Section F Ongoing use of medication: monitoring and reviewing

How should the process of reducing or withdrawing medication work?

If medication is being used to manage challenging behaviour, there is a chance that this behaviour could increase when medication is reduced or withdrawn. Before medication starts to be reduced, you could put in place any social or environmental changes that would benefit your relative and develop a ‘just in case’ plan. This should be done with help from a professional, and could help you and your relative cope with the process of withdrawing from medication. It is important that everyone responsible for the care of a person with a learning disability is aware of the plan to reduce medication.

Medication should be reduced slowly and carefully, with gradual reductions in doses. This should always be done following a clear withdrawal plan from a doctor with specialist experience in this field. Information should be given to family members and support staff about the potential withdrawal effects before medication is reduced. For a list of potential withdrawal effects, look at the Mind website where you can find information on withdrawal effects for antidepressants, antipsychotics and mood stabilisers.

It is important to remember that any withdrawal effects should be monitored and reported to the doctor. It can be difficult to distinguish between withdrawal effects and behaviours that would have happened anyway, so you should make a plan with your doctor about the best way to monitor this. Before medication is reduced, you should ask your doctor about common side effects and what to do if these occur. As medication is reduced, you and your doctor should also make a plan for how to react to any other withdrawal effects as they appear.

As well as reducing doses gradually, if your relative is taking more than one dose of the same medication, several times a day, they should reduce each dose they currently take rather than cutting out whole doses. This can help the levels of medication in the body to remain relatively stable, rather than having large increases and decreases.

If it is agreed to reduce or withdraw more than one of your relative’s medications, then they should come off one medication at a time. The first medication to be reduced is usually the medication that is least helpful to your relative. Family members and the doctor should decide jointly which medication is least helpful.

When your relative’s medication is being reduced or withdrawn, it can be useful to know that different people can experience different withdrawal effects. People who have been taking medication for a longer amount of time tend to experience more withdrawal effects. The type of medication that is being reduced or stopped will also make a difference to how someone feels.

Your relative’s health should also be monitored regularly and any concerns discussed with a doctor. As medication is reduced, you should be careful that this does not result in an increase in another restrictive practice.