Trellis: this is your brain on (psych) drugs

My friend Rhi Griffith wrote this very thoughtful piece on the need to withdraw from psychiatric drugs VERY slowly. It’s got very good advice and a wonderful metaphor.

It is always applicable advice, though it seems to me that some people cannot avoid getting sick in withrawal. Perhaps if they took as many years to get off drugs as they were on them, but when you’re talking decades it’s not such a good option.

Nobody chooses to get sick and nobody can afford to lose one’s physical functioning. It’s no one’s fault for having done anything wrong if they do. No one chooses getting sick as hell, the whole reason people withdraw is to get well.  Getting ill is not an option among others, it’s a nasty unintended fall-out. Those of us who get seriously ill have to cope with the devastation of losing much of our lives. I have a clear mind and my soul back and I paid with my body — at least for the time being. I’m glad to have my mind and spirit and passion back. No regrets to have all that back.

The fact is there are most likely ways of mitigating some of the ill effects beyond just the pace of the taper, but there are times that the result of the taper simply is not something that is controllable and I’ve seen it way too many times now. Many people are sick before they even start to taper and make the choice to come off drugs that they might heal from the insult of having been on drugs at all. For such people  tapering may necessitate coping with more illness before getting better. Some of this I’m only now learning in the process of recovery. Systematic study is needed to find what sort of supports really matter as there are certainly some that make a difference. We’re all dealing with this in a hit and miss fashion and with the collected help of one another. We’re all individual so any generalization about withdrawal virtually never applies to everyone. The majority of people can indeed stay much more physically healthy following the below sage advice.

Rhi has written two other pieces on Beyond Meds having to do more specifically with withdrawal of Lamictal and benzodiazepines. Here and here. Her blog can be found here.

Trellis — by Rhi Griffith

1trellI know I’m always carrying on about slow tapers and intermittent holds, but there is a reason for that, honestly!

I really think I’m on to something important here which fits with what scientists are learning about the chemistry and physiology of the brain. And I think a lot of people could be spared a lot of suffering if I could get them to understand and respect the process.

When you take drugs that change your neurotransmitters, which psych meds do–your brain doesn’t like it. Brain chemistry is indescribably complicated, much more complicated than any piece of machinery ever created by humans. Everything affects everything else and it all feeds back on everything else. You can’t mess with one thing without affecting everything. So our brains don’t like it when suddenly one neurotransmitter is screwed up.

So they adapt, or try to. They destroy some cells and grow new ones. They eliminate receptors and grow and install some other new ones. They turn some genes off and turn other genes on. They try very hard to re-establish a normal balance as best they can. This is a difficult and imperfect process and induces a certain amount of havoc and chaos, but the brain does the best it can, and gradually it reshapes itself. It reshapes itself around the new chemistry that the drug has caused. This isn’t a simple, subtle thing; it involves concrete, complex and physical changes.

I like to use the analogy of a plant on a trellis.

The trellis is the new chemistry caused by the introduction of the drug, and the plant is your brain.

When you stop taking a psychiatric drug, it’s like you are removing the trellis. If you yank it out all at once, ouch; the plant is damaged and it collapses and it takes a long time for it to heal itself, and it’s not going to be able to function properly for a while. (Hence the problems with c/t.) If you want to keep that plant functional you have to snip that thing out bit by bit.

At first when you start snipping, the parts of the plant that still have enough support from the trellis will support the parts that you’ve taken the trellis away from.

If you’re going slowly enough the plant will start to grow new stems to support itself, which can replace the trellis, although it takes time to grow new stems so this doesn’t happen fast.

But if you keep going at the same pace day by day, and you’re going faster than the plant can grow, eventually some branches are going to fall down, although not enough to keep the plant from functioning okay. And if you keep going at the same pace, more branches will fall down and the plant will get looser and have less support but still be basically functioning, so it’s easy to not notice that you need to slow down.

This is the part of a taper where you keep going in spite of symptoms because it’s not that bad and basically you haven’t really crashed yet.

But if you keep going at that pace, cutting away the trellis faster than the plant can grow new stems to support itself, sooner or later the day will come when a chunk of the plant will just collapse. That’s when you hit the wall. You can hold there, but it may not help unless you can hold long enough for that plant to regrow its own structure.

And then people say, “well, I tried holding, but I never stabilized so I had to just keep tapering down in spite of the symptoms.” True. You may just want to keep going, because otherwise you’re going to have to wait a long time before things are stablized enough to start afresh and snip safely.

Now, that’s certainly an option for some. But some people don’t have that option. Some people need to be able to stay functional to work, raise families, etc.

And if you are one of those people, then I highly recommend a really slow taper. You can go a little faster at first, but pay very close attention to your symptoms, and stop and hold occasionally to see if your brain is having time to catch up with the cuts you are making. The keys are

  • paying very close attention to your symptoms and not pushing past them, taking intermittent holds to make sure your brain is keeping up with your cut rate
  • not expecting to follow some pre-planned schedule, because growth and healing can’t be scheduled…
  • going slowly enough that when those first branches start falling off, you haven’t already cut so much that the collapse can’t be prevented.

Okay, I know the word “collapse” is pretty strong. Your brain is not going to collapse completely. It’s just an analogy and a pretty imperfect one. For one thing, our brains are WAY more complicated than a single plant; the level of complexity of the brain is more like that of a forest or jungle. Your brain is stronger and more adaptable than just a single plant on a trellis.

But how our brains respond to drugs and tapers is much more like how plants act than like how machines act. Brains and plants come from the same place, from nature, and nature designs using basically the same chemistry and principles over and over.

I know a lot of people suffering from psych med withdrawal can’t benefit from this advice because they are already too far along in the process.

But maybe this can help people understand and respect the process that their brain is going through. You are growing a new brain. This is not something that can be done quickly, whether we like it or not. Growth and healing can’t be scheduled. Trees don’t grow according to an Excel chart. Growth and healing have to be permitted, nurtured and encouraged, and allowed to happen in the time it takes for them to happen.

And it’s going to be easier on your brain if you allow it to adjust to the changes slowly than if you try to push it.

And if you have the time and the patience, if you go slow enough, I believe that your brain can heal, can rebuild its natural chemistry, rebuild its own “trellis,” while you taper.

That’s what I believe, based on all the evidence I’ve seen and heard to date.

More posts on Psychiatric Drug Withdrawal here.

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