Psychiatric Drug Withdrawal for Beginners

This is a primer of sorts to help people start withdrawing from psychiatric drugs as safely as possible and includes resources written by professionals that one might bring their doctor that they might get the appropriate supports. 

For more extensive information to help in psychiatric drug withdrawal look at the drop down menu at the top of the page under Psychiatric Drug Withdrawal.

Whether you want to completely withdraw from meds or simply wish to minimize what you take, the first thing I will refer you to is a paper written by Joanna Moncrieff. It refers mostly to withdrawal from neuroleptics, but much can be inferred about most psychiatric medication.This paper may induce fear in those hoping to withdraw from drugs, but I think it important that people understand that there are, indeed, real dangers and risks associated with drug withdrawal–most notably in precipitous withdrawal or withdrawal without appropriate supports.

There is a warning on the risks of psych med withdrawal here. That was written a while ago and I’ve not edited it. It speaks of my being on meds still. I’ve actually completed my withdrawal and am slowly getting better.

Secondly, I refer you,  to Peter Breggin’s book “Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Medications ”  I’ve not read a lot of David Healy, but he offers many insights into most specifically anti-depressant drugs and the problems associated with taking and withdrawing from this class of drugs. His website is here. On Paxil Progress there is lots of discussion about his work. It is often not conservative enough and the cross-over to Prozac is over-rated. Many people do much better simply tapering as slowly as possible from the original drug they were on.

Other people like Joseph Glenmullen’s work on antidepressants. I’ve also not read it and have been told he moves too fast for many. Again, I put these here as many doctors like to hear something about this phenomena from other doctors.

For benzo withdrawal Heather Ashton’s  Manual is the best resource written by a professional. It’s available for free download.  It too, however, is sometimes not as cautious as it should be, though she is pretty good about putting in those sorts of caveats.

These people are professionals with experience and expertise in the matter. They can help support your needs when approaching other professionals.

I’ve found, for better or worse, that it’s the organized patients online that know the most about withdrawal and will be the most cautious and give the best advice, though it too is sometimes flawed. Everyone is subject to their own particular dogmas since we are dealing in a world of anecdotes that lacks systemic study. That said  doctors have even less anecdotal experience because they simply have not dealt with the sheer volume of people that we who frequent these underground internet worlds have. I say this both as a person who has had to struggle to get good information and as a professional.

So, these books are helpful and important. In my experience, however, having read some and knowing a bit about the others, I don’t think they go far enough in two ways. They do not address diet and nutrition and they fail to emphasize just how slow the taper must be for many individuals. Breggin in one instance does go so far as to say that people who’ve been on neuroleptics for many years may have to wait up to two months between tapers. This is mentioned only once however and briefly. In my experience with many people tapering, holding for some length of time between tapers is often necessary and prudent with any drug they may be tapering.

There are people, who I’ve had contact with, who’ve gone cold-turkey and recovered, but there is much danger in attempting this and the potential for long-term “discontinuance syndromes” or complete relapse is very high. The most successful people will take months and in some cases, for people on high doses, multiples meds and long-term use it can take years. I fall into this latter category. It took me a little over six years to free myself from six drugs. Patience is key. This is something most people need to develop it’s a particularly arduous journey. There is generally no reason to suffer to any huge degree, though some trouble, as well as suffering a potential multitude of unpleasant symptoms must be expected. Some significant minority of folks seem to not be able to avoid illness regardless of the care they took to free themselves from the drugs. These meds cause injury and people recover from their insult with different time tables.

Breggin suggests what has come to be known the 10% rule. Any given drug should not be reduced anymore than 10% at a time. Once a taper is complete the next taper should not exceed 10% of the new dose. Therefore, the milligram, then fraction of milligram amount decreases with each new taper. I’ve found that I have to sometimes go in even smaller amounts. As low as 5% and sometimes people go as small as 2.5%–for people on benzodiazepines it is not unusual to go in even smaller amounts. Cutting pills is not always enough. Sometimes liquid titration is necessary. This may involve dissolving the smallest dose pill in water, club soda or even alcohol, which can then be diluted with water, then using a syringe to cut down milliliters at a time. Medications also sometimes come in liquid form and can be gotten by prescription. Another option is to bring your drug to a compounding pharmacy which will crush and carefully compound bits of it into capsules. This is more expensive but it one can afford it it can be very convenient.

It should be noted that some medications should not be dissolved, crushed or cut. Especially time released medications. This would be extremely dangerous.

Exercise can be an important part of withdrawal, but often needs to be limited to gentle walking or perhaps swimming if one is having a difficult withdrawal. Vigorous exercise can be over-stimulating and exacerbate withdrawal symptoms. My own experience with exercise is that before my aggressive withdrawal process began and during the time I took a long break, I took vigorous long hikes a couple of times a week coupled with equally vigorous exercise at the gym. As a result of my withdrawal, I lost the capacity to do anything at all. This is not the norm but it’s not certainly not unheard of either that some become bedridden in this process.  It is important to put aside desires to lose weight until withdrawal is complete. Some people gain for a while others lose a lot of weight as a result of withdrawal. But eating well is so important that calorie reduction should not be considered unless it is in the context of continuing to eat enough healthy food which often involves eating frequently to control blood sugar levels which most people withdrawing from drugs have problems with.

There are lists of potential withdrawal symptoms here for both antidepressants and benzodiazepines. There is much cross-over with all the drugs, including neuroleptics and mood stabilizers though there are not comprehensive lists for those classes of drugs online that I’ve seen.

The above was written a while ago. I have completed my withdrawal and am coping with post withdrawal syndrome, a severe illness, of which we know the most from benzo withdrawal. Some people do get sick regardless of taking all precautions.  I see this commonly among those on antidepressants and benzodiazepines in the withdrawal groups. There are not enough or large enough groups of people coming off other meds but I suspect those meds complicate things quite a bit further.  It seems any drug can cause protracted issues in those who are somehow predisposed to it.

And finally,  diet and nutrition has been extremely important. I was unable to continue withdrawing before making changes in my diet. I stick to the diet religiously, only very occasionally taking one bite of something I miss. The bottom line, however, is that I don’t truly miss anything. I am happy to do what my body needs to heal. It’s really not difficult altering your diet once you understand how much it helps. In most instances the thought of eating food I “miss” has no appeal. For tips on diet and nutrition see this page on nutrition and gut health. 

I wrote the above quite a while ago. I’ve edited it slightly, but not much. I’ve completed withdrawal from six psych meds. It took me over six years.  I’m physically disabled and I followed the careful rules above. I’m getting better but it’s slow. There are real risks involved in withdrawal. — I’m learning even more about the importance of the health of the gut. I had what I’m realizing was superficial improvement and I’m now taking measures to bring about more profound healing.

My mind is clearer but my life is limited by physical impairment. This is serious business. The good news is most people do not get sick like me and most people don’t have as much to come off of. But caution is always warranted.

I have to say in spite of getting physically ill the fact that I have my passion back and an ability to see and appreciate life’s beauty (and pain) with no fog, is well worth it. I realize I’ve been very lucky in having the supports I needed, both emotional and financial to pull this off.

Psychiatric drug withdrawal and protracted withdrawal syndrome round-up  — important additional links and information.

For additional info see here includes list of groups for online support.

If you do become sick while tapering this post is a good resource for help: Tool box for coping with psychiatric drug withdrawal syndromes

See here for the Freedom Center and Icarus manual:  Harm Reduction Guide To Coming Off Psychiatric Drugs & Withdrawal (newly revised edition)

For more extensive info on supporting your body/mind/spirit in withdrawal visit the about tab where there are links to much more information.

Video: Coming Off Psychiatric Drugs: A Harm Reduction Approach | Will Hall

10/2012: New: Beyond Meds Facebook page

To navigate the rest of the archives on this blog look at drop down menus at the top of the page

Comments

  1. What a delight to find your website. I thought I was pretty much alone. I was diagnosed in 1967 and have been quite medicated for much of my life. I have suceeded in getting off the Risperdal, Abilify , Valium, and Lexapro. I am almost off the Tegretol but am having a hard time getting off the last 200 mg.-I shake uncontrolably when I drop the last of it. Do you have any ideas about this?
    It seems like I am not quite like most people (if there is such a thing as most people) but I don’t think that I am crazy. Anyway, its nice to run into you. Grace

  2. Grace,
    thanks for visiting. I don’t know about Tegretol in particular, just mood stabilizers in general and I’ve had a real rough time coming off Lamictal.

    I’m so glad you stopped by. I sent you an email.

  3. Thanks Giannakali,

    You know, I recently realized that everything we are, everything we become, has to be learned, since when we are born, our minds are like blank sheets of paper waiting for ink (any ink !!) to be splashed onto them. Hence the disorders that we may have, had to be learned (!!) regardless of any biological factors ! Hence, correcting these “disorders” is a matter of correct learning, learning how to be, how to (properly) think – this is of course how the brain develops – through experience and through active thought. Of course, inherent in this process is a matter of “unlearning”, and “unlearning” something that we’ve learnt is always more difficult than learning the same, especially given the fact that our brain sort of solidifies what we have learnt, though thankfully modification can take place !!

    Am I making any sense here ?!

    P.S. Nice website !

    Jayson

  4. Beautiful ideas Jayson. Yes you’re making lots of sense…

    Welcome to my blog and please stick around and keep on making comments.

  5. Yeah, having developed some mental/psychological disorder is painful, but man, the withdrawal symptoms when coming off the meds that are readily prescribed is ridiculous. I’ve just lowered my efexor dosage from 225mg to 150mg. Can’t go 24 hours without being in some trouble. I say I’ve just lowered my dosage, because I’ve done it against the “advice” of the psychiatrist I’m seeing. I mentioned that I wanted to get off the meds and he got a little upset and asked me if I still wanted psychiatric treatment !! I decided to keep seeing him for now, but I am going to come of the meds ! (this he dosen’t know!) .I’m starting to feel a lot better as I’ve thought this thing through and looked at some of the research being done. Yeah, most, if not all of these “disorders” can be corrected, properly corrected, by applying honest logic !! The process of course will be painful – its almost (!) the case of a machine trying to fix itself, but the beauty of it is that it can be done, we are “machines” with a will/ability that is conducive to modification/correction of self.

    :)

  6. Jayson..jumping off that much effexor is dangerous and can make you very ill…I told you the safe amount to go off of in another message…and this very post talks about the safest way to taper…

    and you really should have a doctor you can talk to about this if at all possible.

    going off drugs too quickly can cause rebound effects and you can be worse off than when you started them.

    be careful

  7. Giannakali, I think I’ve got this under control. For myself, it has all come down to thought control, and as I’ve mentioned previously, unlearning and learning, modifying my thought patterns positively. It’s of course not exactly plain sailing, but it is possible. Thanks for the concern – it can be done. Yes, it probably would be better to taper at a slower rate. I guess I’m a little angry at not being made aware of the withdrawal symptoms of these drugs, and am determined to rid myself of them as soon as possible. I didn’t mention that I’ve been on the efexor for 8 months now, probably a lesser amount of time than people in general before they start to taper off it.

  8. With reference to my last comment, the following is from the paper by Joanna Moncrieff :

    ********************************************
    Research shows that a proportion of people even
    with severe psychotic disorders (somewhere between
    20% and 40%) can stop long-term drug treatment without difficulty.

    This paper suggests that if withdrawal related disorders can
    be managed effectively, there may be cause to
    be more optimistic about the outcome of stopping
    psychiatric drugs.
    *********************************************

  9. yes, all you say is true, but I always suggest caution because you don’t know if you’ll be one of the people who has a really hard time..

    I do wish you the best of luck…

    youth helps too…I don’t know how old you are.

  10. I’m 27 years old. I do rather wish I did have some sort of support system. I currently live alone, and my family don’t have any idea that I have (been diagnosed with) bipolar disorder (they live in another city). My support system is really the acquisition of knowledge on these disorders. I also have to cope with quite a bit of stigma – yeah I’ve had a few emberrassing episodes, mostly while I was asleep (!), though the more I understand the disorder, the more I’m able to cope and work through it. I do admit though that I still have some way to go, and recognise the possibility of at least “scars” remaining … Nice to communicate with someone who’s kinda been through and/or is going through something similar. I’ve experienced a bit of chronic fatigue myself, and yes what’s particularly hard to deal with is that society in general don’t recognise it is a real illness …

  11. Thank you Gianna. I think the most exciting part was your ability in your reading, writing comprehension and decrease in brain fog. There’s times when I can hardly sign my name. I know there are some scary things ahead, but I realize it’ll pay off in the end. If I don’t talk to you before, I’ll let you know how my appt. goes tomorrow. It’s at 1:30 central time but we may go by the museum afterwards. A real stress reliever for me, one of my favorite places! Enjoy your night. Amy

  12. I wish you good luck with your recovery. I wish I was clear-headed enough to look up these types of sites BEFORE I started my withdrawl, but hopefully I will still be okay. I was diagnosed with bipolar in 2005 but never forced to take anything, but then I was hospitalized by a different place in 2006 and they diagnosed me with schizophrenia and didn’t really give me any option other than taking meds except for being held there for 30 days and then court ordered to take them.

    So, I just complied in order to get out of the hospital ASAP. They injected me with zyprexa immediately on arrival and then gave me those instant dissovle things for the rest of my stay.

    By the time I got home I was just like so traumatized and drugged up that I just kind of was in this like complacent, obedient, non-opinionated state for a year and 1/2.

    But finally the 100 pound weight gain within that time period (even with diet and excercize and switching to abilify after about 6 months) thank God it finally got bad enough to wake me up and I decided to just go off the meds.

    I started cutting down just on my own ideas of what would make sense. I was on one 15mg abilify a day so I started taking 3/4 a pill for 1 month, 1/2 the next, 1/4 the next, then 1/8 and finally none.

    But every now and then I get some minor symptoms so I take a tiny bit of a pill just for that instance and then I never have any more problems.

    Unless I stay up all the time taking WAY too much Benadryl.

    I think that they are what caused my symptoms.

    I only get them when I take those.

    Anyway, I just think that I’m in a position of being safe because I don’t think I really have a biological basis for my symptoms other than drug use. And it seems like it’s not permanent damage… it just occurs when I use them…

    But, I still have this problem of isomnia, cuz if I don’t sleep much then I get symtoms, so I take pills to get to sleep, then I get too high of a tolerance for them and take way too many and then I get even worse symptoms.

    I just wish life didn’t revolve around the day!

    If I could start my days 2pm-10pm i/o 7am-3am then I’d be a lot better off!!

    I don’t know what to do. I would look ridiculous going into drug treatment for Benadryl!!! (diphenhydramine / unisom / etc. ).

    But I have been trying to quit for like a year now and I really can’t do it on my own.

    Well, I still have a huge stash of leftover pills, so I’m going to start taking tiny amounts and try to find a new psychologist who is willing to accept the possiblity that my symptoms are caused by a substance and might only be temporary. and therefore not require me to take the drugs.

    I gained so much weight and lost so much mental capacity.

    I used to be a straight A student AND helped my mom take care of 2 kids AND volunteered AND sometimes worked.

    Then after meds I could only take 3 classes a semester (instead of 6) and it took all I had just to do that.

    They say the disorders cause mental decay.

    But now that I’m off the meds I’m getting back to normal. I have opinions and I can think fast. My memory is like 100% better. I’m organized. I’m not apathetic.

    Oh yeah, and I laugh again. I thought all my favorite shows just started sucking for like the last 2 years.

    But now I laugh so much all the time… like I used to.

    But I don’t want to ever fall back into the scared deluded persecuted type of psychosis that I was in before. It was really scary. It hasn’t happened yet, but I’m getting some treatments.

    But hopefully now that I’m capable of effectively doing the research I might be able to find compatible mental health professionals.

    Thanks for giving me a starting point!

  13. Robyn,
    If you are taking benedryl and unisom and that is your problem it sounds like sleep is your issue…

    Find a good holistic doc, or naturopath or even an integrative doctor and learn how to use amino acids…

    also have you changed your diet? other supplemental nutrients may help too…

    You have my blessings—the best to you…

  14. Jeanne Allyn says:

    I’m glad you reposted this link. I’m going to look at the water titration method. have to find out if neurontin is water soluble this way. If it clunps or doesn’t dissolve it could be tricky.

    I only got into eating crap when I was so medicated. I was a back-to-the-land organic type hippie. My carbohydrate craving was attributed to depression and character disorder. Very shamimg to grow so huge and feel so unable to control the drive to stuff myself with “food-like substances” (like Froot Loops for heaven’s sake!)

    I get a clearer idea of the acute loss you are coping with right now from reading this part of your history. But, this does give me hope that being as well as you were at the time you posted this, it bodes well for your future healing.

    You are leading people out of literal hell. I’m a little fuzzy on spirituality right now, but if there is karmic law, peace is coming to you in return for the light you show on a dark pathway.

  15. Saralynn Ingrassia says:

    Hi. I have a question about tapering. I don’t understand about the blood/brain barrier issue. If you taper slowly as you suggest (the 10% rule) does that mean the drug will be removed from your brain/liver etc. or does it take much longer for that to happen? Do you know how long this stuff stays in your brain as opposed to your body? When it is out of the brain, is that when you no longer have withdrawal symptoms?

    Sorry for these technical questions, but,it is difficult to find the answers on the Net and I thought you might be able to enlighten me. I like to know what’s going on, you know? It takes some of the fear out of the process.

  16. I don’t have answers to any of that and as far as I know nor do scientists…different drugs have different lengths of time for clearing out…some have very long lasting metabolites so there might be some info on that…but there really is no way to test brain or even fat tissue in some sort of meaningful way.

    Withdrawal is not only about the drug leaving the body…it’s about the BODY and BRAIN readjusting to NO drug and when drugs cause structural changes like psychotropics do there simply is no answer as to how long it might take…it depends on the body and brain of the given individual and how resilient it is…as well as how long the person has been on the offending drugs…

    sorry…I’d like answers to these questions too but there simply has been no systematic study and that is part of the reason why this is such a travesty and crime.

  17. Saralynn Ingrassia says:

    I have another question about tapering. I was down to 12.5 Seroquel and then, last night, “backslid” up to 50 mg because I had insomnia and was feeling desperate. I felt like I just HAD to sleep and I didn’t want to risk not sleeping because it makes me so depressed and discouraged when I don’t get some rest. I could have just gone up a notch, but, I didn’t want to risk it not working…I was scared. My question is….do I just resume 12.5 again tonight or do I have to modify my schedule in some way? I feel awful this morning. Not only tired and lethargic from the drugs, but saddened by my seeming failure. Sigh. Thanks for your help.

  18. hi Saralynn,
    you should be able to just resume where you left off if you’ve been okay for the most part…if you’ve tapered too fast you might need to be on a higher dose?? I don’t know enough particulars.

    I’m sorry if you’ve told me but are you doing stuff to support your body and mind? Dietary and other lifestyle changes?

    For some natural sleep aids see this post:

    http://bipolarblast.wordpress.com/2009/05/10/natural-sleep/

    also meditation can help…just following your breath while laying in bed can be very calming.

  19. Saralynn Ingrassia says:

    I’m not doing as much as I should be in terms of supporting my body and mind. The fatigue makes exercise challenging, the nausea makes me avoid food. I’m trying to take fish oils on a regular basis, but, the pills make me gag. Right now, I’m struggling to keep my spirits up by keeping my mind busy. Can’t read anything complicated, but, I browse around on the web to distract myself.

  20. I use Carlson’s liquid fish oil…it tastes like lemon and can be mixed in with a smoothie (another thing I do when I can’t eat) I use plain yogurt, milled flax seeds, frozen blueberries and 2 raw eggs…I sip just a tiny bit of it…like two swallows every couple of hours…it’s loaded with protein and blueberries are an awesome food..flax seed is a great source of fiber and omega fatty acids…

    if you use raw eggs you really need to have a local farm and know they are fresh and free range to avoid salmonella.

    you can get carlson’s fish oil at vitacost.com for pretty darn cheap and if the smoothie doesn’t appeal you can really mix it with anything cold you eat or drink…or take it by the spoonful plain…it really does not taste fishy AT ALL.

  21. Saralynn Ingrassia says:

    Thanks. I will investigate Carlson’s fish oil and try the Smoothie idea. Sounds good. Advice much appreciated.

  22. myra-anne says:

    I am new to this site and have been reading posts for days now. I cannot believe now naive I have been regarding my drugs for bipolar. I was given every anti-depressant for years until it was “discovered” I was bipolar. I had always felt that the AD’s was what was making me feel manic. Since then, have been on the drug-train of Seroquel, Rispirodol, Trileptil, Zopiclone, Clonazopam and Lamactil. The last three of which I am currently on.
    My psychiatrist just kept taking me off and putting me on another when they were making me feel worse-no discussion of withdrawal symptoms or tapering off slowly. I just stopped one and switched to a different drug. I have since become dependent on the benzos which sort of crept up on me and now realize I have become addicted to them. I started taking them more frequently as I changed meds because I had chronic insomnia and felt like I was going out of my mind.
    I want to come off my meds slowly and safely and want to know if they should be tapered one at a time or is there any order in which they should be eliminated?i.e benzos first, Lamactil later (200mg daily). My doctor is not supportive at all in my decision and has actually said perhaps I should come to see her less as I don’t seem to have “any goals I am working towards”.
    I am so grateful for this site and all of the people who share their stories and give encouragement.
    thanks for listening.

  23. Hi Myra Ann,
    welcome…
    you might want to get Peter Breggin’s book “Your Drug May Be Your Problem,” to begin with and also maybe get some books on diet and nutrition that I have on my about page.

    then I would come off the Zoplicone first…that’s short acting and could be hard to come off of if you saved it for last.

    Lamictal and Klonopin I don’t think it matters which you come off of first. Breggin suggests waiting to do benzos last because they are the hardest to come off of, but that isn’t even always true…I’ve encountered people who have said they had a harder time getting off Lamictal then Klonopin/Clonazepam.

    So it’s really your call.

    the most important thing (and Breggin doesn’t stress this enough, in my opinion) is to support your body/mind and spirit with diet and lifestyle changes.

    if you like you can join the social network that accompanies this site.

    http://beyondmeds.ning.com/

    people support one another there and there are lots of us tapering from drugs.
    and you say you’ve been reading lots here…so I imagine you’ve discovered my About page?? there is lots of info there to help prompt you to further research.

Follow

Get every new post delivered to your Inbox.

Join 8,716 other followers

%d bloggers like this: