New Video: Coming Off Psychiatric Drugs: A Harm Reduction Approach


I want to thank Bob Whitaker for inviting me to join the bloggers at Mad In America. As an introduction to my work I enlisted the help of Portland visionary colleagues Kent Bye, Jen Gouvea, and Jonathan Marrs to produce a short introductory video of me describing coming off psychiatric drugs. The approach is drawn from my Harm Reduction Guide to Coming Off Psychiatric Drugs, which can be downloaded for free here:

I’m a survivor of a schizophrenia diagnosis and today work as a therapist and teach internationally on mental diversity, including psychiatric medication. This video provides some basic guidance for anyone considering reducing or coming off psychiatric medications and their supporters, which is discussed in greater detail in the Harm Reduction Guide. This video and Guide are in the spirit of peer support and mutual aid for educational purposes, and not medical advice. (While everyone is different, coming off medications, especially abruptly, can sometimes be dangerous. Seek support when possible and use caution.)

You can contact me at Please share this video; it’s Creative Commons copyright 2011 BY-NC-ND and the url is here:


  1. Will,

    Your video is extremely well done and provides excellent information. By far it is one of the best I have ever seen.

    The concept of patient empowerment is absolutely essential to recovery and as a mental health advocate I support the Participatory Medicine movement.

    Psychiatric patients must become engaged in recognizing symptoms, selecting treatment options, and working in partnership with providers to develop illness self-management recovery programs.

    Providing patients with the necessary tools for empowerment is an important step in their recovery process and has the potential to improve outcomes in patients with mental illnesses.

    In my opinion advocacy is greatly needed to promote best-practice assessment of psychosis/mania. Currently, there are no advocacy groups or organizations advancing this basic concept.

    Under the current paradigm psychiatry uses a rubber-stamp labeling systems that diagnosis most cases of psychosis/mania as schizophrenia/bipolar disorder without testing for underlying causes. Treatment then consists of a blanket pharmacological approach, rather than individualized based on accurate assessment.

    By consensual agreement within the American Psychiatric Association psychiatric diagnoses are descriptive labels only for phenomenology, not etiological or mechanistic explanation for syndromes. Thus, a psychiatric diagnosis labels a pattern of signs and symptoms, but offers no hypothesis concerning the mechanism(s) of the clinical phenomena.(Davidoff et al.,1991).

    It is a misconception that there are no laboratory tests available for individuals in an acute psychotic state and that all individual who experience psychosis are suffering from schizophrenia/bipolar disorder.

    The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) classifies psychotic illnesses as ‚ÄúPsychosis Due to General Medical Conditions‚ÄĚ, and ‚ÄúSubstance Induced Psychosis‚ÄĚ. (DSM-IV Codes 293.81 & 292.11). Distinguishing medical conditions and substance-induced psychosis from schizophrenia or Bipolar disorder through clinical presentation often is difficult.

    Psychosis Due to a Medical Condition involve a surprisingly large number of different medical conditions, some of which include: brain tumors, cerebrovascular disease, Huntington’s disease, multiple sclerosis, Creitzfeld-Jakob disease, anti-NMDAR Encephalitis, herpes zoster-associated encephalitis, head trauma, infections such as neurosyphilis, epilepsy, auditory or visual nerve injury or impairment, deafness, migraine, endocrine disturbances, metabolic disturbances, vitamin B12 deficiency, a decrease in blood gases such as oxygen or carbon dioxide or imbalances in blood sugar levels, and autoimmune disorders with central nervous system involvement such as systemic lupus erythematosus have also been known to cause psychosis.

    A substance-induced psychotic disorder, by definition, is directly caused by the effects of drugs including alcohol, medications, and toxins. Psychotic symptoms can result from intoxication on alcohol, amphetamines (and related substances), cannabis (marijuana), cocaine, hallucinogens, inhalants, opioids, phencyclidine (PCP) and related substances, sedatives, hypnotics, anxiolytics, and other or unknown substances. Psychotic symptoms can also result from withdrawal from alcohol, sedatives, hypnotics, anxiolytics, and other or unknown substances.

    Some medications that may induce psychotic symptoms include anesthetics and analgesics, anticholinergic agents, anticonvulsants, antihistamines, antihypertensive and cardiovascular medications, antimicrobial medications, antiparkinsonian medications, chemotherapeutic agents, corticosteroids, gastrointestinal medications, muscle relaxants, nonsteroidal anti-inflammatory medications, other over-the-counter medications, antidepressant medications, and disulfiram . Toxins that may induce psychotic symptoms include anticholinesterase, organophosphate insecticides, nerve gases, heavy metals, carbon monoxide, carbon dioxide, and volatile substances (such as fuel or paint).

    Before assigning the diagnosis of Bipolar Disorder or Schizophrenia due diligence should be asserted in the clinical evaluation of psychotic and manic symptoms to address ‚ÄúPsychosis Due to General Medical Conditions‚ÄĚ, and ‚ÄúSubstance Induced Psychosis‚ÄĚ (DSM-IV Codes 293.81 & 292.11).

    Improvements in the diagnostic accuracy and treatment of psychosis is cost-effective for both the mental health consumer and society.

    Advocacy for mental illness must include the consideration of underlying etiological factors of psychiatric symptoms.

    Thank you for helping to advance these aspects.

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    • Hi Maria, this is important information and thanks for writing. While no laboratory tests can demonstrate the existence of bipolar or schizophrenia, yes many tests point to the role of physical factors that could be driving psychotic symptoms then diagnosed as bipolar or schizophrenia. When I learned I was gluten and caffeine sensitive for example, removing these from my diet reduced by experiences that would be diagnosed as psychotic, and I frequently work with people who unearth the role of medication side effects such as from steroids in driving their crisis.

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