Mobile phone applications to support tapering of psychiatric medication: a scoping review

Abstract Introduction Gradual dosage reduction (tapering) is the recommended approach for reducing and/or stopping the use of psychiatric medication in order to minimise the risk of withdrawal symptoms. A previous James Lind Alliance Priority Setting Partnership highlighted several gaps in the current evidence base on tapering psychiatric medication.1 To date, the evidence base for mobile phone applications (‘apps’) and app-based interventions in supporting safe and effective discontinuation of psychiatric medications has not been examined. Aim To examine the content, underpinning evidence base, and impact of mobile phone apps and app-based interventions that focused on supporting the tapering of psychiatric medication. Methods A scoping review was conducted using the Joanna Briggs Institute guidance and results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline.2 Seven electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, ACM, IEEE Xplore) and two app stores (Apple’s App Store (iOS) and Google Play Store (Android)) were searched. To meet inclusion criteria, studies of any design identified from peer-reviewed literature (i.e. ‘non-commercial’ apps) and apps identified from searches of commercial app stores (i.e. ‘commercial’ apps) had to focus on supporting the tapering of psychiatric medication. Following screening, key information was extracted from included studies and apps. Identified apps were coded in terms of their functionalities and components of the Behaviour Change Technique Taxonomy version 1 (BCTTv1). The findings were described using narrative synthesis. Results Seven apps met inclusion criteria comprising two non-commercial apps, and five commercial apps. Two non-commercial apps were evaluated using randomised controlled trials (RCTs); one RCT was ongoing and the other was stopped prematurely due to recruitment challenges. All seven apps focused on supporting the tapering of psychiatric medication. Eight functionalities and seventeen BCTs were identified across the seven included apps and app companion websites. The four most common BCT codes were: 1.3 ‘Goal setting (outcome), 2.3 ‘Self-monitoring of behaviour,’ 4.1 ‘Instructions on how to perform the behaviour,’ and 8.7 ‘Graded tasks.’ Most of the identified apps did not provide information about the app development process or specify any theoretical underpinning. Given the lack of reported outcomes for the evaluation studies of app-based interventions and commercial apps, it was not possible to report the impact from a qualitative or quantitative perspective. Conclusion This scoping review demonstrated a paucity of mobile phone apps and studies of app-based interventions that support tapering psychiatric medication. The review’s main strength was that it followed a published protocol, and data extraction and app coding was conducted by two reviewers independently. In terms of limitations, the lack of studies evaluating app-based interventions made it difficult to address the objective relating to the impact of the identified apps. By outlining the key functionalities offered by the identified apps and characterising them in terms of component BCTs, as well as raising awareness of the shortcomings of commercially available apps, the review findings will guide future research on the development and evaluation of apps to support individuals who want to reduce or stop psychiatric medication use.