Withdrawing From Psychiatric Drugs: What Psychiatrists Don’t Learn

Vivek Datta, MD, MPH
73
7938

“What I’d really like to do is stop everything,” I say.

Melissa* smiles nervously at me and shuffles about in her chair. Over the past 14 years of her career as a psychiatric patient, Melissa, now 30, has experienced the full force of the psychiatrist’s pharmacopeia. She has become dependent on benzodiazepines. She has developed akathisia (an internal unrest that makes it necessary for her constantly pace about), tardive dyskinesia, tremors, obesity, hyperlipidemia, and finds it hard to get up in the morning. She also finds it hard to imagine a life without being on psychiatric drugs. Over the years Melissa has garnered multiple diagnostic labels including schizophrenia, bipolar disorder, schizoaffective disorder, psychosis not otherwise specified, major depressive disorder, post traumatic stress disorder, schizotypal personality disorder and so on, all of which were bogus. At times she has been on 3 different neuroleptic medications.

Intuitively, I know these drugs are not helping. Intuitively, I know that she needs to get off most of them. Intuitively, I know she will be no worse off them, even if she is no better. What I do not know is how to stop these drugs.

I am a resident psychiatrist. Like other psychiatrists in training today, I learn a lot about psychotropic drugs: the putative mechanisms of action, the evidence base, the indications, cautions and contraindications, interactions, side effects, toxicity, and monitoring. We learn how to initiate different agents. We learn how to combine different psychotropic drugs, what is called ‘rational polypharmacy’. We even learn how to switch from one drug to another, what is called ‘cross-tapering’. What we do not learn is how to stop these drugs. What there is no guidance on is how to stop these drugs. What there is no evidence on is how to stop these drugs. Unsurprisingly then, we never seem to stop these drugs!


A Change is a-coming

Significant changes have occurred since the 1990s. Firstly, although the number of psychiatrists doing psychotherapy continues to dwindle, the amount of psychotherapy training for psychiatry residents is significantly more than it was in the late 1990s. Secondly, many major academic centers are now pharma free zones. Yes, industry funding still directs the research agenda, but psychiatrists in academic centers have less contact than they did in the past. Thirdly, with healthcare reform, the spiraling costs of psychiatric medications and especially polypharmacy have led Medicaid to tighten its authorization of ridiculous regimens of psychiatric drugs. Fourthly, the psychiatrists-in-training that I know have a healthy skepticism. There is a well-earned suspicion about the latest purported ‘blockbuster drugs’, about the value of psychiatric diagnoses, and limits of psychiatric medication. Many psychiatrists realize that DSM-5 has highlighted the absurdity of psychiatric diagnoses and undermined what credibility was left of the profession. Meanwhile, the ties between the pharmaceutical industry and psychiatry weaken. Newly-qualified psychiatrists no longer want to be seen or market themselves as ‘psychopharmacologists’.

The fact is we cannot afford to go on as we are. We cannot afford to have people taking 6 or 7 psychotropic medications of unclear benefit indefinitely. Quite apart from being completely ineffective and a source of iatrogenic misery, this sort of prescribing is also a financial black hole. As cost containment in the guise of comparative effectiveness marches on, prescribers will be under greater pressure to justify why they are prescribing what they are prescribing, and hopefully also asked to think about how long for. Whilst there is probably a small minority of individuals who do benefit from indefinite drug therapy, this can no longer be accepted uncritically as the default.


Drug withdrawal: who is the expert?

Psychiatrists commonly tell their patients to not stop their medication without discussing this first. This seems fair enough. I tell patients not to stop taking their medication ‘cold turkey’. We all have heard the horrendous experiences of those who have stopped their psychiatric drugs to feel worse than ever before, to experience ‘electric shocks’, nightmares, sleeplessness, flu-like symptoms, unexplained pains, anxiety and so on. The reality is that psychiatrists are not the experts when it comes to getting people off psychiatric drugs. I have recently been asking various mentors about how to stop antidepressants and neuroleptic medication, and the answers are not only very different but wholly unsatisfactory. There is little-to-no literature to guide us. Worse still, few psychiatrists have much, if any, experience in actually stopping drugs.

On the other hand, it is the people that have been taking these drugs that have much to teach the ‘professionals’ on this one. Everything from the struggles of taking medication, the resistances, the reasons for non-adherence, how medication has altered the experience of the self, the (in)compatibility of drugs with the individual’s formulation of one’s problems, the phenomenological experience of withdrawing itself, and even how the individual has managed to stop.

It was not long ago when psychiatrists were unaware of the withdrawal syndromes and dependency problems of benzodiazepines, or the discontinuation reactions that occur with the shorter acting serotonin reuptake inhibitors, or even the supersensitivity psychosis that can occur following neuroleptic discontinuation. It was individual experience that taught us. I wonder if even more useful than a compendium of practitioners facilitating drug withdrawal would be a database of personal experiences of coming off drugs: the hows, the whys, the how-longs, the what-it-was-like. It could be the start of a more systematic enquiry into a very important and overlooked area of psychiatry.

What’s the alternative?

One of the most damaging aspects of current psychiatric practice is that we convince people that they somehow themselves are damaged, whether this due to broken brains, crooked molecules, intrapsychical conflicts, damaged cognitive sets, abusive childhoods, traumatic lives, and so on. In doing so we erode a sense of personal agency, a narrative of resilience and autonomy, and instead create a dependency and helplessness. I think one of the keys to coming off psychiatric drugs is for the individual to have their own coherent narrative of their experiences, and to see these experiences as within their control. That can be very hard when you have been repeatedly told by every institution from the family to the family physician that your situation is beyond your control. Many things are. But those patients that I have seen recover from ‘severe mental illness’, who live their lives without anyone ever knowing they had ever been diagnosed as schizophrenic or bipolar are those who believe, in the words of William Ernest Henley:

It matters not how strait the gait,

How charged with punishments the scroll.

I am the master of my fate:

I am the captain of my soul.

So it is with some suspicion and skepticism I look at those offering alternatives in the form of third wave psychotherapies, herbal remedies, nutritional medicine, naturopathic treatments, orthomolecular products and so on. Given the present state of knowledge we need and should embrace more research into these approaches. It would however be a mistake to necessarily see these as entirely without harm, or superlative to psychiatric drugs. In the wrong hands, and sometimes even in the most well-intentioned, psychotherapy can be experienced as just as repressive as psychiatric drugs. Many non-drug treatments do not have their adverse effects well-studied, indeed studies of psychotherapy rarely if ever consider the possible negative consequences even though anything that has the power to heal must also have the power to harm.

What I did learn

Melissa agreed with some trepidation to a plan to reduce the dose of some of her medications and stop some others entirely. For most of her adult life, the response had been to add more drugs, not take them away. So used to having her feelings blunted by powerful medications, she was scared. So inexperienced in stopping psychiatric medication, I too was scared.

In the inpatient setting, I rapidly tapered her off a number of her medications, and treated her with intensive brief psychotherapy. Nothing bad happened. She was reluctant to come off everything entirely, so we agreed that was something she could look at another time. But for the first time, Melissa came to realize that she herself could manage her powerful emotions. She thanked me for helping her to see more clearly; to allow her to know what she was not supposed to know, and to feel what she wasn’t supposed to feel.**

I wished I had thanked her for introducing me to the how of withdrawing from psychiatric drugs, when I know there is a why.

 

*For confidentiality reasons Melissa represents a composite of individuals and not one individual patient

** ‘On knowing what you are not supposed to know, and feeling what you are not supposed to feel’ is a chapter in A Secure Base by John Bowlby.

 

73 COMMENTS

  1. We’re coming off meds in droves with out without our MDs support because we want our lives back.

    MDs such as yourself should demand research and training in freeing people from the medications. We don’t have that influence.

    I’ve written a post that was entitled: A plea to prescribing physicians and psychiatrists: please help us heal see: http://beyondmeds.com/2012/11/11/plea-to-prescribing-mds/

    The current situation is inexcusable…that we must mostly do this on our own without safe medical support. I appreciate that you are waking up to this and sharing it with others.

    The fact is if MDs want to learn there are huge collections of data on withdrawal boards on the internet. We have become experts. And in fact there has been some researchers who’ve collected information on our boards…see: http://beyondmeds.com/2013/03/22/alarming-report/

    I’m happy to consult with MDs anytime as well (and do on occasion) and I know a good number of my withdrawal colleagues would be as well. Take us up on that, please.

    Right now we hold vasts amounts of knowledge in that the sheer volume of folks we’ve worked with exceeds that of any private practice. If nothing else we could help determine what needs to be systematically studied so that it can eventually be understood and come under the guise of “evidence based.” For now we are too often dismissed because what we see everyday in 1000s of people have not been studied in randomized trials. We need you to help get our knowledge out there.

  2. I am merely a peer expert and someone who is still suffering from a too-fast 3-week taper of Paxil in 2004, but I have poured my knowledge into a hundreds of pages for Web site entirely about tapering off psychiatric drugs, SurvivingAntidepressants.org

    Case histories: http://tinyurl.com/3o4k3j5

    Tapering techniques for specific drugs: http://tinyurl.com/42ewlrl

    Discussion of withdrawal symptoms and self-help: http://tinyurl.com/3hq949z

    Scientific papers: http://tinyurl.com/aqg3bjo

    To my knowledge, tapering at a rate tailored to the individual’s nervous system is the only way to minimize withdrawal symptoms. Withdrawal symptoms should be minimal. “Brain zaps,” disorientation, jolts of anxiety, and sleeplessness are not trivial and indicate the taper is too fast.

    Once the nervous system is destabilized by withdrawal, the only remedy is time, as frequently the person has become hypersensitive to all neuroactive drugs, supplements, and even foods. Very, very gentle interventions might make withdrawal symptoms more bearable. Most people do well with fish oil and magnesium, which tend to reduce anxiety and probably reflects a pervasive dietary deficiency in these important nutrients.

    It is a widespread medical falsehood that withdrawal syndrome is invariably mild, self-limiting, and lasts only a few weeks. If you look closely at the sources for this information, you will find pharma sponsorship.

    Medicine’s refusal to take this issue seriously has grievously injured many people. There are hundreds of thousands of reports all over the Web of severe withdrawal syndrome lasting many months or years.

    There are untold millions who are stuck on their drugs because they suffer withdrawal every time they reduce the dosage and their doctors do not know how to taper them properly.

    This is truly an epidemic.

    PS Dr. Joseph Glenmullen’s “The Antidepressant Solution” is probably the best text for doctors to learn proper tapering techniques and how to monitor for withdrawal symptoms. It was published in 2006. Isn’t it time for doctors to read it?

  3. I spent 10 years heavily medicated on various cocktails of antidepressant, anti anxiety, anti psychotic, mood stabilizer, and sleeping meds. I even resorted to ECT. I was unable to maintain any emotional stability, and am lucky to be alive today, given my repeated and serious suicide attempts. My psychiatrist supported me in trying an alternative micronutrient treatment, because he had run out of med options. At the time, there was no real research on the product. Since then, millions in research has taken place on this specific formulation, and it has shown to be safe and effective for the majority. Dr. Bonnie Kaplan, a Mad In America contributor, is one if the researchers who has seen the results of this formulation. There is a database of participants, and a protocol for med reduction based on over a decade of experience with helping people transition off meds and onto nutrients. I am one such success story! There are many more to be found at http://www.truehope.com

  4. Vivek,
    It’s good to hear psychiatrists admitting that they know nothing about how to help someone withdraw from psych meds. That being said, you may be doing a huge disservice to your patients if you warn them about the dangers of alternative medicine, without speaking highly enough of the benefits. Patients will be scared away from meaningful help and may not venture out simply because the doctor was either negative or unenthusiastic. It’s not either/or. You can still responsibly embrace the alternatives while continuing with the meds reduction. It is up to people to do their own research when it comes to supplements and therapies and decide for themselves what works for them. (If there was big corporate money to be made in the alternatives, we’d get research.) People should have the brains, if they also own their own soul, to be discerning. From personal experience dragging my son through all kinds of supplements (well-researched), and through common alternative stuff to the truly weird, I can say that all of these only moved him further along in his healing process. When my son’s psychiatrist found out about his out of body experiences induced through sound therapy (almost no research exists on this one, but I did my homework), she freaked out and ordered us to stop. We chose to ignore her, which is a frightening prospect when you go against psychiatry’s “orders.” When another psychiatrist noticed the niacin flush on his face and ordered him to stop the niacin, he simply took it at night before bed. I fear that psychiatrists, no matter how well-meaning, want to control the patient, rather than let them truly be the captains of their own soul.

    • Your son has a niacin flush? Are you aware that both Drs. Abram Hoffer and David Horrobin found that most people accurately diagnosed with chronic schizophrenia will not exhibit this flush?

      I didn’t know this either until recently reading Horrobin’s book “The Madness of Adam and Eve”. I myself flush strongly after taking a large dose of niacin.

  5. I truly appreciate you writing openly and frankly about this subject. When my son was put on antipsychotics against his will in 2008, I found it difficult to believe that psychiatrists didn’t have a clue how to get him off them. “Just stop taking them” they said and we listened to them and it nearly killed my son. “There are no withdrawal symptoms from antipsychotic medication. Leave it to the experts”. Luckily I found Dr Breggin’s books and got him off those neuroleptics behind doctors backs. We had to hide so they would not section him and medicate him against his will. It was a nightmare!

  6. Has anybody else here ever been in the odd position of having stopped their psych drugs on their own and then still having to listen to their psychiatrist blather on about how well they’re doing on them? Many patients can’t be honest with their doctors about stopping psych drugs for fear of forced drug injections (or worse).

    • yes, I have coached my daughter how to act ‘normal’ in front of a doctor for fear that he would medicate her against her will. It feels like a form of lying, not being able to be yourself. I have met very few psychiatrists who were not arrogant and intolerant and did not cause me to fear for my daughter’s safety.

  7. Just wanted to point out that folks are again mistaking underlying mental distress, which can re-emerge after drug discontinuation, for withdrawal syndrome.

    Withdrawal syndrome is an iatrogenic (treatment-caused) condition. To my knowledge — and I would enthusiastically embrace any effective treatment of withdrawal syndrome — there are no alternative or natural programs that can take the place of individualized tapering schedules to reduce withdrawal symptoms.

    Please think of withdrawal syndrome as iatrogenic neurological dysregulation rather than a psychiatric disorder.

    On the other hand, many non-drug, alternative, dietary, etc. treatments can be effective to treat mental distress.

    Confusing underlying mental distress with withdrawal syndrome gets these discussions off-track. Doctors need to make going off drugs much safer in terms of minimizing withdrawal symptoms. Society also needs to provide alternatives to treat mental distress.

    People who have not seen or experienced withdrawal syndrome tend to overlook this distinction, which is extremely important. Some people can even cold-turkey off psychiatric drugs (NOT RECOMMENDED) with no symptoms. This is not true for those who are more sensitive to dosage reductions. (You don’t know if this applies to you until you hurt yourself by going off too fast.)

    Withdrawal syndrome is real, it creates additional avoidable injuries in psychiatric treatment, and deserves to be recognized in the psychiatric survivor community rather than meeting a wall of denial.

      • Yes, and thank you! I’m not certain what exactly is the difference between a “drug” and a “medication” but there is something about calling these the latter that really irks. Especially the whole business of calling them “meds,” which to me seems to give it a sort of cool, insider’s cachet and just makes my skin crawl.

      • Duane;

        Thank You.

        It always chaps my hide to read bloggers who were literally put on an elevator to hell by these drugs, Call them ‘Medications’.

        And since there’s nothing even remotely medicinal about them, they don’t have any place in professional medicine.

        I don’t give a rat’s hind foot What the prescriber’s work ticket says, but Especially with Psychiatrists; Shrinks work with these drugs 40 hrs or more a week. A full third of them can’t even be bothered to read the FDA Label.

        And Yet, everybody else is expected to believe that these clowns who do nothing but sell dope and ‘Diagnose’ mystic, incurable spiritual diseases, are so stupid that they still can’t figure out what those drugs actually do.

        It’s called, . . . Plausible Deniability, . . . or as I’ve pointed out time and again, it’s a Courtroom Defense which boils down to: “The Drug Companies Lied To Us about how Safe and Effective their Drugs Are, and We Believed Them.”

        Because an injured consumer has a snowballs chance in hell of beating a Drug Company in Court whereas winning a judgment against a Doctor is a Far, Far, Lower Bar.

      • It seems to me that the word ‘medicine’ implies the substance has ‘medicinal’ qualities – those that are curative, or help ‘heal’.

        Psychiatric drugs do nothing of the sort.

        I realize that the two terms are use interchangeably, but it bothers me that psychiatry has hi-jacked the term ‘medicine’.

        Duane

  8. This is an interesting blog post — well worth reading; IMO, it suggests that Vivek Datta, M.D., M.P.H. is largely getting on the right track.

    Moreover, his replies to commenters, thus far, largely impress me — especially, as he seems quite willing to frankly admit the limits of what he knows.

    Some of his previous blogs (including on his own website) have suggested to me, that he can tend to be (like most psychiatrists) insufferably paternalistic — believing that doctors generally know better than their “patients” what “treatments” shall be best for them.

    In this instance, he’s suggesting that he sensed it would be best for a “patient” to be taken off the psychiatric so-called “medications” she’s come to accept as ‘treatment’.

    [Note: thank you for your contributing comments, Duane. I agree, these compounds are best called drugs — not “medications” — as their would be ‘medicinal’ effects are typically highly questionable, at best.]

    Dr Datta is truly exemplifying the essence of the physicians’ “Do No Harm” Hippocratic Oath.

    Sadly, this blog post is an all too *rare* example of a doctor (a psychiatrist) feeling he knows what’s best for the “patient” — in a *good* way.

    I don’t expect Dr. Datta to be renouncing the use of coercion any time soon; and, IMO, psychiatrists are — on the whole — best avoided, because they are inclined to resort to coercion and force, to apply their ‘craft’; and, that amounts to a most severe form of human rights violation; however, this blog post reflects genuine progress.

    I applaud those at MadInAmerica(dot)com who invited Dr. Datta to blog here — and thank Dr. Datta for offering a fair example (at least, in this particular blog post, of his) of how this MIA website can and does surely function, to reduce the harm done by psychiatry…

    (Also, I see a *lot* of great comments on this page, thus far.)

    • P.S. —

      Dr. Datta,

      You write, “Melissa agreed with some trepidation to a plan to reduce the dose of some of her medications and stop some others entirely. […] She was reluctant to come off everything entirely, so we agreed that was something she could look at another time. But for the first time, Melissa came to realize that she herself could manage her powerful emotions.”

      I well recognize (and appreciate) that, really, this not a story of taking a psychiatric “patient” being taken off psych-drugs…

      It is a story of a “patient” who’s actually become, IMO, a victim of psychiatry (a victim, specifically, of what you, Dr. Datta, inform us that you and your colleagues refer to, ironically, as: “rational polypharmacy”) being taken off some significant number of those drugs and given an opportunity — and, really, some little encouragement — to come off of all of them, entirely, when she may feel ready to do so.

      I am sincerely curious and interested to know whether you, in the back of his mind, may have an intention to encourage her in that way, ultimately?

      Respectfully,

      ~Jonah

  9. I also have had the diagnosis ” schizophrenia, bipolar disorder, schizoaffective disorder, psychosis not otherwise specified, major depressive disorder”.
    I have some advice.
    When a patient withdraws from psychiatric meds, they will have more time on their hands.
    “Idle hands make the devils work.” or “The devil finds work for idle hands.”
    The patient withdrawing has to find a job, a job of their choice, that has meaning or enjoyment to them (the patient). If the job is forced, they will do the job poorly, and eventually stop performing the work or get fired.

  10. Hi, Vivek,

    Thanks for having the courage to speak about this issue. It is not surprising to learn that you get no training in withdrawal, and it reflects the reality I see in foster care: children are almost never taken off of any psych drug without vigorous advocacy, even if the drug is clearly having no positive effect or doing damage.

    I was surprised at your reports of increasing skepticism in the ranks of new practitioners, as well as a resurgence of the radical concept of actually talking to clients in a supportive way about their needs and concerns. I 100% support your belief that the recovery of a sense of personal agency is critical to survival and recovery from any mental/emotional distress.

    I hope you can be a “virus” in the machinery of psychiatry, and encourage your colleagues to do so as well. The idea of listening to the experiences of those victimized by psychiatry is the beginning of learning a new path. Again, I appreciate your courage and humility. Keep your ears and eyes open and your mouth shut as often as possible, and you can be a huge agent of change.

    —- Steve

  11. Thank you, Vivek–this is very thoughtful and helpful. Your humanity and ability to think outside of established professional boxes makes me wonder if we should speak not just of psychiatric-drug survivors, but also of medical-indoctrination survivors. 🙂

  12. If her experience is/was anything like mine, the tardive dyskenisia will be the biggest long-term problem. As she gets off the neuroleptic drugs and her feelings are no longer blunted, it will probably start bothering her immensely. As the years go on and she finds that peoples rejection of her is of a knee-jerk and instinctive sort, she’ll have to come to accept a life time of lonlieness and sexual deprivation. The more and more her brain heals in the regards of sensing and feeling and caring about her life, the more the tardive dyskenisia will be a problem. It could very well be a complete and total obstacle to recovery: the more she recovers in the sense of functioning better and trying to do something with her life, the more the tardive dyskenisia will stop her form being ABLE to do anything with her life… And it goes on and on.

  13. I really appreciate how you use a “composite” story. I am often horrified by detailed and specific case studies published in popular online psychology articles, where the patients or even their friends and family would undoubtedly recognize their stories, even if the names and physical appearances are changed. It’s nothing but an unnecessary betrayal – imagine the potential harm to the patient, and usually anything learned from the case can be shared through non-exploitative communication. Thanks for another excellent article – this one was especially validating.

  14. The only thing I’ve witnessed in the state hospital where I work is that the psychiatrists seldom stop or decrease drugs, they simply add more drugs to the list of what people are already taking! I know some residents who are on ten different paychiatric drugs, none of which actually do anything but tranqualize the person so that they’re quiet and compliant. When you ask the residents what they need to be able to help themselves you hear the mantra of “take my drugs and follow the program.” They are brainwashed and they know that they’ll never get discharged unless and until they take the drugs. Psychiatric drugs do not rehabilitate and restore people to their lives, they create permanent patients whom we maintain and control at the back and call of the system.

    My hospital gets intern psychiatrist from the state university medical center. The interns know nothing other than the drugs and every time we have a new group of interns come into the units you can always tell because they start toying and playing with the drugs that people are on, wrecking havoc on the residents. They don’t seem to understand that they are dealing with human beings who can be hurt and harmed, rather than some kind of lab animal that is there for them to experiment on. I am not impressed at all with the new psychiatrists from our med school. I would love to lock them up on the units and give them a week’s worth of drugs and see how much they enjoy dealing with what happens.

  15. Various official and semi-official guides to tapering psychiatric medication are listed here:

    http://survivingantidepressants.org/index.php?/topic/2930-guides-to-tapering-off-psychiatric-medications/

    Note that patient advocates, along with Peter Breggin, are advocating much slower tapers than the medical sources. We see that decreases of 25% can be much too severe for some people and generally recommend decreases of 10%.

    After all, it’s the peer counselors who are bearing this burden, which should be the responsibility of physicians, and listening to patients’ experiences.

    Please also note that withdrawal symptoms do NOT always immediately appear after dose reduction. Sometimes it takes several weeks. Therefore, 10% decreases at intervals of about a month would be safest, allowing time to catch withdrawal symptoms before attempting another decrease, which would make the withdrawal symptoms worse.

    Decreases are calculated on the last dosage, meaning the absolute amount of decrements gets smaller and smaller, maintaining a constant 10% relationship to the last dose. This creates a smooth but asymptotic curve never reaching zero.

    When to quit altogether is based on the withdrawal history. Do not quit unless you have a solid track record of no withdrawal symptoms after a decrease. For most drugs, the jumping-off point will be a fraction of a milligram.

    Fractional dosage is facilitated by utilizing liquid formulations, compounded liquids, homemade liquids, counting out beads (Effexor XR, Cymbalta), weighing powders on electronic jeweler’s scales, etc.

    Pristiq is a special case in tapering — there is no way to reliably titrate it — and should never be prescribed solely on this basis. It is generating plenty of withdrawal injuries, right up there with Effexor XR, Paxil, and Cymbalta.

  16. Thanks for your blog on psychiatrists not having information on how to withdraw people from psych meds. I’ve long known that doctors are clueless on this issue. I know physicians who would withdraw their loved ones, if only they knew how. What I’m wondering is why no one is writing a grant to find out how to do this. Taking a best guess on what to do, I think I would consult the rather large literature on omega-3s, which according to recent meta-analysis by Sublette et al. has a modest effect on reducing depressive symptoms, as well as the burgeoning literature on N-acetyl-cysteine which is anti-inflammatory and anti-oxidative stress and does cross BBB. Michael Berk and colleagues have published several studies demonstrating efficacy for schizophrenia and depression. Since both omega-3s and N-acetyl-cysteine are targeting inflammation and oxidation, I would make sure that the effects weren’t diluted with heavy consumption of high-fructose corn-syrup or saturated fats—which are inflammatory. There is a branch of the NIMH that funds alternative treatments. Whereas in the past it would have hearsay to suggest that anyone think about discontinuing meds, even psychiatrists should recognize the desirability of withdrawing pregnant women or young women who think they might want to conceive. (Antidepressants are associated with increased rates of autism.) I’ll bet you could get this funded. Just remind Tom Insel of the positions he has already taken.

    • Good suggestions, Jill. Personally, I believe low omega-3 status, due to nutrient depletion in factory farming. may be a large contributor to whatever distress drives people to consider treatment with psychiatric drugs in the first place.

      However, please keep in mind that the greatest danger in withdrawing people from psychiatric drugs is not relapse of depression or whatever, which may be effectively treated with non-drug interventions, but destabilization of the nervous system and consequent hypersensitivities, about which medicine knows absolutely nothing.

      Too-fast withdrawal resulting in nervous system destabilization is like Humpty-Dumpty falling off the wall. People suffering this mostly have to let time do the healing — and it can take a lot of time.

      Omega-3 (and magnesium) supplementation seems to give many people some relief of withdrawal symptoms. We may surmise the nervous system may have been weakened by dietary deficiencies, but nervous system destabilization surpasses such remedies.

      I appreciate your interest in this issue, but to correctly conceptualize the problem, please do not confound relapse with withdrawal syndrome. They are entirely different.

  17. Dear Dr. Datta,

    I enjoyed reading your post.

    In March of 1996 I was dx’d bp after suffering an acute manic episode from toxic encephalopathy. Although the hospital was made aware of long-term chemical exposure in my work environment by my family members, I was not referred to the Dept. of Occupational Medicine and only give a psych dx.

    Below is a link to a narrative I wrote that was published in the Journal of Participatory Medicine describing my experiences.

    I consider myself very fortunate that my case was assigned to a very knowledgeable and experienced psychopharmacologist who respected my choices and worked with me in partnership rather than tried to control my treatment options.

    In my hometown of Syracuse, NY I know of 3 psychiatrists who are also licensed acupuncturist and I have been under the care of psychiatrists who prescribed essential fatty acids. vitamin C with Lithium to reduce the toxic side effects and were more than willing to provide just talk therapy to monitor possible exacerbation of symptoms. I have met many psychiatrists who are very skilled at their profession and do not over prescribe.

    In my case, tapering off of psych meds was only possible once the underlying cause was determined and treated.

    The BMJ published Best Practice Assessment of Psychosis guidelines. Below is a link to them.

    As a mental health advocate my goal is to create an awareness of the critical need to recognize underlying causes of psychosis/mania and the benefits of Functional Medicine/Integrative Psychiatry/Orthomolecular and Participatory Medicine concepts.

    Kind Regards, Maria

    http://psychoticdisorders.wordpress.com/bmj-best-practice-assessment-of-psychosis/

    http://www.jopm.org/perspective/narratives/2011/03/28/psychosis-possibly-linked-to-an-occupational-disease-an-e-patient%E2%80%99s-participatory-approach-to-consideration-of-etiologic-factors/

    Psychosis Possibly Linked to an Occupational Disease: An e-Patient’s Participatory Approach to Consideration of Etiologic Factors

    Summary: The purpose of this narrative-analysis is to: Consider medical conditions and substances that may induce psychotic symptoms; identify some unique challenges that providers and patients dealing with psychotic disorders must overcome in order to establish effective recovery strategies; and to illustrate the benefits of participatory concepts in mental health care. This article describes one patient’s experience with discovering that her psychosis might have been caused by toxic encephalopathy from occupational exposure, and the benefit she gained from becoming an active participant in her own care.

  18. You are right Doctor! Someone needs to do more comprehensive studies of people coming off meds (Benzos more specifically for me). The approach in my opinion should ALWAYS be slow and should almost always involve switching over to Valium.

    The problem is most clinical phychs don’t even know everything they need to know about the drugs period. I’ve had dodctors tell me clonazepam is longer acting than Valium, i’ve had them tell me the closer you get to being off the meds, the faster you can go, i’ve had doctors tell me that my dose wasn’t even a theraputic dose and I must stop cold turkey…..all were wrong. I ended up, with the help of the Ashtons manual and analyzing my own withdraws…..coming up with my OWN plan on how to get off the meds and then presented it to a doctor that let me do it….and it has been working.

    Here’s a SMALL in a nutshell version of my story:
    I get an appendectomy (emergency of course)with no history of Anxiety and I have no worries of the surgery. I send my family home to sleep while it happens. I have an uncaught reaction to neostigmine/droperidol (that wasn’t caught until much later with a HR up to 150, but that’s a different story) but what happens next is the ride of my life…

    After the heart rate issue I decline pain meds after the dose they gave me upon waking up until about 10 hours later where I get a little nervous about not being able to fill a pain prescription since it is getting dark. I think nothing of it. That night I have crazy night sweats, I wake up and can’t sleep, im so tired I could die, my heart begins racing for now reason, I feel like a mental case, etc.

    I go the to the ER and get prescribed Ativan, which at first mildly helps (enough to sleep) the next day the same and another trip to the ER where they give me a benadryl drip that fixed the first problem stated above with the neostigmine. My heart rate goes below 100 for the first time and I sleep. I wake up and it is back, I take my now prescribed hydroxyzine but to no avail. Just makes me tired, but all I can do is walk 10 miles a day and cry, etc.

    I see a behavioral therapist and they say to take the Ativan regularly….for the first time my symptoms calm down. Then a doctor tells me to quit taking them on the spot because they are dangerous (this is about a week later) after the 5 half lives of ativan my body temp drops to 96 degrees, im am sweating and shaking like crazy, and 15 other symptoms. I take more ativan.

    The next day I see the mental health clinic, she prescribes clonazepam since it is the longest acting (not really) and even 1/4 MG 2-3x/day makes it so I can barely see, but i still have tons of symptoms. I drop my own dose, and she says I have adjustmental anxiety and I need to accept it and refers me off base to intensive outpatient therapy.

    I ask the doctor if he ever heard of The Dr. Ashton. He had not so I showed him where to look and said that’s the plan I need to follow.

    I seen a lady post on benzobuddies.com the same thing happened to her right after a surgery. A year later she looked in her records and found they gave her 2MG of Midazolam during anesthesia…..a benzo. I went and looked at my records and behold, hand written in a corner, it states I was given 2MG Versed (midazolam)

    So, one dose shut me down. I have a hyper-sensitivty benzos. We tranfered over to 7.5M/day of Valium and went down to 7MG after a week, then 6,5,4,3,2,1 in one week intervals….. We were going to go slower, but I had a really good spell of feeling great between 5mg-2mg that we kept on with it……BAD choice. at 1 MG it came punishing back. I eventually had to go back up to 3MG/day and stabilize. I am now staying steady at least 3 weeks per .5MG drop of valium. At the end of three weeks is the exact point where a single dose taken over three weeks, is steady in your system. In fact I worked out the mathematics on it. I did it by how much of an original dose is in the body during every day…days 1-21.

    Sorry this is choppy, but there’s tooo much to write in order to make it correct and to have all the information. I’m just trying to get the basics out. I drop down to 2MG this saturday.

    The point is thatsome people’s brains shut down very quick when this is active in their system and it takes them a very long time to being to function normally. Most people CAN come off these drugs if changed over to Valium and decrease at a very slow rate. You should NEVER go down if you haven’t felt pretty dang good for at least a few weeks.

    If it takes you 6-8 weeks to go down .5MG of Valium a day, then do it. Screw the quick mode. The more times you fail, the harder it can be mentally. Over and over again during withdraws I have to remind myself it IS the meds talking. I went from just barely stabilizing on 7.5MG of valium a day, to stabilizing the same on 2.5….when done slowly and properly.

    BTW, I don’t just get the list of common withdraw symptoms I get well over half of the uncommon ones, simultaneously.

    The moral is this, not one medical doctor had the right plan or even knew what the heck was going on. Most didn’t even care to look at all my medical documents, compare how many symptoms I had compared to anxiety patients, etc. Had I not did my own research, pushed my own plan, and got results, I probably wouldn’t be here today.

    Even one of my doctors (the one who let me do it my way when I presented Dr. Ashtons research, and was overall responsible for me getting on the proper path because of said reasons) takes benzos for anxiety himself and didn’t know all the things I know and i’m just a regular Joe with no medical degree.

    I plan on writing a book, getting more research done, and hopefully having someone publish what happened to em and how I got off.

    The solution to getting off a benzo?

    Get on Valium—-Get stabilized—–decrease in small increments——–wait until any new withdraw symptoms dissipate——wait a couple more weeks after that, AT LEAST——-lower in a small increment again—–REPEAT.

    The fact is, that your Brain has a threshold I have found for how much of a decrease in medicine (most likely a percentage vs a MG amount during certain phases) that you can go before X symptoms appear….i get physical symptoms first, then mental ones. So, by the time you get real bad, you are most likely at least 3 weeks or X doses too far into the hole. At that point you need to go up in order to get stable. Each time you go too fast, you end up having to backtrack and it will just take longer. It could take some people a couple years to fully come off this crap.

    I used mathematical calculatations in conjunction with my symptoms to guide me where I need to go up to (in terms of medicaine) when we went too fast. I determined how many weeks (or doses) it took to get really bad. I then went to the mathematical point at which I should have been good and then sat there for 3 weeks before coming down slowly.

    This is just the tip.

  19. Dr. Datta,

    In the article above, you say: “In the inpatient setting, I rapidly tapered her off a number of her medications, and treated her with intensive brief psychotherapy. Nothing bad happened.”

    You need to be aware that many of these drugs (benzos and SSRIs especially) can cause what’s referred to in the psych drug withdrawal support communities as “delayed withdrawal”.

    It happened to me and it’s happened to many others I speak with daily in the support groups. I, too, was detoxed from benzos and a polydrug cocktail in an inpatient setting. I am sure that the doctors there thought “nothing bad happened” as well, b/c in that first month off the drugs, I appeared seemingly “OK”. I did, in hindsight, have some symptoms and signs that the withdrawal was lurking below, but they weren’t severe enough for me to know what was happening. Specifically, I had one episode of choking on food where it got “stuck” in my esophagus and severe constipation. No one in the detox center seemed concerned.

    It wasn’t until I got HOME that as the weeks and months passed that I deteriorated into full blown, severe, acute withdrawal. The worst of it didn’t START until 3 months later. When I tried calling the center who CT’ed me, they didn’t return my calls and washed their hands of me. So, I was discharged from their “care” and they, I assume, believed “nothing bad happened”, yet I was at home, with my family in psychosis and suicidal from a withdrawal syndrome that took months to become severe.

    This happens all too often. Even if some people seemingly rapidly detox and do “OK”, there are thousands of others who DO NOT. It is for this reason, that patients should NEVER be rapidly taken off of their medications and everyone tapered slowly, as you have no way to know ahead of time who is going to be who. And if you’re not following them for months after their detox, you won’t know, unless they come back to you begging for help down the line. At that point, however, you have already put them into a severe withdrawal syndrome at which time reinstating the medications may or may not work to stop the syndrome so the patient can become stable again and taper. In my circumstance, going back on the benzo DID NOT stop the w/d syndrome (I was in CT w/d for 4 months and had a suicide attempt b/c the suffering was so barbaric, I could not cope any longer) and I was left in a constant state of withdrawal, even back on the drug. I had to taper off of the reinstatement.

    My CT was in October 2010. I am still in withdrawal now, after having tapered off 18 months ago. And it is still crippling. I know, had I never been detoxed, and had I been given the chance to taper properly from the beginning, that I wouldn’t be this crippled and suffering this badly.

    Thank you for this article and for listening to my comments.

  20. I want to completely recover from my schizoaffective disorder. Do you have an answer to that? I’ve seen too much crap in this life and the way the stigma and prejudice is still commonplace for me. I always thought that success is my greatest revenge. And I’m looking forward to look beyond my means.

  21. Hi Vivek, I’m one of those survivors out in the trenches of the protracted drug withdrawal community. Since my esteemed colleagues have already done such an excellent job providing you resources, so you can learn the entire ugly truth of this public health nightmare, I only want to chime in with my thanks for your writing this article. I have been working as Educational Director and Volunteer Coordinator for The Law Project for Psychiatric Rights for the last four years, and aside from our litigation work, psych drug withdrawal has been our focus, partially because I have spent the last six years in withdrawal myself, with possibly another year ahead of me in my liquid titration from klonopin. The dangerous misinformation we are getting from well intentioned psychiatrists is actually more of a problem that psychiatrists who know nothing. I have been working in conjunction with a few other organisations to build a safe practitioner list, and I am at the point where I only accept people who are willing to “partner in learning”. The situation is desperate. I hope you can, in some way, help to get the ball rolling.

  22. Dr. Datta as a 20 year 24/7 student I assure you that you are spot on with your beliefs that you have written. I’m not a psychiatrist nor patient I am a mom who when my healthy and happy young daughter hit a roadblock (what should have been a relatively simple life challenge and passage in her life twenty years ago) and took a misstep into the “mental health system” and a grave mistake and we have been in hell and almost back . She naively stepped carelessly from the ground into a raging river.. I saw her, jumped in after her and have been hanging on to her ever since . Unwittingly thrusting me/her into a world completely unfamiliar…I so thoroughly understand the problem that is “mental health care” and “meds” and in spite of everything we have managed to fight our way back to the river bank but like you, haven’t had the courage to climb out. But this shall be the final challenge it is all in the belief that it can be done and the sky won’t fall. As for my daughter who once totally believed in herself but now after years of traumatic experiences and thorough undermining of her self identity and confidence it shall be no small task. I have thought of a new disorder for the insane pharmaceutical $ndustry ……”Label affective disorder” but there is no “med ” for that but a recommendation …..just turn and run! I may write a book someday if I could relive the hell who knows.

  23. I’m going through hell right now with Haldol. I have akathisia and the shakes, plus very small appetite, sexual dysfunction, etc. I want to taper off rapidly, but I don’t want to be cross-tapered. My life is sheer torture right now, with no ability to function.

    Are you telling me that it’s possible to be rapidly tapered and be all right afterwards? Should I go to a hospital? Around here, the hospitals have different inpatient doctors than your outpatient doctor, so I would end up with someone who didn’t understand the direness of my situation and would probably only put me back on Seroquel, which I hate.

    I’m considering a rapid taper at home, as the side effects are so profound and disabling. The good of this drug is physical: my body can regulate itself, temperature-wise, and I feel strong, physically. I don’t want to be on anything else, though, and it’s easy to get committed around here.

    The only reason I can type this is that I skipped my afternoon dose. I’m on 15 mg Haldol, 5-5-5. I skipped one of the 5s. And I can function enough to type this. I want to go from 15 to 10 today, and then from 10 to 5 after a few days.

    Thanks,
    Sara

  24. While most of patients might be in need of refuction of dosage, nonpsychotic patients with chronic anxiety mayrequire anti anxiety agents on a long term basis as props to lead a good quality of life. Unless yhey are given good amount of insight and support on the cause of the anxiety they will have to depend on medication