2026-03-31
Mark Horowitz, Thomas L. Perry
Long-term antidepressant pharmacotherapy is frequently continued beyond guideline-recommended durations. This occurs particularly among women, despite limited evidence of ongoing benefit for many people treated for mild-to-moderate depression and an increasing burden of adverse effects over time. In randomised trials, average symptom improvement over placebo is small (approximately 2 points on the 52-point Hamilton Depression Rating Scale), with an estimated number needed to treat of about 7–10 for a clinically meaningful benefit, underscoring the importance of planning for discontinuation once treatment is initiated. Antidepressant withdrawal is common yet under-recognised: at least half of people experience withdrawal symptoms when stopping, with risk and severity increasing with higher doses, longer duration of use and prior withdrawal experiences. This Therapeutic Letter outlines a practical, patient-centred approach to deprescribing that tailors tapering to individual risk, uses clinical response to guide the pace of reduction and emphasises careful differentiation of withdrawal symptoms from relapse. To minimise harms, abrupt discontinuation should be avoided; higher-risk patients may require very gradual tapering over months or years, often using hyperbolic dose reductions enabled by liquid formulations or dissolving tablets, with close follow-up every 2–4 weeks and the option to pause or reverse tapering if symptoms emerge. The guidance also highlights strategies for challenging presentations, including withdrawal-associated akathisia and protracted withdrawal, alongside patient education, shared decision-making and informed consent to support safer discontinuation and improved outcomes.
2026-03-13
Maphefo S. Aphane, Ramadimetja S. Mooa, Molatelo M. Rasweswe
Background: Menopause is a natural process with exacerbating symptoms for some women. Indigenous practices offer culturally rooted options that need systematic evaluation for safety and efficacy, while hormonal therapy, though effective, carries recognised risks and requires monitoring. An evidence-informed understanding of both approaches is essential for safe, individualised and effective menopausal care. Aim: To investigate the role of indigenous traditional knowledge practitioners in the holistic management of menopausal symptoms among indigenous women in the Gauteng province, South Africa. Setting: Selected homes of the participants in the Tshwane district, Gauteng province. Methods: A qualitative focused ethnography approach utilised purposive and snowball sampling to select 10 indigenous knowledge users and holders and 10 traditional health practitioners. Data were collected through in-depth interviews and non-participant observation and analysed using Brewer’s ethnographic analytical framework with computer-assisted qualitative data analysis software. Results: Pitsa (Pot) as a holistic traditional remedy and cultural existentialism emerged as main themes with three sub-themes. Cultural existentialism is a philosophy that situates menopausal meaning-making and care practices within the framework of cultural identity, heritage and shared traditional knowledge. Conclusion: The study shows that Pitsa is perceived by indigenous women as a cultural practice that supports their holistic menopausal experience. It is valued more for identity, meaning-making and cultural support than for proven clinical effectiveness. Recognising such an indigenous knowledge system in menopausal health discourse is important, alongside further empirical evaluation of its clinical effects. Contribution: The study highlights the need for understanding and supporting the practices preferred by menopausal women.