Beginner’s guide to psychiatric drug withdrawal

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I’ve posted this piece three times since I first started this blog. It’s a primer of sorts to help people start withdrawing 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. It’s no secret I did all the heavy lifting in my care and my doctors at best cooperated with me.

Update 2016: It’s become clear to me that whenever it’s possible that it’s helpful for folks who’ve not begun withdrawal and have the time to consider a carefully thought out plan to attempt to bring greater well-being to your body before starting the withdrawal. That means learning how to profoundly nourish your body/mind and spirit prior to beginning a withdrawal. For suggestions on how to go about doing that check the drop-down menus on this blog for ideas. Anything that helps you learn how to live well can be part of your plan. That plan will look different for everyone as we learn to follow our hearts and find our own unique paths in the world. Things to begin considering are diet, exercise and movement, meditation/contemplation etc. Paying attention to all these things as you do them helps too. The body will start letting us know what it needs as we learn to pay attention. 

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. It’s not been edited in a long time but it serves as basic disclaimer. No one really knows what might happen in withdrawal.

Secondly, I will mention some books written by professionals for the sake of having them to reference. The unfortunate reality is we don’t get the best or most complete information from such sources. For better or worse we get the most complete picture of the spectrum of possibility online amongst others, like us, who’ve needed to make our way off medications largely on our own. There has simply been very little clinical study on these issues so that professionals simply aren’t appropriately trained and their practices are very small and subject to self-selection. Communities online may be skewed in other ways…certainly many of the worst case scenarios who’ve not been able to find competent professional help show up on the internet withdrawal boards.

So some books: first:  “Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Medications“

David Healy 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 usually needs to be limited to gentle walking or perhaps swimming. 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 these two prior posts: here and here. (scroll to the top of the page once you click on the link)

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.

Water taper for a slow and controlled withdrawal

Some thoughts on stopping psychiatric medications — things to think about before deciding if you should discontinue your medications

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

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

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