The Taper

Kelly Brogan, MD, ABIHM
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Part of what has scared me straight about ever starting a patient on an antidepressant (or antipsychotic or mood stabilizer) again is bearing witness to the incredible havoc that medication discontinuation can wreak. This can range from transient headache, gastrointestinal distress, and irritability to violence, suicide, physiologic disability, and diffusion of identity. Patients, even in my practice, where I support and advocate for cautious withdrawal, feel understandably afraid of life without medication, and their fears are often realized.

As readers of MadinAmerica know, the wake of medication taper is an iatrogenic illness – it is medication-induced physiologic destabilization. I have made diagnostic efforts to quantify this withdrawal/relapse phenomenon by looking at adrenal cortisol patterns, inflammatory markers, and amino acid perturbance without clarification. I do know that most of my patients present to me on SSRIs and their cortisol rhythms are grossly suppressed. A paper entitled, Do Antidepressants Regulate How Cortisol Effects the Brain? addresses this, stating:

“Studies in depressed patients, animals and cellular models have demonstrated that antidepressants increase glucocorticoid receptor (GR) and mineralocorticoid receptor (MR) expression and function; this, in turn, is associated with enhanced negative feedback by endogenous glucocorticoids, and thus with reduced resting and stimulated hypothalamic–pituitary–adrenal (HPA) axis activity.”

I work to restore resiliency prior to taper by unearthing physiologic imbalances, autoimmune phenomenon, and perceived stress before medication decreases as a means of mitigating the taper’s effects – helping the body to become more adaptive to the absence of medication because it has more available resources in wellness. However; there is no antidote, no magic bullet, when patients are in the throws of taper. This is why the informed consent process becomes paramount.  Patients need to know, before filling that first prescription, that their episode is likely to resolve on its own within 3 months (no treatment), that there are effective alternatives, and that there are significant potential short and long term risks.

To further quantify this, Professor Dee Mangin, will be evaluating patterns of relapse/discontinuation in 330 patients prescribed and weaned off of antidepressants. I, for one, cannot wait for the pearls of truth to emerge, but I remain concerned that it may take a lot more to change practice, particularly given analyses, which suggest a 17 year lag in clinical translation of medical data. In the meantime, we are learning from patients reports about their experiences and cautionary tales.

If we leave the monoamine hypothesis behind and we recognize the dangers of perturbing a system with a pharmaceutical product, then we can only look at what the symptoms are trying to tell us. Many wonderful clinicians listen to these symptoms and help to translate their message through energy medicine, acupuncture, chiropractic, and homeopathy. I see mental illness and I think of a gene/environment mismatch – I look to sources of inflammation and hormonal disruption, such as diet, stress, sedentary lifestyle, and toxic exposures, and I get to the root.

I am half way through the first e-course of its kind, and it has been incredibly well-received. There are so many people out there, disenfranchised by psychiatry, skeptical of its promises, and who want a better way, a more thoughtful assessment of them as whole persons. We seem to be onto something here, so let’s keep the dialogue flowing, keep our eyes wide open, and reform what psychiatry means, one patient at a time.

The first part of the course was pre-recorded, and can be purchased at GreenMedInfo or BeyondMeds.

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Of further interest: short interview with Dee Mangin at the Dartmouth conference on over diagnosis:

3 COMMENTS

  1. I love this, a study on withdrawal! The hardest thing for me is explaining how when I was only getting worse and worse from taking ‘medication’ is how I forgot what I was like before taking them (better by far) and didn’t quit years sooner. Intoxication anosognosia , is that the right term ? It was more like amnesia of some sort. Very difficult to explain.

  2. A wise article – should be required reading for all those who prescribe drugs and those who might take them.

    Few doctors make the effort to get to the root. It’s much easier to write a prescription and not bother to mention the adverse effects and the withdrawal effects.

    I had the most bizarre and almost lethal experience when I was prescribed a benzodiazepine for caregiver exhaustion and bereavement-related insomnia. I became jittery when I stopped the benzo. Doctors did not recognize the withdrawal syndrome, decided I must be depressed, and medicated me accordingly. With each drug I became worse – much worse. Doctors recognized this as proof of escalating mental illness. I did take the drugs – I would have ingested almost anything to stop the severe agitation which I now know to be akathisia.

    I was treated aggressively with 35 drugs for 8 months and was forced to undergo 25 anesthetics and 25 bilateral electroconvulsive ‘treatments.’ I was told I would need weekly maintenance ECT for the rest of my life and pharmaceuticals for the rest of my life. I was also told I was demented. I had been driven insane.

    The damage is profound – both physical and emotional.

    The answer to my insomnia came through ‘energy medicine’ and the solution through homeopathy. I had a stress-related thyroid problem. My taper schedule was worked out by an intuitive healer.

    And no, I did not have anxiety disorder, depression, dysthymia, anhedonia, agitated depression, major depression, personality disorder, major depression with agitation, adjustment disorder, vegetative depression (got that label when I fell asleep during an appointment – I had been given sleeping pills three times a day to control agitation and once a night for sleep!!!!),bipolar disorder, psychotic depression, schizotypal traits, dissociative identity disorder, somatization disorder, avoidant personality traits, suicidal ideation, paranoid ideation nor dementia.

    Before you take that drug – get another opinion. I tell my story because I am still alive to tell it – many are not.

    My story has circulated on the internet for a few years as ‘Iatrogenic Insanity’ and ‘An Open Letter to Doctors.’

    My comments on Philip Hickey’s MIA article ‘Is Electroconvulsive Therapy Effective ‘ Nov 21/13, appear under the name ‘amnesia’

    Drugs and ECT do permanent damage to the human energy field.

    Thank you for your article Dr. Brogan. Looking forward to Dr. Mangin’s research. And looking forward also to your e-course.

  3. It’s great to see all the support for medication withdrawal, and a desire to increase awareness and knowledge around this.

    As an energy healer, myself, I work with clients only under the premise that ANYTHING can heal. In the energy healing world, there is no such thing as a chronic illness. Although, in order to heal, we must, first and foremost, have the belief that we can heal from anything. It’s unfortunate and distressing that we can be scared out of this natural and innate power of self-healing by clinicians, and the illusions perpetuated by many who are in the medical business.

    When I tapered off of nine psych meds, after 20 years of one cocktail or another, my withdrawal was over the top painful, like I’ve seen described by others. I felt brain-damaged for a while, along with kidney, liver, and stomach damaged. Neither my body nor my mind functioned terribly well for a while, but still, I was feeling that healing was occurring.

    Eventually, after a couple of years of reparation through a variety of practices, all the brain zaps, the body pains, the fogginess and confusion, digestive issues, insomnia, rashes, etc., subsided. Now, 9 years after having taken my last dose, it’s as though none of this happened, other than the fact that I learned a great deal about the underbelly of society, and, of course, my own shadow. But I no longer have any residual from the meds or withdrawal.

    During this time, I did several things which helped support withdrawal. I started healing my gut from the mayhem caused by the meds. For a year, I was very strict with my diet of greens and probiotics, and at the end of that year, I had a digestive system filled with healthy restorative flora, boosting immunity, and most of my symptoms had disappeared. These days, I no longer follow any kind of prescribed diet, I just make sure I’m eating balanced, like any health-conscious person would do. It was merely a matter of conversion, until the internal shift took place. My system ‘cooled’ as a result. (Chinese medicine divides foods into ‘cooling’ or ‘warming.’ When our systems heat up too much, we experience imbalance).

    I also started a Qi Gong practice to build foundational energy. This is something I still practice, and even teach now, because I find it so grounding and enjoyable. Acupuncture and herbs (from a qualified herbalist whom I trusted) rounded out the healing support and regeneration of my cells. After a time, I didn’t need herbs, unless I wanted to take them for whatever health issue. But, unlike psych meds, herbs aren’t addictive. They train your body to heal naturally through vibration, so there’s no issue of dependence.

    Other than that, I kept my sights on what my goals had been before I became ill from the meds, and I returned to them. It was hard at first because I was changing so much, due to the detox, but with patience, all the internal malaise and negative introjections quieted down to the point of disappearing altogether.

    I feel the single most important factor in my healing, however, is what I firmly believed I could and would heal, even at the scoffing of the medical community. If we really and truly believe we can heal, then we will. If we believe in chronic illness and permanent damage, then we will, more than likely, experience this, until we change our beliefs about this. I firmly believe that the reality which we experience is contingent solely on what it is we believe. I believe that anyone can heal from absolutely anything, with focus, patience, trust, ownership, and due diligence.

    It was also vital for me to get away from negative influences, and skeptics. I gravitated toward those who were encouraging and supportive, which meant giving up a lot of relationships, and certainly, it meant dissociating altogether from the mental health industry. I found no support nor encouragement, in that world, that I could heal fully and naturally. It was a bit overwhelming to discover to what extent I was being influence (and drained) by the negativity of others, but that was a fantastic revelation. My belief in my own ability to heal won out, however, and now I understand the world a whole lot better than I did before. Lesson learned: stay away from toxic people and communities, as this is what most made me feel crazy. That, and those damn pills. When I cleaned up one, the other followed suit, so I saw firsthand how my internal experience directly influenced my external experience. I learned and grew more during this period than at any other time in my life. It was truly transformative.

    Best wishes with your exciting and groundbreaking work!