Psychiatric Drug Withdrawal for Beginners

Whether you want to completely withdraw from meds or simply wish to minimize what you take, the first thing I will refer you to is a paper written by Joanna Moncrieff. It refers mostly to withdrawal from neuroleptics, but much can be inferred about most psychiatric medication.This paper may induce fear in those hoping to withdraw from drugs, but I think it important that people understand that there are, indeed, real dangers and risks associated with drug withdrawal–most notably in precipitous withdrawal or withdrawal without appropriate supports. Secondly, I refer you, once again, to Peter Breggin’s book “Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Medications.” For more information on the toxicity of drugs and alternatives to them, read, also Breggins’, “Toxic Psychiatry: Why Therapy, Empathy, and Love Must Replace the Drugs, Electroshock and Biochemical Theories of the “New Psychiatry.” I’ve not read a lot of David Healy, but he offers many insights into most specifically anti-depressant drugs and the problems associated with taking and withdrawing from this class of drugs. His website is here. These people are professionals with experience and expertise in the matter.

These books are helpful and important. In my experience, however, having read some and knowing a bit about the others, I don’t think they go far enough in two ways. They do not address diet and nutrition and they fail to emphasize just how slow the taper must be for many individuals. Breggin in one instance does go so far as to say that people who’ve been on neuroleptics for many years may have to wait up to two months between tapers. This is mentioned only once however and briefly. In my experience with many people tapering, holding for some length of time between tapers is often necessary and prudent with any drug they may be tapering.

There are people, who I’ve had contact with, who’ve gone cold turkey and recovered, but there is much danger in attempting this and the potential for long term “discontinuance syndromes” or complete relapse is very high. The most successful people will take months and in some cases, for people on high doses, multiples meds and long term use it can take years. I fall into this latter category. I am currently in the middle of a several year withdrawal process. I’ve been at it for 3 years. (the first 2 being completely clueless as to what I was doing) In the last 8 months I’ve educated myself very well and realize that it may take up to another three years or more if I manage it successfully. Patience is key. This is something I’ve needed to develop and my failure to have patience means I’ve suffered the consequence of a too rapid withdrawal, and have needed to temporarily increase my dose after suffering terrible withdrawal symptoms–once for two months before I came to my senses. There is no reason to suffer to any huge degree, though some trouble, as well as suffering a potential multitude of unpleasant symptoms must be expected.

Breggin suggests what has come to be known the 10% rule. Any given drug should not be reduced anymore than 10% at a time. Once a taper is complete the next taper should not exceed 10% of the new dose. Therefore, the milligram, then fraction of milligram amount decreases with each new taper. I’ve found that I have to sometimes go in even smaller amounts. As low as 5% and sometimes people go as small as 2.5%–for people on benzodiazepines it is not unusual to go in even smaller amounts. Cutting pills is not always enough. Sometimes liquid titration is necessary. This may involve dissolving the smallest dose pill in water, club soda or even alcohol, which can then be diluted with water, then using a syringe to cut down milliliters at a time. Medications also sometimes come in liquid form and can be gotten by prescription. It should be noted that some medications should not be dissolved. Especially time released medications. This would be extremely dangerous.

Exercise can be an important part of withdrawal, but usually needs to be limited to gentle walking or perhaps swimming. Vigorous exercise can be over-stimulating and and exacerbate withdrawal symptoms. My own experience with exercise is that before my aggressive withdrawal process began and during the time I took a long break, I took vigorous long hikes a couple of times a week coupled with equally vigorous exercise at the gym. As a result of my withdrawal, I am now too exhausted and fatigued to do more than a gentle hour hike at any given time. Often I cannot even do that. I lost 40 of the 80 lbs I had gained as side-effects of the medications. I have gained 20 lbs back. I have now stabilized at this weight because I eat well and continue gentle exercise. I’ve learned that it is important to put aside my desire to lose weight until withdrawal is complete. Eating well is so important that calorie reduction should not be considered unless it is in the context of continuing to eat enough healthy food which often involves eating frequently to control blood sugar levels which most people withdrawing from drugs have problems with.

How have I managed my withdrawal process so far? Once educated I have usually tapered by less than 10% at a time waiting at least one week (this may be too fast for many people…I’ve had the additional support of neurofeedback) and up to two months. In one case, after suffering terrible withdrawals from tapering too quickly off Risperdal, I increased the dose slightly, stabilized and then switched to tapering Lamictal. (I was at 400 mg of Lamictal, twice the recommended therapeutic dose and never experienced any improvement. I intend to at the very least come down to 200 mg) Neuroleptics (in this case Risperdal) alter brain chemistry and function so much I decided to take the break so that my brain could recover from what has been a huge reduction of the drug. (11 mg down to 1 1/2 mg)

The withdrawal symptoms I’ve encountered have been first and foremost terrible exhaustion and fatigue. This has been relentless. Currently I almost feel as though I’m on more drugs rather than less. Also I’ve experienced some insomnia and at it’s worst, when I tapered the Risperdal too quickly–extreme agitation, insomnia, and neck, shoulder and back pain. I had tapered down to 7/8 of a milligram–I reinstated at 1 1/2 mg. These symptoms resolved themselves once I increased the dose. Mood disturbances and general irritability have not been unusual. The mood problems are limited to fluctuations between normal and depressed states. As far as the depression goes I have a lot going on in my life, most specifically my brother is dying of cancer, so I can’t be sure how much that is the main cause of the depressive symptoms. I’ve also experienced short-lived mild intermittent periods of depersonalization and derealization. Also I have a small job which kept me extremely busy in January and February and the logistics of it–the phone calls and paperwork–caused extreme agitation and anxiety. The actual meat of the job I enjoyed very much. What has been clear during this time however, is that I’ve not had anything resembling relapse.

And finally, I must add again, that my diet and nutrition has been extremely important. I was unable to continue withdrawing before making changes in my diet. I stick to the diet religiously, only very occasionally taking one bite of something I miss. The bottom line, however, is that I don’t truly miss anything. I am happy to do what my body needs to heal. It’s really not difficult altering your diet once you understand how much it helps. In most instances the thought of eating food I “miss” has no appeal. For tips on diet and nutrition see these two prior posts: here and here. (scroll to the top of the page once you click on the link)

Now, as a final note, I want to emphasize I’ve already benefited tremendously from my incomplete withdrawal. My cognition has improved dramatically. Even six months ago I could hardly write a coherent sentence. I’m far from being able to write with the agility I had while at university and I hope my brain fog continues to clear. My reading comprehension has improved dramatically too, although I still have problems focusing on denser and more scholarly work. My hope is that these abilities will continue to improve. There is good reason to assume that they will. I am still, after all, on a whole lot of medication.

Water taper for a slow and controlled withdrawal

For additional info see here.