You’ve been diagnosed with a mental disorder and have been in treatment now for years. You’ve done both psychotherapy and psychiatric medications, and now it’s time to try to live life drug-free. You’ve successfully ended your psychotherapy treatment, but now you’re looking for advice and information about how to end your psychiatric medications.
My first suggestion to you would be to talk to your doctor or psychiatrist. Nobody should go off of any medication without first getting their doctor’s consent and, hopefully, cooperation (or, if not their consent, at least their grudging acceptance that it’s your body and you can do with it what you want). Ideally, you’re seeing a psychiatrist for your psychiatric medications and not just your family doctor. If you are just seeing your family doctor, you may need a little more help than someone seeing a psychiatrist, because psychiatrists have much greater familiarity with helping people get off of the medications they previously prescribed to them. (In my experience, I’ve found many family doctors simply have little clue about the idiosyncrasies of discontinuing psychiatric medications, because of their unique tapering properties.)
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I came off my anti-depresants cold turkey. Big mistake. The worst part of it was my family doctor – I wasn’t seeing a pscyhiatrist at the time, did not inform me that I had to back off of the medication gradually. Boy, was I sick – felt like I had the flu.
As one who successfully completed my taper in June off of 4 psych meds, over 4 years, I wanted to thank Dr. Grohol for posting this very important article. Sadly, the issue of withdrawal is greatly neglected in the mental health community and hopefully by it being posted on a site that is considered to be mainstream like psych central, the issue will get some well deserved attention.
While normally, the admonition to consult with your doctor is excellent advice, sadly, even many psychiatrists are clueless about tapering. While I at least received the grudging acceptance you mention in the article, I am convinced that if I had followed his tapering schedule, there is no way I would have been successful like I have been.
Fortunately, I found http://www.paxilprogress.org which I greatly credit for my success. It is a peer support site for anyone wanting to taper off of antidepressants and not just Paxil. Their advice is to taper at 10% of current dose every 3 to 6 weeks. Many people find they have to taper even more slowly which I suspect would also be true for heavy duty drugs like antipsychotics and mood stabilizers.
By the way, many people end up at this site because they followed the advice to see their doctor and found the tapering advice to not be helpful and in many cases, it was quite harmful.
Of course, your mileage will vary but I would strongly urge anyone who is considering tapering their psych meds (particularly antidepressants) who has not been helped by their physician to visit http://www.paxilprogress.org. I
While what Dr. Grohol has written is very important, there is a question which should be addressed when considering whether to withdraw from medication at all!
I ask patients who have had psychotherapy and are on medication the following question: “What has changed in your coping mechanisms which makes you believe that you will handle a future disappointment or loss better than you have handled them in the past?” When the patient can answer that question to his and to my satisfaction, then I think he is ready for the steps Dr. Grohol outlined.
Withdrawal can often be more dangerous than continuing on a medication. The symptoms from withdrawal can sometimes be worse than the original problem.
The Physicians Desk Reference states that SSRI antidepressants and all antidepressants can cause mania, psychosis, abnormal thinking, paranoia, hostility, etc. These side effects can also appear during withdrawal. Also, these adverse reactions are not listed as Rare but are listed as either Frequent or Infrequent.
Go to http://www.SSRIstories.com where there are over 4,000 cases, with the full media article available, involving bizarre murders, suicides, school shootings/incidents [56 of these] and murder-suicides – all of which involve SSRI antidepressants like Prozac, Zoloft, Paxil, etc, . The media article usually tells which SSRI antidepressant the perpetrator was taking or had been using.
Dr. Judi,
I am curious why the patient has to answer the question to your satisfaction. That comes across as very authoritative even if that isn’t your intention.
In my opinion, it is about the patient being clear in his/her own mind about the reasons for the tapering. In my own situation, concern about horrific side effects was enough of a reason for me to taper. Nothing else mattered and I had no desire to try out any more drugs that I felt would be more of the same.
I had no idea about what had changed in my coping mechanisms and would have flunked your test.
However, I did realize I had to figure it out and fortunately, I did. By the way, when I started, I prayed that my life would stay calm for a few years so I would get off to a good start. Silly me for thinking that as first, a close relative died and then I had employment difficulties.
But I never stopped tapering in spite of the common advice that you wait until there is stability in your life. I learned very quickly that there is nothing guaranteed in life and if I waited for the perfect time to taper, I would be waiting a long time.
Goodness tapering rings true with all psych meds especially the benzodiazepines! I thought it would be great to stop taking klonopin COLD TURKEY because I thought I didn’t need these pills in my life anymore…BAD IDEA. Being self-righteous is not only a bad thing but it can cause you your life if you aren’t careful…some patients can experience seizures if they discontinue benzodiazepines cold turkey(lucky I didn’t), I just felt awful for a couple of days, couldn’t sleep and I wasn’t ready to go off of them…the anxiety was still there(though that could be a withdrawal symptom in itself). Months later I did successfully taper off the klonopin(with the help and blessing of my doctor)…I did it over a span of a few months and I didn’t experience not one withdrawal symptom.
AA-
The reason Dr. Judi asks about increased coping mechanisms is that is the patient goes off their medication for anxiety or depression (and other problems) and hasn’t learned new coping mechanisms, unfortunately there is a very high likelihood that the depression or anxiety will return. Something like 80% In some cases, like a history of 4+ Episodes of Major Depression, the likelihood of a patient relapsing is so high (95%+) that staying on antidepressants for life is recommended. Going to therapy and/or learning better ways to cope with your illness will help decrease the likelihood that you will relapse.
Granted the patient could just disregard the Dr’s opinion and taper off anyway or go to a different doctor or lie. But if the Dr doesn’t ask those very important questions and explain the risks of going off the meds, then a patient would probably blame her in 6 months when he’s severely depressed again. She is the doctor after all.
I would also suggest getting rid of the psych meds before ending therapy. Things come up and/or intesify when the emotional numbing effects of psych meds is removed.
Tapering is the way to go. The choice is the individual’s and some don’t get very good advice about tapering from their psychiatrist or their medical doctor. There is good information online from the pharmaceutical companies and from those who have successfully completed tapering off to be med free.
Hi Lynn,
I greatly appreciate you responding.
Regarding the points you made, I have a different take. I think the statistics you quote are due to withdrawal symptoms being confused with a relapse.
Many doctors (not all) are clueless about how to taper and put patients on a way too fast tapering schedule. As a result, when they experience withdrawal symptoms that look like a return of the illness but aren’t, the professional says, “see, that proves you need the drug” when that proves nothing of the kind.
Unfortunately, I can’t provide you with a scientific study because many researchers, like professionals are still in the dark about withdrawal issues.
Please don’t misunderstand me, I think therapy can be very valuable and that people do have to deal with the original issue that brought them to the meds.
But in my opinion, tapering someone too fast and confusing withdrawal symptoms with relapse is the main issue that needs to be addressed.
I was first on a tricyclic antidepressant for six months in 1985. It was a horrible experience for me–all side effects and no benefits. My doctor said I needed to taper off of the high dose I was on, but never specified what that meant. I interpreted that to mean I could taper off over the course of a week. It was rough, but I was young and I got through it OK. My depression cleared up mostly on its own, almost as mysteriously as it had arrived.
Six and a half years ago, I was (erroneously, it turns out) diagnosed with bipolar disorder, Type II, following a year of taking Lexapro for depression. The SSRI was prescribed by my family doctor, who I am now convinced received all of his psych-med-prescribing expertise from the pretty pharmaceutical rep who was leaving the day I came in regarding chronic insomnia (and I walked out with Lexapro samples to address the problem). As it turns out, I cannot take SSRIs, but my family doctor kept saying the drugs were fine—I just needed to try harder to feel better.
After eventually spiraling into the stratosphere of mood extremes, I hired a psychiatrist who told me to stop taking Lexapro and Wellbutrin. He told me it would take about a week to ten days to taper off. I cannot articulate how inadequate this amount of time was for this task. I was desperately, horrible ill. In addition to the awful physical symptoms, I could not think, I could not put together sentences that made sense, I could not sleep, and I could not stop crying, nearly nonstop, throughout every waking hour. I was sick for almost two months after completely stopping the medications, but those first two weeks were so bad, I believe I should have been in a detox facility alongside the drug addicts who were also trying to survive withdrawal.
Someone I knew at the time who worked for a mega-major pharmaceutical company told me, “Those medications are not addictive, so you were NOT in withdrawal. It’s just a step-down reaction.” You say tomato, I say you’re brainwashed.
It took six years to get my brain back. I did go through a lot of therapy. I did develop coping skills I lacked earlier. I did learn to be VERY, VERY wary of family physicians/osteopaths bearing prescription pads and seeing 30 patients a day. I learned that my psychiatrist had more faith in my ability to monitor my own mental state than I did. I learned to listen to my body.
Almost eight months ago, when further medical evaluation revealed my problem was likely not, at its core, a mental disorder, after all, I decided to discontinue medication. I have other health problems, and overall, I was over-medicated and not feeling much benefit from pharmaceuticals. I did not tell my doctor I was going off of medication; however, I read extensively and long about how best to proceed and what to expect if anything went wrong. I knew I could not withstand a repeat of the SSRI withdrawal experience, so I did my homework, and I cannot stress enough how critical that is for anyone discontinuing medication!
I discontinued one medication at a time, and each one extremely slowly, at that. The entire process took over six months. Slowly, slowly, slowly…one at a time.
People here and elsewhere warned me I was doing a bad thing, but I knew it was time to try. It has been about two months without medication, and I feel great. I can think. I have regained my balance and lost my hand tremor. I have lost 25 pounds without dieting. I am much more alert. My blood pressure has come down. I am careful to manage my stress and monitor my moods. I hope that I continue to feel better without backsliding.
Slow and steady is the way to go. Ultimately, you must know your own body. Going on medication was a leap of faith; discontinuing it was an act of courage. If something is not working, you need to ask yourself who really cares about you and who has your best interests at the top of their priority list. Nobody other than you does, really—your wellbeing is up to you to know and to control. You are the one who has to be willing to question and take charge. You are also the one who will be responsible for the consequences, so proceed with education and caution guiding you—not only when you stop medication, but all along the way, every day.
Please change “successfully ended your psychotherapy treatment”. It implies SUCCESS.
I had many physical sysmtoms plus incresing bad blood test, my pcp called the psychiatrist who refused to beleive I had any side effects. Visable side effects included, blurred vision, hair falling out, endemia, heart problems, and non visable were my blood test. The psychiatrist, told my Doctor that I was just manipulating her! Wow when had a acquired the power to affect blood tests? My therapist and pcp got together and weaned me off of the drugs, it took longer than I wanted. I just wanted the entire nightmare to be over with. Later seeing a differant shrink, I was put back on that same medicine despite my telling her how it affects me. Clearly I wasn’t being heard and never took it. I haven’t trusted shinks since that time. I’ll go if my therapist beleives I need some short term help, and the pyschiatrist will work with my therapist. But I’ll never forget that shrink who would have let me die before admitting the combiation of drugs she had me on could have killed me. Frankly pyshiatrist are the largest group of doctors who discriminate agaist anyone with a mental health label. I have PTSD and it doesn’t help that I must also gaurd agaist prejudicism in pyshiatrists.
I am on my tenth year with hyyperglycemia and diabetes, after becoming chronically sick from the drug in June 2001. Virtually no aid from the APA by the way with that situation. Had luckily to go elsewhere to get the needed help to handle the exploitative damage done by these doctors, the psychiatirsts that is. One day healthy, the next day, chronically ill from a psychiatrist’s order the following day. The mental health field may as well be nonexistant, thankfully, and the need for newer safer medications is imperative for those who would need to go on the drugs if that appears anytime in the future.