Tapering Psychiatric Medications
These days many new patients who call are interested in getting off of psychiatric medications. Often they do not feel that the medicines are effective, they hate the side effects, and worry about the long term consequences of ingesting synthetic chemicals.
I was trained to believe that stopping a psychiatric medication was not a big deal; you just halve the dose, wait maybe a week and then decrease it again by 50% and then stop. No problem. Many patients, however, experience serious adverse side effects when attempting to decrease their medication at this rate.
For example, Effexor (generic venlafaxine), a very commonly prescribed anti-depressant, may induce serious side effects when a patient tries to stop it, particularly if done too quickly. There are numerous reports of a “discontinuation syndrome” characterized by “serious”: agitation, anorexia, anxiety, confusion, impaired coordination, diarrhea, dizziness, dry mouth, dysphoric mood, fasciculation, fatigue, headaches, hypomania, insomnia, nausea, nervousness, nightmares, sensory disturbances (including shock-like electrical sensations), somnolence, sweating, tremor, vertigo, and vomiting.”
Withdrawal effects from anti depressants are not uncommonly interpreted as an indication that the symptoms that the medication was originally prescribed to treat are returning, and that the patient possibly needs to go back up on the dose or begin taking another pharmaceutical.
There are reports that delaying the dose of Effexor for as little as 8-12 hours can result in a “discontinuation syndrome”. Some patients experience such severe dizziness and disorientation, that it becomes hazardous to operate a motor vehicle. Most patients are told not to stop the medication abruptly, but rarely are cautioned that missing a dose can result in such severe adverse reactions.
Benzodiazepines are a class of medication prescribed alarmingly casually for anxiety and insomnia, that when taken as prescribed, can lead to dependency in some individuals. What was originally intended as short term solution devolves into a long term serious problem, characterized by a devastating withdrawal syndrome for some people. Common symptoms of benzodiazepine withdrawal can include irritability and agitation, inability to concentrate and memory problems, body aches and sleep disturbance, anxiety and panic accompanied by feeling flushed, increased pulse rate, increased blood pressure, and sweating. In severe cases the withdrawal syndrome can even progress to include seizures, confusion, suicidal thoughts and can even be fatal.
There are many sobering accounts of people trying to get off of these medications, not to mention that long term use has been linked with an increased risk of dementia. Caetlin Mangan has written terrific post entitled “Benzo Withdrawal: The Ultimate Guide to Symptom Relief”, that can serve as a valuable resource, if you are experiencing withdrawal symptoms from benzodiazepines.
In my practice, I often recommend tapering medications on a schedule of 10% of the dose a month. Sometimes people feel quite impatient with this recommendation, as they are so eager to stop taking medications. But they can run into trouble when it is done more quickly. Many psychiatric medications have anti-histaminic properties, and patients can experience symptoms of histamine overload when they try and stop psychiatric medications abruptly, particularly symptoms of depression, anxiety, fatigue, racing thoughts, attention and memory problems, and insomnia.
In addition to weaning very slowly from medications, I recommend that patients simultaneously adopt nutritional changes to improve gut health which decreases inflammation. The most fundamental instruction is to stop gluten, dairy, minimize sugar and to eat a whole foods diet. If a patient is more ambitious, I will recommend the Paleo diet, but the gold standard is the Paleo Auto Immune Protocol , an elimination diet. Implementation of the Paleo Auto Immune Protocol, with eventual careful reintroduction of potentially allergenic food, will allow a person to identify which specific foods are contributing to her psychiatric symptoms. In addition, general immunity can be significantly boosted through the regular inclusion of fermented foods and nourishing broths in the diet, as well as probiotics.
The emotional and spiritual life, the histories of the family of origin and the ancestors, digestive health and immune status, movement and sleep habits, the role of pleasure and play, time spent in sunlight, toxic exposure, alcohol and drug use and choice of contraception are all important domaines to explore in the initial consultation. All of these factors play a critical role in supporting a person holistically as they take on the rigors of tapering off of psychiatric medications.
I also typically recommend ordering the laboratory studies necessary to implement the Walsh Approach, which involves prescribing protocols of nutrients, mostly familiar inexpensive anti-oxidants and minerals, to treat biochemical imbalances, such as elevated copper, pyroluria, and methylation disorders, all of which are correlated with psychiatric symptoms. These protocols of nutrients are very effective and much safer than pharmaceuticals.
Mad In America is a non-profit organization which is a passionate advocate for alternatives to the pharmaceutical approach to psychiatric treatment. Its mission is ” to serve as a catalyst for remaking psychiatric care in the United States (and abroad). We believe that the current drug-based paradigm of care has failed our society, and that scientific research, as well as the lived experience of those who have been diagnosed with a psychiatric disorder, calls for profound change.” They have an excellent resource page for withdrawal from psychiatric medications.
Here is the courageous Monica Cassani, creator of Beyond Meds, a website with a wealth of information and wisdom about alternatives to psychiatric medications. In this moving video she describes the spiritual resources she drew upon during her hellish protracted withdrawal experience from psychiatric medications.
What do you do if the psychiatrist will not let you taper your medication?
You may want to get a consultation with an integrative psychiatrist who may have more knowledge and skills about this.
I have been trying to wean myself off Olanzapene. I am now at 1.25 mg and that does is too small to cut in half. How do I do a 10% taper when I have read that this drug can not be compounded to a liquid. I live in Atlanta and can’t find a doctor who embraces this 10% taper which I totally agree with. Going any faster results in all kinds of withdrawal symptons. I have been on Olanzapine for 3 years, started at 10 mg, to 7.5, to 5mg, to 2.5, to present dose of 1.25. Your comments would be appreciated.
I am puzzled that you read that the drug cannot be compounded to a liquid. That is what the compounding pharmacies in this area do. I would suggest that you call a compounding pharmacy in your area and clarify this.
Hello, I am trying to get off of Lamictal, and am having a difficult time. It was causing panic attacks and extreme dysphoria and paranoid fear, even though I was only on 10 mg (I cut down to that on my own because it was causing such bad symptoms, but my Dr. insisted I remain on it). It took me three months to get down to 4 mg using liquid suspension, going down 1/3 mg. every three days. This proved to bring about extremely bad symptoms eventually. So I stopped reducing. I’m trying to do 10% now, but am discouraged because this quickly turns into a long period of indefinite time. At what point can you simply stop taking the drug? It would take me about 10 10% reductions to get down to 1 mg, then more than 10 more to get close to .5. When exactly can I cut if off, based on my track record of sensitivity? Thanks for reading.
I am sorry to hear how awful it is. It’s very individualized in terms of a person’s response and not predictable. Given the history you describe, it seems like you will be safest if you proceed very very slowly, even though it will feel interminable and tedious. I would also recommend not going it alone and finding a doctor trained in functional medicine to support you holistically while you taper.
Do you know of patients who have found the DNRS program helpful while tapering from a benzodiazapine?
Absolutely. A perfect application.
I’ve also been reading that the 10% taper method is likely the best method to use. But how would that work if you’re on an injectable drug such as Invega Sustenna? How would you follow a 10% taper method in this case?
Currently, I’m on 156 mgs of Invega Sustenna once monthly. Or do you recommend that I switch to the oral form of Risperdal using a pipette to titrate the dose?
Thanks for your valuable blog post!
Sincerely,
Yvette
Hi Yvette. I cannot give you that sort of advice given that you are not my patient. I also do not know the answer. I am not familiar with the injectable forms of Invega. That 10% rule does seem to mitigate against a withdrawal syndrome.
I have been reading the many entries in your blog over the last several years with great interest. I developed a whole host of odd symptoms after I eating which have crept up over the last few years (to the point that I have been unable to work). I note that a lot of your readers have the same ones. After an exhaustive medical workup, an internist suggested that my flushing, tingling, headaches, weakness, brainfog (this is a mild term) and aura-type symptoms are likely due to neuroactive amines coming from my gut. As I had been checked multiple times for carcinoid symdrome, he surmises I likely have Mast Cell Activation Syndrome.
I wanted to bring this up as many of the contributers to this discussion seen to have similar symptoms to me. Try as I might, I cannot pin down specific foods that cause it every time. Cereal grains are definitetly bad, but eating known high histamine foods will sometimes cause problems, and sometimes not. It seems to be that the histamine, and likely other substances are coming from inside me in response to just eating. My symptoms are helped much by oral cromolyn, ketotifen, and reactine. I will be seeing Lawrence Afrin (writer of “Never Bet Against Occam”) soon to bounce this off of him. I just wanted to put this out there for people to consider as a possible alternative cause for their symptoms when specific food triggers are hard to pin down.
MCAS is now being recognized as very common and can affect different people in different ways, but food related reactions similar to HI are very common. It does help to avoid added histamine in foods, but it is actually treated with mast cell stabilizers, which are generally harmless, if not inexpensive medications. I hope this can help someone out there. Thank you for your amazing website.
Thank you for taking the time to write this thoughtful comment. Please keep us updated about anything more that you discover. The beneficial effects of stimulating the vagus nerve for MCAS is an area that is of interest to me. Here is a post about it. http://twitchylifemastcelldisorder.blogspot.com/2015/09/yoga-and-vagus-nerve.html
This is one of the few places on the web where I have found agreement with the 10% rule – though at surviving antidepressants dot org, we also emphasize that the 10% is 10% of your last dose, not total dose – not making a straight line decrease, because the occupation of receptors is not straight line, either.
For peer support in tapering, surviving antidepressants is sadly, one of the few in the world which understands the costs these drugs have on our health.
We need more MD’s to understand this, more clinics to go against the “add a drug to deal with symptoms from your last drug” prescribing policy. Thank you for all that you do.
Good advice; it’s worth being patient. Note, however, that certain of your recommendations, such as fermented foods, can be high in histamine, which may not be tolerated when withdrawing from antidepressants.
It really depends on the person. This is a very individual matter.