or clinical pharmacist who's embedded in the healthcare system, they really are able to stop taking some of these medications and they feel a lot better. They feel much more energy, they're able to do the things that they really enjoy. They have a greater quality of life, but it's something that just takes time. Speaker 2 (09:28): And I imagine it's something you have to balance when someone really might need a medication to treat something and then managing the side effects. That's really interesting. I know the second study looked at a particular intervention and this was the use of educational materials for benzodiazepines. What led you to explore this area and what did you find? Speaker 1 (09:49): Great question. So benzodiazepines are, as I mentioned earlier, medications that are often used for sleep or anxiety. The typical recommendation for benzodiazepines is that they really should be taken short term. These are medications that, you know, physicians typically recommend somebody take for a maximum of four weeks. What we have found in some of our research is that people are actually taking these for years, if not decades. And so stopping these medications can be quite challenging and sometimes patients aren't fully convinced about why they should be stopping these medications. So we took an intervention that started in Canada. It was developed by researchers in Canada, in Quebec, and this is called the Empower Intervention. And what we did is we tailored it to a health system here in the US. The Empower Intervention is a really great brochure that contains some pretty striking facts about benzodiazepines. Speaker 1 (10:45): To give you some examples of benzodiazepine, these are like your Xanax, your Ativan, your Klonopin. These are the medications that we're talking about here. These brochures highlighted some really interesting facts such as the fact that they can be harmful or linked to hip fractures and car accidents and they can make people feel very tired and weak. What we did for this intervention is we sent these brochures to about 300 people along with a letter from their primary care physician, emphasizing that these medications can be harmful if taken for too long and especially among older adults. So what we did for this study is we compared patients who had received these brochures to patients who did not receive them. So kind of they're going on their usual care, their physicians may have mentioned something to them. This was our control group, right? We didn't send anything to this particular group. Speaker 1 (11:40): We reviewed the medical records for both groups and we looked at what kinds of medications they had been prescribed. And what we found is that patients who received the brochures were really activated. You know, when they received this messaging, they would send messages in the patient portal to their physicians saying, I didn't know that there were these risks of these medications. I would really like to come in and talk to you about them. They made appointments to start tapering down these medications. What we found was for every 10 brochures that we sent, one person completely stopped taking these medications, which is a really good return on investment. This is a simple intervention. It has now been done in some other health systems in the US, particularly the Veterans Affairs health system. And you know, groups have found similar effects. We also found that the probability that someone in the intervention group completely stopped their medications was about 10% greater compared to the group that did not get the brochure. Speaker 1 (12:41): So again, you know, for a cheap simple intervention, we were pretty excited about these results. What's been really interesting is I just came back from two conferences, the US De-Prescribing Research Network and the Society for General Internal Medicine Annual Meeting. And we find that other researchers are also finding that engaging patients in reducing these potentially harmful medications is actually one of the most effective forms of deprescribing. There have been plenty of studies where researchers have actually engaged physicians and those have not been as successful. So what I'm really excited about in terms of thinking about future interventions is, how do we really engage patients in learning about what are the best options for them to manage their health? Speaker 2 (13:28): So you just said that physicians, it's been a little harder to see change in their prescribing behaviors. What do we know about ways they can introduce the idea of reducing or stopping a medication? Speaker 1 (13:39): Yeah, I think it's a great question. I think communicating when, how and why a medication should be reduced or stopped can be really challenging. What researchers have found is that when physicians focus on improving a patient's quality of life, that is what is most effective. So for example, thinking about stopping or reducing certain medications can give somebody more energy, help them move around better, they're not feeling as unsteady on their feet or dizzy. They can think more clearly because they're no longer feeling feelings of brain fog or sleepiness or drowsiness. I think these can be some really effective messages. I think some of the challenges that physicians face in de-prescribing is that de-prescribing takes a lot of time. As we all know, our primary care visits are very short. Physicians, particularly in the primary care setting, are really rushed through their visits. And so I think having some of these conversations can just be something that's challenging. Speaker 1 (14:41): I also think they're quite complex conversations to have. They may not have received the training, for example, on how to taper a medication in a safe way so that a patient does not feel withdrawal effects. And I do think that there is something about getting physician buy-in, in terms of, they are concerned about, you know, if they bring it up, the patient may be angry with them, they may be upset. And so I think really showing physicians ways in which this can be brought up that's really framed around, how do we center the patient's health and quality of life? I think those are are still questions that we as researchers are working on. Speaker 2 (15:17): We've talked about physicians and obviously patients themselves. How about caregivers? What role can they play in helping address some of these issues? And are there interventions that especially aim to include them? Speaker 1 (15:28): Yeah, great question. I think it's really important for caregivers to be aware of the medications their loved ones are taking. For many reasons. I think they can be amazing advocates in helping bring up potential side effects during doctor's visits. So for example, if a caregiver is noticing that someone is feeling drowsy or doesn't have that much energy or is feeling dizzy, any sort of cognitive impairments, right? So, such as those that may be seen in dementia, may actually be a result of medication side effects. So I think really becoming an advocate for somebody when seeing the doctor is one really important thing that caregivers can do. Another area where caregivers can play a really important role is among people with dementia. People with dementia can have some challenges in managing their medications. They may miss doses, they may take several medications twice, so they may have an overdose or they may take the wrong medication altogether. So caregivers can play really pivotal roles in helping somebody manage medication changes. There have been some early interventions looking at how to engage caregivers and persons with dementia. And some of the challenges that those researchers have seen is that there are often more than one person actually caring for somebody with dementia. And so engaging that whole group of people who may be working with that person has been a real challenge. Speaker 2 (16:54): Are there particular challenges faciing under-resourced communities or populations with language barriers? I imagine some of this communication is even harder in these cases. What do you think needs to be done in these areas? Speaker 1 (17:09): Absolutely. There is research showing that patients with language barriers have a greater risk of being hospitalized or rehospitalized because of some of the communication challenges that come with medication management. So you can imagine that for example, you know, older adults and their caregivers with language barriers may have a difficult time understanding medication instructions, which can lead to improper use. So when and how to take medications, recognizing potential side effects, understanding the purpose of each medication. And on top of that, you can layer on things like, you know, if somebody doesn't have a great understanding of the condition, right? So we call that disease literacy. Or they may have health literacy issues, or on top of that, we may even have literacy concerns where the person does not know how to read or has a limited ability to read. So layering on all these challenges can really make it difficult to both manage your medications and communicate with physicians about their concerns or side effects regarding medications. Speaker 1 (18:14): Right now, mentee and I are working on this review of interventions that have been done specifically for patients with language barriers focused on improving medication management. And what we found was that interventions that really engaged people from communities with language barriers have been some of the most effective ways to really help people learn about which medications are working really well for them, how to improve medication adherence and other important outcomes. So for example, an intervention that we found was researchers engaged folks in the community. They co-created videos about medications in the community and why it was important to take them. And then when they actually distributed these interventions, they made sure that both in terms of the videos and some of the other educational materials that were handed out to folks, that these really were very tailored both language wise, literacy wise, and culturally tailored to the communities that they were serving. Speaker 2 (19:16): Another area I wanna touch on is your work improving doctor patient communication. And I'm curious if your background as a newspaper reporter has informed your research in this area, and what are some of the ways that patients lose out when communication is not clear? Speaker 1 (19:32): So I think a lot about how we can help clinicians communicate complex information about medications and other treatments in simple, accessible ways. Which is really something that I aimed to do as a reporter, right? When I worked as a reporter, oftentimes I would take studies from medical journals and I would break them down in a way that was really easy and accessible for the public to read. And so that is really something that I'm very interested in. How do we help clinicians do the same thing? Or if we're designing interventions for patients, how do we do something similar? How do we make the risks and benefits of medications very clear to people so that they're able to make the best decisions about those for their health? So one area that I'm really interested in is these new medications for dementia that have come out, which are the anti amyloid medications. These medications have some pretty potentially serious side effects such as brain bleeding and swelling. And I'm working on a research proposal thinking about, how do we best present these medications to patients in a way that they feel like they're able to make the best decisions for themselves and their loved ones? I think it'd be really critical, particularly in terms of health equity for people to have a very good sense of how these medications can potentially help but also understand the serious risks associated with the new dementia medications. Speaker 2 (21:02): And speaking of dementia, I think you've also looked at the diagnosis of dementia and whether or not there's differences in minority populations. Is that something you can tell us a little bit about? Speaker 1 (21:14): Absolutely. So that is an area of research that I'm actually just starting to get into because what we are learning is that older black and Latino adults tend to get diagnosed with dementia once the disease has progressed more. And what that means is that they may not have received some of the services that may help them or their families. So for example, they may not have received enough support to be able to plan for the rest of their lives, or their families may not necessarily have received caregiving support early on in disease progress. I think in regards to these particular dementia medications, for example, if older adults are diagnosed with dementia at a place where they're no longer eligible to receive these medications, I think that'll be a really pretty serious health equity issue. So I am really interested in, how do we make sure that people are getting diagnosed in time to make them eligible for really potentially beneficial treatments that may help them down the road? So I'm thinking about how do we train physicians who are working in under-resourced settings, which may serve large proportions of black and Latino older adults, how to diagnose dementia in a primary care setting, and working with some colleagues in the Los Angeles Department of Health Services on how we can think about making physicians feel more confident, their diagnosis of dementia among older adults. Speaker 2 (22:40): And I wanna go back to sleep and anxiety because I know that's something that affects so many people at all ages. If these interventions are successful and people are able to stop taking some of these medications, are there strategies or interventions that we know might work for helping them with the initial conditions they were struggling with to begin with? Speaker 1 (23:01): Yeah, absolutely. I think that's a really good question because sleep and anxiety are things that can really affect somebody's quality of life and functioning, right? The most effective strategies that we see de-prescribing these medications is offering something else. So for example, some of the most evidence for insomnia really exists around using cognitive behavioral therapy. There's also been really well done systematic reviews that have found evidence that music or acupuncture may help people with insomnia. So I think one thing that's very important to think about when we de-prescribe medications is what else can we offer people? We're not just leaving people in the lurch and saying, we're taking this away and we're leaving you with nothing. We're actually able to offer them some non-pharmacological options as well. Speaker 2 (23:48): That's a really helpful note to end on. Thank you for joining us, and I know that people are really gonna benefit from learning about all you've been working on and all your work that's gonna continue in the future. Speaker 1 (23:59): Thank you so much for having me today. It's been a real pleasure. Speaker 2 (24:02): That wraps up this lesson in Lifespan Health. Thanks to Professor Michelle Keller for her time and expertise and to all of you for choosing to listen. Join us next time for another Lesson in Lifespan Health, and please subscribe to our podcast@lifespanhealth.usc.edu. Lessons in Lifespan Health is supported by the Ney Center for Healthspan Science.

It's a therapeutics evidence feast this month. We start with deprescribing in older adults - Anna Hung, assistant professor at the Duke University School of Medicine has written a summary of the evidence, and we discuss why there are so few trials on an important topic. Metformin is typically first line for type II diabetes, but what should be next? A new cohort study emulating a comparative effectiveness trial has been published, and the team discuss using observational data for this very common problem. Finally, a new trial on nirmaltrevir for covid 19 in those at higher risk of severe disease or those who are unvaccinated.   Links BMJ - Deprescribing in older adults with polypharmacy BMJ - Comparative effectiveness of second line oral antidiabetic treatments among people with type 2 diabetes mellitus: emulation of a target trial using routinely collected health data NEJM - Nirmatrelvir for Vaccinated or Unvaccinated Adult Outpatients with Covid-19

About this episode: One in five U.S. adults is taking five or more prescription drugs at a time, often for years without reassessment of need, dosage, or possible interactions. Today, a look at polypharmacy and why it's important for physicians to periodically check in with patients about all the prescription—and nonprescription—drugs they're taking. The guests also discuss the importance of considering non-pharmaceutical treatments like physical or talk therapy, and empowering patients and their care partners to ask questions about what they're being prescribed. Guests: Dr. Cynthia Boyd is a geriatrician and faculty at Johns Hopkins Medicine. She is also a senior associate with the Johns Hopkins Center on Aging and Health. Dr. Ariel Green is a geriatrician and faculty at Johns Hopkins Medicine. She is also a core faculty member of the Johns Hopkins Bloomberg School of Public Health Center for Drug Safety and Effectiveness. Host: Stephanie Desmon, MA, is a former journalist, author, and the director of public relations and communications for the Johns Hopkins Center for Communication Programs, the largest center at the Johns Hopkins Bloomberg School of Public Health. Show links and related content: Taking Multiple Medications? You May Need to Scale Back.—The New York Times Taking more than 5 pills in a day? ‘Deprescribing' can prevent harm—especially for older people—The Conversation Contact us: Have a question about something you heard? Want to suggest a topic or guest? Contact us via email or visit our website. Follow us: @‌PublicHealthPod on X @‌JohnsHopkinsSPH on Instagram @‌JohnsHopkinsSPH on Facebook @‌PublicHealthOnCall on YouTube Here's our RSS feed

Episode: D2D Edition | Deprescribing of Anticoagulants: The IF, WHEN and HOW, a Discussion with a Cardiologist Host: Sabine von Preyss-Friedman MD, FACP, CMD Guest(s): Nicole Orr, MD; Irene Hamrick MD, CMD  In This Episode: In this episode, host Sabine von Preyss-Friedman, MD, FACP, CMD, and special guests Nicole Orr, MD, and Irene Hamrick, MD, CMD, discuss the updated guidelines for ASA and deprescribing of anticoagulants.  Date Recorded: March 11, 2024 Available Credit: The American Board of Post-Acute and Long-Term Care Medicine (ABPLM) issues CMD credits for AMDA On-The-Go and affiliate podcast episodes as follows: Claim CMD Credit

Dr. Mark Horowitz, a Clinical Research Fellow in Psychiatry from the UK and co-author of “The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs,” delves into the complexities of deprescribing psychiatric medications such as antidepressants, benzodiazepines, and sleep aids. Dr. Horowitz outlines the origins and importance of the deprescribing movement, explaining how polypharmacy and overprescription have necessitated a careful approach to reducing medication loads safely. He discusses the physiological and withdrawal challenges faced by patients on long-term psychiatric medication, emphasizing the vital role of slow and individualized tapering processes. He covers the substantial influence of pharmaceutical companies on prescription guidelines in the US compared to the UK, shedding light on the differences in medication usage and prescribing cultures. Dr. Horowitz also debunks the chemical imbalance theory of depression, arguing for a more nuanced understanding of mental health issues and their treatment. He introduces Outro, a new clinic founded by Dr. Horowitz in California, aimed at supporting individuals through the deprescribing process.

Dr. Hoffman continues his conversation with Dr. Mark Horowitz, co-author of "The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs."

More than half of Americans take four or more medications a day. That number increases to at least seven when we add over-the-counter medications. All of these have side effects and interactions. Today my guest is DeLon Canterbury, Founder of Geriatrix.org who hopes to revolutionize the way we look at medications by educating the public on deprescribing. In this episode, we discuss the importance of knowing the medications your care partners are taking, what he considers dangerous drugs, the most over prescribed drugs and how to discuss deprescribing with your care partners physician. SHOW NOTES

More than half of Americans take four or more medications a day. That number increases to at least seven when we add over-the-counter medications. All of these have side effects and interactions. Today my guest is DeLon Canterbury, Founder of Geriatrix.org who hopes to revolutionize the way we look at medications by educating the public on deprescribing. In this episode, we discuss the importance of knowing the medications your care partners are taking, what he considers dangerous drugs, the most over prescribed drugs and how to discuss deprescribing with your care partners physician. SHOW NOTES

This week Family Medicine Physician Ammon Thompson, M.D., joins us on Health Dose to discuss the benefits of deprescribing medications to his patients.

All sorts of medications are prescribed for anxiety in older adults. Today, we look at when and how to discontinue them.CME: Take the CME Post-Test for this EpisodePublished On: 03/25/2024Duration: 22 minutes, 47 secondChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Join Kristin as she talks with Dr Mark Horowitz about how to deprescribe psychotropics like antidepressants, what is known about the causes of depression, what evidence is behind the antidepressants commonly used, what the symptoms of antidepressant withdrawal look like and the origins of the phrase "it's Bedlam here." The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs are available for purchase here:  https://www.wiley.com/en-us/The+Maudsley+Deprescribing+Guidelines%3A+Antidepressants%2C+Benzodiazepines%2C+Gabapentinoids+and+Z+drugs-p-9781119823025  This podcast has been released to co-incide with MedsAware which is SHPA's Deprescribing Action Week, 18-24 March 2024 - find out more here: https://www.shpa.org.au/news-advocacy/MedsAware   

This episode of the Thyroid Beginner Series features Dr. Christianson discussing the pros and cons of using thyroid medications to help you make informed decisions about your health.   While thyroid meds are super important for those without a thyroid or with severe hypothyroidism, a lot of people may not benefit and could even face health complications. Dr. C discusses what you must consider when starting, continuing, or stopping thyroid medication. He emphasizes the importance of personalized care and informed decision-making.    Dr. Christianson also reveals some surprising findings from studies on deprescribing. Turns out, lots of people can successfully lower or even stop medication usage without any adverse effects. He also talks about the difference between synthetic and natural thyroid hormones and how to optimize treatment approaches for better outcomes.    Don't miss out on the opportunity to receive expert guidance on how to manage your thyroid health effectively and make informed decisions about medication. Join us now to take the first step towards a healthier you!   Key Takeaways: (00:02) Introduction (00:35) Overview of thyroid medications as the widely prescribed medications globally. (00:58) Efficacy and risks of thyroid medications; why some people do not benefit from thyroid medications and are exposed to substantial health risks. (02:12) Considerations for feeling better on medication (03:09) How introducing external hormones to the body disrupts the natural balance of hormones. (03:59) Symptoms and challenges of taking thyroid medications and why making a hormone is not the same as taking a hormone. (05:45) Thyroid medication as a necessity for those without a thyroid or severe hyperthyroidism. (06:25) Considerations for starting or continuing thyroid medication. (07:15) Deprescribing and lowering dosage. (08:31) Process of deprescribing thyroid medications and adjusting dosage based on health improvements. (11:05) Conclusion and preview of the next episode; "the iodine story." (12:00) Closing   "The phrase that I've thought of is that making a hormone is not the same as taking a hormone, and as much as possible, we want our bodies to make the hormone. The paradox is that if you're taking it, you can make it harder for your body to make it, of course."   Did you find this episode helpful? Let us know by leaving a review! Visit these links to learn more: ●  https://www.drchristianson.com/ ● Dr. Christianson on Facebook ● Dr. Christianson on Instagram   Subscribe for more Medical Myths, Legends, & Fairytales: ● Apple Podcasts ● Spotify ● YouTube  

Prescribing and deprescribing for the geriatric population can be complex. In this podcast, NP experts Drs. Shantha Franks and Audrey Stevenson will review the pharmacodynamics and pharmacokinetics of aging, discuss inappropriate prescribing and the American Geriatrics Society Beer's Criteria, and walk you through the process of deprescribing with use of a case study. To earn 0.9 contact hours of continuing education (CE) credit, all of which is Rx credit, you will need the participation code provided at the end of the podcast. To claim your CE credit, log in and register for the activity within the AANP CE Center, then enter the participation code and complete the post-test and evaluation. CE credit is available for this podcast through March 2025. Resources https://deprescribing.org/resources/ https://psnet.ahrq.gov/primer/deprescribing-patient-safety-strategy

Listen to Roger Bedimo, MD, MS, FACP, discuss considerations for older people living with HIV, including:Polypharmacy and deprescribingThe risk of cardiovascular events with various ART regimensApproaches for managing weight gainPresenter:Roger Bedimo, MD, MS, FACPProfessor of MedicineInterim Director, Office of Global HealthUT Southwestern Medical CenterChief, Infectious Diseases SectionVA North Texas Health Care SystemDallas, TexasGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.To download the slides:  https://bit.ly/49zrnZsTo view the full online program:https://bit.ly/49x0W6D

Swapnil Gupta is an Associate Professor and Medical Director of Ambulatory Psychiatry at Mount Sinai Morningside Hospital. She was trained as a psychiatrist in India and the United States, at SUNY Downstate Medical Center and Yale University, and PGI Chandigarh in India. She is known for her work on deprescribing from and discontinuation of psychiatric drugs. Dr. Gupta's career began with research on the role of the endocannabinoid system in the pathophysiology of schizophrenia as an academic psychiatrist. Her subsequent scholarship has focused on applying deprescribing, the systematic reduction of unnecessary medications, to psychiatry by rooting it in the principles of recovery-oriented care. She has authored several peer-reviewed papers on deprescribing and co-authored a book with Rebecca Miller and John Cahill. She is an active member of two organizations that aim to enhance stakeholder engagement in psychiatric research. She is also a part of the editorial board of the Community Mental Health Journal. Currently, she is working on creating educational resources to help people discontinue psychiatric medications and gathering information on the knowledge and opinions of psychiatrists regarding the discontinuation of such drugs. In this interview, we discuss deprescribing from psychiatric drugs, the difficult decisions faced by patients, the importance of psychosocial support during withdrawal, and how deprescribing is central to recovery-oriented practices such as shared decision and patient choice. We will also tackle the complex issue of whether the recurrence of symptoms once a drug is tapered is a mark of relapse or withdrawal caused by the psychiatric medication. *** Thank you for being with us to listen to the podcast and read our articles this year. MIA is funded entirely by reader donations. If you value MIA, please help us continue to survive and grow. To find the Mad in America podcast on your preferred podcast player, click here

Join Shawn and friends this spring for an all-inclusive intimate cabin retreat in the beautiful Smokey Mountains of Tennessee. Two dates to choose from. Use code CARNIVOREDIET to get your discount. Go to https://wired4healing.com/retreats/ to sign up before tickets run out! Timestamps: 00:00 Introductions. 05:29 Scott, former fitness business owner, finds new interest in carnivore. 07:03 Educational farm tour, focus on wellness and fun. 12:53 Health professionals and fitness instructors. 15:38 Carnivore diet healing properties. 17:16 Carnivore diet research. 21:19 A high-fat diet for diabetics. 24:50 Not all carbs are harmful, but some are. 28:14 People's health and exercise routines are individual. 31:26 Deprescribing medications. 34:42 Community connection. 38:56 Carnivore diet health benefits. 40:54 How to visit. See open positions at Revero: https://jobs.lever.co/Revero/ Join Carnivore Diet for a free 30 day trial: https://carnivore.diet/join/ Carnivore Shirts: https://merch.carnivore.diet Subscribe to our Newsletter: https://carnivore.diet/subscribe/ . ‪#revero #shawnbaker #Carnivorediet #MeatHeals #HealthCreation   #humanfood #AnimalBased #ZeroCarb #DietCoach  #FatAdapted #Carnivore #sugarfree  ‪

Join me on the Flex Diet Podcast as I sit down with the esteemed cardiologist Dr. Michael Twyman to tackle the vital subject of cardiovascular health and the power of early risk detection. We discuss the significance of functional testing and specific scans that could revolutionize your approach to heart disease prevention. Listen in as Dr. Twyman shares his transformation from invasive to preventative cardiology and learn about the essential tests he recommends for gaining invaluable insights into your heart health.For Dr. Twyman's top 4 takeaways, go to https://miketnelson.com/flex4. Special thanks to Flex Diet Podcast sponsor LMNT. Choose LMNT for all your hydration needs. Check out https://drinklmnt.com/mikenelson.Episode Chapters:(0:00:00) - Cardiovascular Health and Early Detection(0:06:22) - Cardiovascular Risk and Plaque Development(0:12:37) - Understanding Heart Health and Cholesterol(0:19:13) - Understanding Lipoproteins and Cardiovascular Health(0:27:54) - Functional Testing for Arterial Health(0:36:32) - Nitric Oxide and Arterial Health(0:44:18) - Understanding the Calcium Score Test(0:50:34) - The Importance of Circadian Rhythms(1:00:47) - Optimal Red Light Therapy Parameters Connect with Dr. Twyman:InstagramWebsite 

Dr Mark Horowitz discusses why psychiatric medication has turned out to be far harder to stop than any one expected. For Mark, this is as much a personal as well as a professional interest. For as a patient, at one point he was taking five different psychiatric drugs. Ironically, although Mark was working in London at the Institute of Psychiatry, he found the mostly useful information about deprescribing came -  not from the medical profession - but from peer support websites. This experience has driven his research and interest in safely stopping psychiatric medication. He, along with Professor David Taylor, has just written a new handbook The Maudsley Deprescribing Guidelines, providing step-by-step instructions on how to effectively stop all commonly used antidepressants, benzodiazepines, gabapentinoids and z-drugs. One of the key findings from this work, is that it is essential to taper off the drugs much more slowly than patients have previously been advised. And perhaps most surprising of all, is  how a small amount of medication can have a completely disproportionate effect. In some cases, a 1mg dose can have nearly half the effect of a 20 mg dose, which means patients may have to taper far more gradually as they move down to smaller and smaller amounts of a drug. A process that may need to take months or even years. The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs (The Maudsley Prescribing Guidelines Series) by Mark Horowitz and David Taylor, published by Wiley-Blackwell will be available from 15 February 2024.   The host of the podcast, Liz Tucker is an award winning medical journalist and former BBC producer and director.  You can follow Liz on Twitter at https://twitter.com/lizctucker and read her Substack newsletter about the podcast at https://liztucker.substack.com If you would like to support this podcast you can do so at patreon.com/whatyourgpdoesnttellyou or via PayPal at https://www.patreon.com/WhatYourGPDoesntTellYou

Doctors Lisa and Sara talk to Senior Pharmacist Sarah Hafeez about Polypharmacy. She explains the difference between inappropriate and appropriate polypharmacy before talking through some typical cases that illustrate several examples of common scenarios.  This leads to discussions on prioritising concerns, weaning/stopping medications, counselling patients on the effects of Opioids and Gabapentinoids and involving community teams aiming for successful reductions of addiction forming medications. Other gems include a discussion of the potential long term risks of Proton Pump Inhibitors and advice on weaning, remembering to consider anticholinergic burdens as well as handy resources for tackling Polypharmacy, Structured Medications Reviews and medication reductions. You can use these podcasts as part of your CPD - we don't do certificates but they still count :) Useful resources:  Greater Manchester Medicines Management Group: Inappropriate Polypharmacy Review and Treatment Optimisation: Resource Pack (from Dec 2022, accessed Dec 2023): https://gmmmg.nhs.uk/wp-content/uploads/2023/02/GMMMG-Polypharmacy-resource-pack-v3.0.pdf Scotland Polypharmacy Resources for Professionals and for Patients: https://www.polypharmacy.scot.nhs.uk/for-patients-and-carers/ Scottish Polypharmacy Guidance 2018: https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/04/Polypharmacy-Guidance-2018.pdf Lewis T. Using the NO TEARS tool for medication review. BMJ. 2004 Aug 21;329(7463):434. doi: 10.1136/bmj.329.7463.434. PMID: 15321901; PMCID: PMC514207 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC514207/ Toolkit for General Practice in Supporting Older People Living with Frailty (includes a great Appendix of the STOPP/START criteria (2017): https://www.england.nhs.uk/wp-content/uploads/2017/03/toolkit-general-practice-frailty-1.pdf An example of an Anticholinergic Burdon Resource from West Essex CCG 2020: https://westessexccg.nhs.uk/your-health/medicines-optimisation-and-pharmacy/clinical-guidelines-and-prescribing-formularies/04-central-nervous-system/61-anticholinergic-side-effects-and-prescribing-guidance/file Canadian Resource for Deprescribing including reducing medications and some patient information leaflets: https://deprescribing.org/ Resource for help reducing and stopping medications: https://medstopper.com/ Me and My Medicines Resource for Patients to look through their medications before reviews or for information: https://meandmymedicines.org.uk/ Anticholinergic Medications and Risks of Dementia Cochrane Editorial with Reports in Link (Sept 2021): https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000154/full Anticholinergic drugs and risk of dementia: Time for action? British Pharmacological Society. Bell B et al Jun 2021 (9:3). Accessed 15/1/2024:  https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1002/prp2.793 Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder. Clin Interv Aging. 2020; 15: 1493–1503: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457731/ Greater Manchester Medicines Management Group: Management of Overactive Bladder Including a simple Bladder Diary before and after stopping Medications (Jun 2019): https://gmmmg.nhs.uk/wp-content/uploads/2021/08/Management-of-OAB-in-adults-v3-0-approved-Aug-2019.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it's release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

In this week's interview, a board-certified geriatric pharmacist explains why taking an older person off a medication might be just as important as putting them on one. In fact, since prescriptions tend to accumulate over time, the delicate art of deprescribing is even more essential. This pharmacist helps physicians determine how to reduce the number […]

Looking 4 Healing Radio with Dr. Jana Schmidt – Overmedication is increasingly common, with one in four seniors on ten or more drugs, often unnecessarily. I discuss how nutrition and lifestyle changes can replace some medications, like statins, which may harm liver health and deplete COQ10. Understanding your prescriptions and considering deprescribing is essential for better health. Informed consent and patient-provider partnership...

Looking 4 Healing Radio with Dr. Jana Schmidt – Overmedication is increasingly common, with one in four seniors on ten or more drugs, often unnecessarily. I discuss how nutrition and lifestyle changes can replace some medications, like statins, which may harm liver health and deplete COQ10. Understanding your prescriptions and considering deprescribing is essential for better health. Informed consent and patient-provider partnership...

All Home Care Matters is honored to welcome Dr. DeLon Canterbury as a guest to the show. Dr. DeLon Canterbury is the founder of GeriatRx and is helping to revolutionize the way we look at prescription medications and is educating the public on deprescribing. GeriatRx is a pharmacist-led medication management company that focuses on helping overwhelmed caregivers stop their loved ones from being overmedicated using genetic-drug screening, deprescribing, and health cost savings strategies. We specialize in developing medication action plans for patients of all ages, but with a specialty in Geriatric care. Unlike your traditional pharmacist, we develop a three-month strategy to address overmedicated patients using a holistic and evidence-based approach in accordance with your prescriber so that there are no gaps in communication of care. Founder of the Deprescribing Accelerator, DeLon envisions all pharmacists and senior care providers as Deprescribing Advocates and coaches professionals how to integrate, leverage, and monetize Deprescribing into clinical practice! The Deprescribing Accelerator trains passionate nurses, pharmacists, and prescribers on how they can be serve our overmedicated seniors by increasing your revenue's practice with referrals and a value-based, sustainable care model within your business.