Discontinuing Psychiatric Medications: What You Need to Know
See a qualified mental health professional.
Discontinuing psychotropic medicines is a process that requires a comprehensive assessment and collaboration between you and your doctor. How do you know if your doctor is qualified?
First, make sure that your doctor has experience or specialty training and certification to treat your illness. It’s reasonable to ask the following questions, according to Banov: “Are you familiar with various options for treating me and for discontinuing treatment? Do you feel comfortable treating me during discontinuation? About how often have you treated this disorder and discontinued the medicines I am taking?”
If you tell your doctor that you’d like to stop taking a medicine, and he or she agrees without question and without doing a thorough assessment, that’s a problem, Banov said. Again, the decision to stop medicine shouldn’t be made lightly.
If you haven’t started a medicine yet, Baldessarini encourages people to ask their doctors the following: “Can you give me an idea of how long I’ll be taking the medicine? What are the common side effects? What is the cost? When and how do I come off the medicine?”
A big problem with taking and stopping a psychotropic medicine “is that many patients are excessively passive about taking advice” from doctors,” he said. “We tend to view doctors as ‘all-knowing.’ But doctors can’t adequately do their jobs if patients don’t ask questions and aren’t active in the conduct of their own treatment.”
You should be closely monitored.
Because people may not experience symptoms for weeks or even months after stopping a medicine, Baldessarini noted that patients should be “especially closely monitored clinically during and following drug discontinuation for several months.”
In addition to the above, experts suggest the following may also help when it comes time to discontinue a psychiatric medication:
- Lead a healthy lifestyle. Both experts underscore the importance of engaging in healthy habits, including a regular sleep and activity schedule, and a nutritious diet. Attempts to discontinue a psychotropic medicine aren’t likely to go well if you’re under stress, overworked and sleep-deprived.
- Participate in regular physical activity. Several research studies indicate that exercise can provide a significant antidepressant effect, according to Banov. He also said that “mild to moderate depression may do about as well with exercise or talking as with medicine.” Exercise also has other benefits, including helping you cope with stress and alleviate anxiety. Just be sure to pick physical activities that you genuinely enjoy.
- Seek psychotherapy. Both experts also stressed the importance of participating in counseling or psychotherapy, regardless of the type of mental illness you have. Many “research studies have demonstrated the value of such approaches, alone or in combination with drugs, depending on the nature and severity of your condition,” Baldessarini said.
- Be flexible. You may attempt to go through the discontinuation process with your doctor, but still might not be able to stop your medicine. This is “no badge of shame,” Dr. Banov said. “The goal is not to be medication-free but to be well.”
Unfortunately, as he said, concern about potential stigma about taking psychiatric medicines, or fear of becoming dependent on them lead many people to avoid or want to discontinue them. There also may be “pressure from family or friends or even doctors,” Banov said. Both experts view medicine as just one among many treatments for psychiatric illnesses, and that their use needs to be tailored to each person’s needs.
Baldessarini RJ, Tondo L, Faedda GL, Viguera AC, Baethge C, Bratti I, Hennen J. (2006). Latency, discontinuation, and re-use of lithium treatment. Chapt 38 in: Bauer M, Grof P, Müller-Oerlinghausen B, editors. Lithium in Neuropsychiatry: The Comprehensive Guide. London: Taylor & Francis, 465–481.
Baldessarini, R.J., Tondo L., Ghiani C., & Lepri B. (2010). Illness risk following rapid versus gradual discontinuation of antidepressants. American Journal of Psychiatry, 167 (8), 934–941.
Viguera, A.C., Baldessarini, R.J., Hegarty J.D., van Kammen, D.P., & Tohen M. (1997). Clinical risk following abrupt and gradual withdrawal of maintenance neuroleptic treatment. Archives of General Psychiatry, 54 (1), 49–55.
Tartakovsky, M. (2013). Discontinuing Psychiatric Medications: What You Need to Know. Psych Central. Retrieved on April 1, 2015, from http://psychcentral.com/lib/discontinuing-psychiatric-medications-what-you-need-to-know/0005742