Many patients who come to see me have been taking medications for anxiety and depression for years and would like to stop taking them. They often do not feel like the medications are really helping them to feel better and have tried to stop them on their own, either cold turkey or over a short period of time. These attempts to discontinue the medications often result in distressing withdrawal symptoms, such as disabling anxiety, depression, mood swings, difficulty concentrating, insomnia, headaches, tiredness, irritability, sweating, unstable blood pressure, racing heart, dizziness, brain zaps (sensations of electrical shocks or jolts), nausea, and even flu-like symptoms, including chills and aching muscles, to name a few.
Some patients report that, when they asked their prescribing psychiatrist or nurse practitioners to help them get off the medicine, some have outright refused, insisting that the patient needs to be on the medication because they will be at risk of a recurrence of symptoms if they discontinue taking them. Prescribers who do agree often lower the dose much too quickly.
When a patient does experience an increase in symptoms because of a too-rapid reduction in dosage, these symptoms are often misunderstood and seen as a relapse of the condition for which the medications were prescribed in the first place. It is viewed as evidence that the patient needs to remain on the medication and not as related to a withdrawal syndrome. Many psychiatric medications have intrinsic antihistaminic properties, and when the dosage is decreased quickly, there is a rebound of histamine, which can result in the symptoms that I mentioned above.
What to Expect
Before I agree to work with a patient to wean off medications, I make it clear that I will be recommending a holistic approach that is not simply about reducing the dosage of the medication. Patients must commit to a holistic approach, or else I am not the right person to help them with this. The process of successfully weaning off of medications requires a major commitment. It may involve dietary changes, implementing a mind-body-spirit practice to calm down the autonomic nervous system, sunlight, daily movement, and various other lifestyle changes that support holistic healing.
The first step is a brief phone conversation to help me understand your situation and which will allow me to assess your level of motivation and commitment to a holistic approach, as well as to determine if we would be a good fit to work together. If we decide to set up an initial consultation, then I will send you paperwork to complete and we will meet for a ninety-minute thorough medical and psychiatric evaluation. At the end of that first meeting, we both will decide if we would like to embark on this journey together. During the first meeting we will discuss the variety of approaches to be implemented to support your nervous system before beginning the taper. Stabilization of the nervous system and decreasing inflammation will set you up for success in the tapering process. Once you have stabilized, we will begin a very slow and cautious taper, not to exceed decreasing the dosage by ten percent a month. Patients who are tapering from benzodiazepines sometimes prefer to follow the Ashton Method rather than getting their medication compounded.
Ketamine Assisted Psychotherapy can also be supportive in the withdrawal process. Ketamine acts as a tonic for the nervous system. Unlike other psychedelic therapies such as MDMA or psilocybin, it is not necessary to first wean from anti-depressant medications. If this is something you would like to try, I offer this unique healing modality to my patients.