Ten Practical Considerations During Medication Withdrawal

2008 May 1
by giannakali

The above article as noted in the title is written by Alice Lee-Bloem. She has given me permission to post it.

The article follows here. It is the best practical advice I’ve read yet on psych med withdrawal. (unfortunately, though her practical advice here is very sound, this doctor cold-turkeyed me off of a large amount of medication and made me very very ill…I leave her advice as written here because it’s sound and really quite brilliant, but what she did to me was dangerous. In the end we must trust our guts and I didn’t with her…I handed over my power, just like I had to traditional psychiatrists. If any doctor wants you to hand over your power, run) I am healthy again and have resumed a slow withdrawal after reinstating what she took me off so precipitously. Some of the greatest thinkers in history have made mistakes so I leave this here because as a written piece it’s wonderful and flawless. In her practice I found some flaws. The theory though still stands and I believe it can be practiced artfully.

Ten Practical Considerations During Medication Withdrawal

There are many important considerations when undertaking medication withdrawal, and the following list provides only a few of these considerations. It would be helpful to consider this list as simply informal, clinical notes on this broad and complicated topic, but even so, I believe it can be of help to those who are interested in this topic. It is not meant to replace competent medical supervision and care, but to heighten awareness of the common pitfalls and problems associated with withdrawal.

When helping a patient through medication withdrawal . . . .

1. Realize that there are at least THREE areas that need to be healed and supported: a) withdrawal symptoms, b) underlying health problems, which led to the patient’s need for medications, and c) damage done to the patient from using a xenobiotic (medication) over time. The naive assumption that, if patients are stable, all there is to do is help them lower their medication(s) will result in some surprising outcomes. Being aware of three areas and not just one when tackling withdrawal allows a better assessment of what will happen during the withdrawal process. For example, if a patient had a difficult to treat underlying problem that began in utero or from early childhood, had been taking medications for decades, many of which were highly damaging to the body, then, even if the patient comes in looking sweet as a rose before medication withdrawal, you will be opening a Pandora’s box when you do so. How a patient presents (symptoms and complaints) does not determine how difficult the withdrawal will be. A patient who comes in after taking a medication for just a few weeks, complaining of a great many symptoms after taking the medication, may be able to withdraw from the medication very easily, especially if the underlying illness has all but healed.

Medications do have varying abilities to damage the body, some being harsher than others. As patients use these medications over time, this damage will accrue over time. This damage is in addition to the emotional and psychological dependence to psychotropic medications, which generally increases over time. Being aware that the amount of time a patient has been on medications will allow a more accurate estimate of how difficult the withdrawal process will be.

2. The rate of withdrawal depends on a lot of factors. So, “slowly” is quite relative to: a) what the patient is taking with respect to orthomolecular and energy medicine support, b) the person’s state of health and diet, c) the toxicity and addictive nature of the medication, d) the psychosocial stressors during withdrawal, e) how long the patient has been on the medication(s), f) whether or not nutritional support is the best way to ameliorate the effects of the medication or heal the underlying illness, and g) how many receptors are being affected simultaneously by the medication. The better the support, the more quickly patients can withdraw from their medications. So, slowly is not a hard and fast rule in medication withdrawal. However, if patients without any knowledge about the intricacies of medication withdrawal were told by an ignorant physician to do it on their own (slowly), not knowing that nutritional support would be critical, it may be impossible for them to go slowly enough to avoid the pitfalls of withdrawal, and they may end up with chronic health problems despite their best efforts.

My clinical experience has been that medications which affect multiple receptors will be more difficult to withdraw than medications that only affect one receptor. My assumption is that one taper of such a multi-receptor medication would be the equivalent of simultaneously lowering multiple single-receptor medications. It would be more demanding on the body and more difficult to support both nutritionally and enzymatically.

3. “Protracted Withdrawal” happens when something hasn’t healed during the withdrawal process. It could be the immune system, the gall bladder, the hormones, the liver, or some other part of the body. During withdrawal, if all three areas are not healing well, some aspect of the patient’s illness will become evident as the medication, which had suppressed the expression of clinical symptoms, is tapered. As a consequence, the less one knows about how to help a patient heal the three areas of health, the more the patient will suffer from “protracted withdrawal.” Sometimes, patients end up with “protracted withdrawal” that is very debilitating for years when they try to withdraw on their own, not knowing that their “psychotropic” medications not only had a profound impact on their nervous system, but also their hormones, immune system, liver, etc. “Protracted withdrawal” should not be used to place blame on the medication’s mysterious and nefarious machinations, for clinicians who handle withdrawal very well will struggle less with protracted withdrawal.

4. Supplements can only do so much. Although the patient may be taking highly absorbable, comprehensive, and highly supportive supplements during withdrawal, there are still limits to what supplements can do. A supplement cannot eliminate a patient’s hypersensitivity and allergic responses to the supplements, nor can it work when the basic enzymes and structures for handling supplements are no longer operable, nor will it change the curvature of a patient’s cervical spine. Sometimes, despite the patient’s desparate need for nutritional support, the first line of action may be detoxification, elimination of wheat and dairy, or a chiropractor. Sometimes, the patient needs energy medicine to heal a problem with “massive reversals,” a condition that is suggested by the patient’s repeated patterns of self-destructive choices and relationships, despite best laid plans for well-being. The best analogy would be that of a house in the process of being repaired. If the house is just suffering from old wall paper and out-of-date furniture, then one can go in and spruce up the place with a few well chosen touch-ups. If , however, the house in question lacks electricity and plumbing, the roof is caving in, and the foundation is sagging half off the cliff, then a few rolls of wallpaper and a new sofa just won’t do the job. When approaching a patient who wants to withdraw from medication(s), consider what is really underneath the superficial layer of medication induced function. Be open to other tools to help with withdrawal in addition to nutritional supplements.

5. Don’t put the cart before the horse. In the rush to get off medications, patients will often taper first and ask questions later. That is not wise. As the knight would say in the movie Indiana Jones and the Last Crusade, “He chose . . . poorly.” In just about all cases of medication withdrawal, it is important to take time to heal the body, strengthen its systems, and increase resilience before one attempts to lower a medication. If, however, a person chooses to lower a medication before healing occurs, at the very least, the person will return to the original state of illness prior to starting medication(s). For many patients, the effect of lowering a medication after taking it for several years follows the following formula:

(original illness + underlying, undetected, untreated, and evolving illness + worsened health due to damage done by the medications used + withdrawal effects) x years of medication use and health neglect = degree of abysmal misery.

As this formula begins to unfold in all its amazing enormity, the patient then calls the orthomolecular physician for assistance. At this point, the withdrawal may have resulted in gastrointestinal dysfunction, hormone imbalance, and insomnia. The healing process will be quite difficult at this point in the patient’s treatment. However, physicians who take the time to help such patients may still be able to remedy the situation. But it would be helpful to explain to the patient the reason why their recovery may be more difficult to manage and a collaborative effort could be established between the physician and patient.

6. Keep a close watch on how healing progresses after the medication(s) have been stopped. Withdrawal and the need for vigilance will last beyond the last pill taken. The longer the patient has been taking medications, the higher the dosage of the medication taken daily, and the more pervasive the effect of the medication, the longer the withdrawal process required before the task is done. This needs to be explained to the patient beforehand, so that they don’t stop treatment prematurely, thinking that they are all done with their recovery when they may still have 20% of the journey left to go.

7. Never underestimate the power of energy medicine. If you happen to be a supplement kind of person, then this may come to you as a surprise. But of all the tools in my arsenal for helping patients with withdrawal, the one I value most is energy medicine–yes, even above the wonderful effects of nutritional supplements and herbal remedies. I call energy medicine, “the quantum physics of healing.” The reason I find energy medicine so valuable is because it helps with the formation, information, and transformation of health at the subatomic level. Here is where little things (energy, vibration, and thoughts) result in moving mountains, not slowly even, but miraculously. As all of the testimonials in this newsletter mention, almost casually, energy medicine is very helpful during the withdrawal process. Patients like it. An eleven-year-old can learn to do it. I taught EFT to a six-year-old once, and he was able to learn it without difficulty. And as the follow up testimonial attests, at least one of my patients remained well with just using energy medicine despite having a diagnosis of bipolar disorder with psychotic symptoms–even when she stopped all orthomolecular nutritional supplements (believe me, she did it while my back was turned). Energy medicine is a vast and burgeoning field. To go from orthomolecular medicine to energy medicine requires a mental leap, just as physicists had to make that leap years ago when they went from Newtonian physics to quantum physics. Consider this: if all matter is made of energy, and we are made of matter, than we are also fundamentally made of energy. The laws of quantum physics are not simply applicable to technology. They hold just as many helpful truths about the matter between our ears.

8. Supplements and detoxification have different levels of immediacy in different patients. Some patients are so toxic that they can’t handle the work of healing in addition to detoxification. It is like a river that is completely plugged up with boulders, adding more water to the river will not help it to flow. The boulders must be removed first. Detoxification must be done in a way that would not cause the patient additional stress. It is far easier to detox through the skin (epsom salt baths) or lymph system (detox foot pads), than taking supplements that cause toxins to be dumped into the blood, causing the exhausted liver and adrenals more grief.

9. Supplements need to be carefully selected for absorbability and comprehensive coverage of physiological needs. I tell patients that at a minimum, they need support in the following areas: vitamines, minerals (macro and micro), essential fatty acids, amino acids, glycoproteins, antioxidants, gastrointestinal support with probiotics and digestive enzymes, and detoxification. Once these basic areas are covered, additional supplements will generally be necessary to help specifically with the type of withdrawal being done. For example, amino acids that calm (L-theanine, taurine, and tryptophan) will likely be needed when withdrawing from a calming, sedating medication such as an antipsychotic. These amino acids along with vitamins and minerals will be converted by the body to neurotransmitters that will support the medication taper. Supplements that are highly absorbable give themselves away by appearing as liquids or powders. Whole food supplements may seem to lack the amount of nutrients found in fractionated supplements, but because of their high rate of absorbability (urine doesn’t turn bright yellow for example), their effect may be a hundred times more potent. Sometimes, glandular supplements or protomorphogens may be helpful in supporting the liver, pineal gland, or adrenals. A healthy diet is important for the recovery process. Unfortunately, this often means that the patient will need to abstain from wheat, dairy, and white, refined sugar. Sometimes, when the burden of supplements exceeds what the patient can do (due to age, level of debility, vegetarian/Kosher habits, and/or sensitivities), I have used energy medicine techniques to help the patient nutritionally and to support withdrawal.

10. A person is more than biology. When all is said and done, repairing the body is like repairing a radio. Just because the radio is repaired, doesn’t stop it from playing bad music. Healing our neurotransmitters and hormones, liver and adrenals is all very good, but they only ALLOW the person to be happy. They do not MAKE the person happy. Nothing does, short of real growth in wisdom, love, forgiveness, and compassion. I have had patients who suffered from severe abuse or childhood neglect who were able to heal their bodies long before they are able to feel a consistent state of well-being. There is a learned aspect of being that has to be reconfigured. A person has to learn to heal from real traumas and heartaches. The road to well-being is paved with lessons. Skipping lessons does not lead to well-being. Some of those lessons lead to self-mastery, some to spiritual strength, and some to forgiveness. Unfortunately, happiness cannot be bought in a bottle, but is a side effect of living life masterfully.

15 Responses leave one →
  1. 2008 May 1

    This is a fantastic post, thanks! I know I had to do back steps with the vitamin support, I had some in place but not enough and really upped my raw fruit and vegetables. I even did round the clock vitamin C, anyway you look at it, this person is right on target that there are far more variables than we (me)consider/ed when beginning a taper, and frankly for the dread I had with removing Xanax, you’d think I would have had this stuff down! I made it through this last bad patch with emegency action, and I won’t be doing that again! talk about writing a term paper an hour before it’s due!
    Thanks for the diligent and persistent postings here Gianna, inspite of your sufferings, we are all still learning from you.

  2. 2008 May 1
    sbwrites permalink

    Great post! It restores my faith in psychiatry–well at least in one psychiatrist!

    Susan

  3. 2008 May 1

    This is great! Thank you for posting it. I really ought to look around for a new physician…

  4. 2008 May 1
    Sally permalink

    Thank you. I especially like the paragraph about the need to detoxify in order to repair.

  5. 2008 May 1
    Pablo permalink

    very good. The points that stood out to me were 5 and 10 – what I would call “foundational principles”

  6. 2008 May 1

    wonderful….

  7. 2008 May 1

    Great! Another one, that would have to get translated…Thanks for posting this! (BTW, I just love the link to the anti-psych discussion ;) )

  8. 2008 May 1

    Can you imagine if Psychiatry were filled with doctors like Alice Lee-Bloem?

    People would actually get well.

    And could learn to appreciate the process, and themselves while doing so….

    Duane

  9. 2008 May 2
    markps2 permalink

    Great post!

  10. 2008 May 3

    I read the paragraph on “Protracted Withdrawal” discussing damage to the immune system-this was the first time I’ve read any direct reference to a cause/effect. I was diagnosed with psychotropic drug toxicity.My shrink said yes, go ahead, you won’t have any problems going off your anti-psychotic cold turkey.Not after years of being on them-sure. It was the very worst withdrawal and I had severe neurological damage. It’d hiding under there for the years and it was advanced. The symptoms had been seen as purely psychological.I ended up on two crutches and lost the use of one hand.In time with aggressive intervention it may heal. The brain/nervous system is so fragile-pure and I let my body ingest toxins that destroyed my immune system.
    The good part is I can now think clearly and can find joy in my life again drugfree.

  11. 2008 May 3

    The good part is I can now think clearly and can find joy in my life again drugfree.

    Shelby I always find your story comforting when you share it for exactly the reason I cut and pasted above…

    I have heard to people with neurological problems getting better over time…

    Did you see the video I posted on neuroplasticity…it’s on the home page right now…

    http://bipolarblast.wordpress.com/2008/05/02/more-on-neuroplasticity-of-the-brain/

    thanks for stopping by…

  12. 2008 May 8

    I agree, this is an excellent article. It is hopeful to know that there are at least some doctors who understand.

    I have believed for a long time that just popping pills does not cure our problems. We have to come to terms with our lives: our disapointments, our broken dreams, our past abuse, our inadequacies, etc. Many times we have to just accept our past misfortunes and move on–we can’t change the past with its mean people. We are also in a living body composed of many systems–more than one system may be involved in our mental issues.

    An ancient Greek once said that all medicines are poisons–they harm us in some ways, while they may cause healing in some other parts of the body. That old pain killer Vilox worked like a miracle drug for me (took all my pain away), but it was taken off the market because it killed people.

    Thanks for posting this article. It is another that I would have missed were it not for your efforts at keeping your site going.
    Jim S

  13. 2009 February 3

    I hear ya brothers and sisters! That article is amazing! My shrink read it and said he felt “greatly educated by it”. I am on 4 drugs and currently trying to get off sero-kill (quel). I have fainted, had a TIA (small stroke), my feet are perpetually rigid…. I would’nt give this drug to a dead person. Luckily I live in the beautiful mtns. of Va. in a community that is vast in its healers. I have an excellent herbalist (whose office is in a yurt), an acupuncturist who has been to Tom Brown’s school many times and a polarity/synergy genius of a woman on my team. I have several friends who are very supportive.
    Still my friends, it is no picnic. I have been on seroquel 2 years this spring. I am on 400 mg. and can only go down 12.5 mg at a time. I find kava helps me and the amino gaba. I am a vegan and I work outdoors. But like I said I struggle with the withdrawal feelings. My eyes are so sore and relaxed I can’t read or paint or play my instrument. Nor do I have the energy. But I do have eternal hope. Let us be kind to ourselves on this journey. Namaste`. Lisa

  14. 2009 February 3

    Lisa,
    if you’re a vegan I hope you’re supplementing…people with mental health issues in general need supplementation but as a vegan it’s even more important…

    best to you…

    and a note of caution…once you get down to smaller amounts 12.5 mg cuts may be too large…it gets harder the smaller down you go…even fragments of a mg sometimes can be felt at the end…it’s truly bizarre.

  15. 2009 May 2
    JoahuaBell permalink

    Very informative post. I had no idea that coming off meds was so complicated. The task seems overwhelming, but the people who are successful give me much hope. I can’t wait to learn more about this. Who knows…maybe even one day I’ll be able to withdrawal off of my psychotropic drugs. hopeful >:)

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