By: Professor Peter C. Gøtzsche, the Nordic Cochrane Centre; Pharmacist Birgit Toft; Pharmacist Bertel Rüdinger; Child and adolescent psychiatrist Lisbeth Kortegaard; Psychologist Olga Runciman; and Psychologist Anders Sørensen
We held the first course ever on psychiatric drug withdrawal on 12 June 2017 in Copenhagen. The course was open to patients, relatives, psychologists, doctors and other social and healthcare workers, and 77 people participated.
Our practical guides, an abstinence chart, a list of doctors and others willing to help with tapering, and the lectures (with English subtitles) are available from the front page of www.deadlymedicines.dk.
In October 2016, two of us were involved in co-founding the International Institute for Psychiatric Drug Withdrawal in Göteborg, Sweden, and this institute has also just finished its first course. At the Nordic Cochrane Centre, we do research on drug withdrawal, and everyone with an interest in this is most welcome.
Withdrawal courses are badly needed. About 5% of the inhabitants in Western countries have become dependent on psychiatric drugs and have difficulty getting help with tapering off them. Very few doctors know how to do it properly and the official recommendations are poor, e.g. to halve the dose when withdrawing from depression pills,1 which is much too fast.2 3 One can reduce withdrawal symptoms by reducing the dose by only 10 percentage points at a time, from 100% to 90%, and after another 2-4 weeks, to 80% of the usual dose, etc., perhaps with even smaller steps when the dose has been reduced to about 30%.
Often, the most difficult step is to go from a low dose to nothing, which to a considerable extent is a psychological barrier. The patient has often built their identity around a diagnosis with accompanying pill intake, and half of patients or more have been told that their mental disorder is due to a chemical imbalance in the brain. This is a myth, but it has the unfortunate effect that some patients are scared of becoming drug-free because they think they are chemically defective and that the drugs fix this.
Several patients had experienced being unable to get help with tapering, or psychiatrists dismissing them when they had tapered off the drugs on their own, but still wanted to stay in contact with psychiatry in order to get psychological support. A staff member in a group home (supported living facility) had asked what she should do if she wanted to support patients in the drug withdrawal process, but the supervising psychiatrist was unwilling to discuss the issue. The answer was that if you handle the medication, you act as a medical assistant and are required to follow the instructions. However, in Denmark, the National Board of Social Welfare has published several useful leaflets about drug pedagogics including “The Good Consultation,” and social psychiatry has good experiences with using them.
Psychiatric drugs affect normal brain functions, and it is therefore important to have a tapering plan.4 During withdrawal, there is typically a phase where feelings and the sense of one’s own body return. This can be a chaotic and difficult time to get through because the patient has not functioned normally for a very long time, neither at work, nor socially or during leisure time. In this phase, help from family, friends, and acquaintances is essential to support the patient’s hope of a better, medication-free life on the other side, and to prevent the patient from having second thoughts about withdrawal and resuming full medical treatment. In this phase, patients and their relatives often benefit from supportive talks with a professional therapist.
When people get in closer contact with themselves, they tend to relive the reason why they ended up in psychiatry in the first place. Therefore, many will benefit greatly from working therapeutically on what happened to them in their life. For example, most of those with a schizophrenia diagnosis have experienced severe traumas.
Another difficult phase occurs when patients have become drug free and resume social contact. Perhaps they have had little or no contact with family and friends, and it can be difficult to comprehend that their loved ones are well and have a good job, while the patient may be left in a group home surrounded by people who are having a hard time.
Our knowledge of what happens during drug withdrawal, and especially after withdrawal, is poor. If the patient gets symptoms some months after withdrawal, many will interpret this as a relapse of the disorder, but this is far from clear. Often it is a question of late withdrawal symptoms that can be triggered by stress or trauma in a brain that has not recovered fully. It may take a very long time for the brain’s receptor systems to revert to their normal condition, and sometimes it never happens, which means that the treatment has caused permanent brain damage.
A drug withdrawal process must be adapted to what the patient can cope with and therefore must be controlled by the patient. It is not possible to say anything with certainty about the duration; in most cases, it will last some months, at worst, several years or withdrawal will never be successful.
If a patient is taking more than one drug, it is most often recommended to withdraw from one drug at a time because it is difficult to know what caused the withdrawal symptoms if a dose of several drugs is being reduced at the same time. If the first drug the patient received caused side effects that led to a new psychiatric diagnosis and medicine for this iatrogenic suffering, one should start with the first drug. For example, if a patient was prescribed a depression pill for symptoms of depression elicited by prior treatment with a central stimulant. In this case, the first step is to withdraw the central stimulant, and next the depression pill. If they start with the depression pill, the patient may experience an withdrawal depression due to the “chemical imbalance” caused by the drug.
A withdrawal depression is harm caused by the drug. It is not a true depression that would have come anyway, even without medication. It is characteristic that if the full dose is resumed, the patients get better after a few hours, just like an alcoholic gets better when alcohol is on the table again.
For other patients, it is advantageous to start with the most troublesome medication. If the patient succeeds, there is a good chance of success with the other drugs as well. Therefore, it is often recommended to start with neuroleptic drugs and end with sleeping pills.
If the withdrawal symptoms become too severe, it is recommended to endure them, as they usually resolve pretty quickly, and then the tapering interval can be extended. Others prefer to increase the dose to the level the patient was on before the withdrawal symptoms became too severe, and then extend the tapering interval.
It is important that the patient keeps an eye on themselves and is supported by family, friends, and acquaintances who are often more objective than patients whose brains are affected by chemicals. It can be very useful to keep a diary and fill in a withdrawal chart, where additional symptoms that are not on the chart can be added, and to follow these day by day. To get an overall impression of the withdrawal process, one can rate the symptoms each day from 1 to 10, with 10 being the best.
The drug companies have made drug withdrawal very difficult by failing to produce drugs of lower strengths. This is why we must act ourselves. We have prepared a brief guide explaining how most tablets can be crushed or dissolved in water and dosed with a plastic syringe, and how capsules can be split.
Psychiatrists like to call people paranoid, when in fact people can be out to get your money (if you have any). Myself I carry a camera when ever in public, If someone starts messing with you , you can take still photos or a video. These photos or videos are for your own peace of mind . To know what you experience was real or not.
Report comment
Thank you for working to educate doctors of the importance of helping people wean from the psychiatric drugs. Thank you for your honest statements like, “If they start with the depression pill, the patient may experience a withdrawal depression due to the ‘chemical imbalance’ caused by the drug.” This is a pretty good description of the common symptoms of antidepressant withdrawal.
https://en.wikipedia.org/wiki/Antidepressant_discontinuation_syndrome
But today’s medical community knows less than zero about withdrawal symptoms. To the contrary, they tend to believe these withdrawal symptoms are “bipolar,” despite this being untrue, and a blatant misdiagnosis, even according to the DSM.
Withdrawal from the “bipolar” drug cocktails can create a “drug withdrawal induced super sensitivity manic psychosis.” The doctors think this is “a return of the illness,” despite this being incorrect. A neuroleptic and/or antidepressant anticholinergic toxidrome induced “psychosis” is infinitely worse than a drug withdrawal induced “psychosis,” in my opinion, and they are very different types of “psychosis.”
From my experience, the best way to deal with this is to put the excess energy towards exercise, and productive endeavors. Being held against one’s will in a hospital, strapped to a bed, and “snowed” into oblivion, is the opposite of what is beneficial, contrary to what the greed inspired medical community believes. Despite the fact the medical evidence does show that forced psychiatric treatment does increase suicides.
https://www.madinamerica.com/2014/09/suicides-rise-increasing-psychiatric-involvement/
Today’s medical community, especially the psychiatrists, really needs to be taught about the importance of treating others as they’d like to be treated. And, of course, they need to overcome their staggering ignorance, and complete denial, of the plethora of adverse effects of the drugs they prescribe.
Report comment
One slight correction. There is no such thing as a “side-effect” when it comes to psychotropic drugs. Psychotropic drugs produce the intended effects of altering the brain. There is no therapeutic value to the drugs, thus what is commonly called a “side-effect” is actually just one of the many effects of the drug.
I would also take exception to the following claim:
“It is important that the patient keeps an eye on themselves and is supported by family, friends, and acquaintances who are often more objective than patients whose brains are affected by chemicals.”
While it is true that victims of psychiatry may suffer from a variety of problems, it is rare indeed when a family member or friend has a more “objective” understanding of the effects of psychotropic drugs. In fact, no one knows better than the sufferer himself what the effects of psychotropic drugging are. More often than not, those who should offer support and relief simply have no way of knowing the truth about psychiatry.
https://psychiatricsurvivors.wordpress.com/2016/05/10/the-truth-about-psychiatry/
Report comment
“…a family member or friend has a more “objective” understanding of the effects of psychotropic drugs.” they (family/friend) don’t have to take the drugs/ do not know the effects of the drugs, so would rather have the angry person drugged.
Report comment
Yes and no. They cannot appreciate the suffering the drugs cause–not fully. But when I went gaga on Anafranil I was living at home and Mom and Dad noticed my weird behaviors long before I did. Drunks sometimes have driving accidents because they can’t tell they’re drunk.
Mind altering drugs ruin objectivity. Remember Peter Breggin’s talk on the spellbinding effect?
Report comment
Thank you for the article, Dr. Goetzhe. Ironically my depression vanished after tapering off my “antidepressant” and my “antipsychotics” frequently produced fits of tardive psychosis. A bunch of Orwellian double-speak! I believe now all my mood swings came from my cocktail; I never was bipolar in any other sense.
Unfortunately I am physically sick from 25 years of drug use and the strain of withdrawal withdrawal. It seems to be getting better at a rate of maybe 1% a week now.
Report comment
In my entourage, some psychotics have stopped neuroleptics in this way:
1) indeterminate will to stop neuroleptics, to emancipate themselves from the psychiatric system,
2) study of advices from relatives, vulgarization and scientific literature about the long-term benefits and short-term risks of weaning,
3) decision to stop in an indefinite time, when the person feels ready,
4) Last injection. Taking neuroleptic pills only if worry, crisis or to reduce the withdrawal syndrome.
5) Nil or very punctual consumption of neuroleptics.
I think the first three steps are the most important. Weaning must be gradual, and the dose must be increased on demand, but the most important is the informed choice to stop, and the initiative comes from the person himself.
I add that having a psychotic crisis is not a problem in itself. I have a friend who still lives with her angel and her demon, who has visions and voices but is capable of managing her crisis and working, by isolating herself for a while, or taking a punctual dose of neuroleptic. Note also some crises are very pleasant to her, or emotionally neutral, and there is therefore no reason to prevent them.
Report comment
“Our knowledge of what happens during drug withdrawal, and especially after withdrawal, is poor.”
If my experience is any help, it’s insomnia, that goes on for a long long time.. years. also PTSD, in the form of intrusive memory thoughts of the coercive abuse by the psychiatrists: “The only option is to take the pills or we will have to ECT you, and if you stop you may never get better”. Other very abusive and humiliating stuff, I do not wish to repeat. Plus, I always have trouble logging on to this due to my hands shaking thanks to 2 years on lithium.
Report comment
Thank you very much, Dr. Gøtzsche, for this excellent report.
I was on Ritalin, Vyvanse, and Wellbutrin when I decided to stop my mind-numbing cocktail cold turkey. I’ve been taking psychostimulants for 3.5 years but I decided enough was enough. My psychiatrist warned me against stopping my medication because my “depression and ADHD” would likely get worse. Bullshit! There is nothing wrong with me and I am not “mentally ill”!!!!!! I have been clean for 44 days and I recently had some intense cravings so I joined Narcotics Anonymous and its been extremely helpful. I hope I can stay clean for the rest of my life. I’m done with psychiatry!
Report comment
Rx “meds” = street drugs.
A drug is a drug is a drug.
Report comment
Touché 🙂
Report comment
Of course any mood altering chemical will likely create a physical and a psychological addiction.
All the more so if someone is being told by therapists that they have be afraid of their feelings. This is usual way it goes when they think they can pin someone with the Bipolar or Schizophrenia label. Making them afraid of their own feelings binds them to the system.
So while understanding how these drug withdrawls tend to go is important, it is even more important that no one be compounding the problem by telling the client that they have some sort of medical or moral defect. It is essential that never is there any support for Psychotherapy, Recovery, or Motivationalism.
And thank you Dr. Gøtzsche for your work in trying to get these horrible drugs off of the market.
Report comment
Addiction recovery has used the construct of post acute withdrawal (PAW) to describe the symptoms that occur for months and sometimes years after drug or alcohol abstinence begins. Here’s a link to several articles on PAW by Terrance Gorski, who has specialized his practice and research on PAWS: https://terrygorski.com/?s=paw
Report comment
Many thanks, Dr. Gøtzsche, for your valuable work in this area. I’m an art therapist with addictions/mental health qualifications working in aged care. i’ve come across several residents who i believe have been misdiagnosed 3o to 50 years ago and have been on antipsychotics ever since with the resulting physical symptoms of tremors, constant physical illness etc. do you or anyone have any info. on people successfully tapering off their meds after such long times on them – preferably [but not necessarily] in aged care as this will carry more weight with the orgainisation who runs these places. many thanks in anticipation.
Report comment
From what I recall, I did not have emotional problems when I first approached mental health professionals. I was experiencing eating issues and was eating erratically. I binged every few days and fasted in between. What happened was that my belly was so full that I was extremely uncomfortable and this caused me to become severely depressed and unable to get out of bed or do much. Over the next few days, when I didn’t eat, I gradually felt better. Finally, my blood sugar was so low I felt lightheaded and high. I was afraid to eat again for fear that it would turn into yet one more binge. I was afraid of food, scared that it would only go on and on, hated my life like that. This wasn’t a mental disorder, nor a personality disorder, it was a nutritional issue, and I certainly didn’t need dangerous amounts of antipsychotics. Therapy wasn’t helping, mindfulness was a joke, my family wasn’t to blame, and none of these incompetent professionals ever asked about my eating for about 30 years. When I tried to tell them, they jeered at me and told me it was “trivial.” They never even questioned when my weight dropped dangerously low. Who were the psychotic ones?
I am left with permanent insomnia from dangerously high doses of antipsychotic drugs that were given to me over a period of decades. This has nothing to do with withdrawal and everything to do with the ridiculous doses I was given all those years. I notice that most psych victims fall for the “underlying condition” lie they are fed by the time they reach their 50’s. The fancy sleep study places seem to be linked to device manufacturers (hmm…scammy I suspect) and even the Sleepio app does not even acknowledge damage from prescribed drugs (I wrote to Sleepio and they do not acknowledge this exists even though it’s $300, don’t waste your money!)
I truly believe that these drugs cause the body/brain to lose its ability to initiate and sustain the sleep state. And as far as I can tell it is permanent. I have met people who have had insomnia ten or more years from having been given high doses of sedating drugs. Can we get a lawsuit going…PLEASE…. Don’t cave in to “underlying condition”! Let’s hold the doctors that do this accountable!
My doctor had me on three antipsychotics at highest possible dose simultaneously and I was not psychotic nor manic. My complaint was my eating disorder, which didn’t need antipsychotics.
“What you gave me isn’t working.”
“Okay, I’ll give you more.”
“That didn’t help.”
“Okay, we’ll double the dose and add another drug.”
Folks, we live in a society where we trust these people. I’m asking anyone out there….Let’s take action.
Report comment
What I would like to know from anyone with any knowledge , is why can’t it be proved when someone passes away by looking at the brain ? In sports especially football , CTE is showing up and it can only be confirmed once someone is dead . Why aren’t they looking at peoples brains who succumb to akathisia among other things to prove this? Has noone thought of this? I would imagine the severe distress from withdrawal would show come change in the brain ?
Report comment
Gratified to see Peter agrees with this article I wrote in 2012
Taking multiple psych drugs? Which drug to taper first?
https://www.survivingantidepressants.org/topic/2207-taking-multiple-psych-drugs-which-drug-to-taper-first/
Report comment