Preparation is the process behind any successful withdrawal
My holistic journey with medication withdrawal evolved in five phases:
Recognizing and differentiating withdrawal from the underlying illness.
Appreciating the magnitude of each medication's unique withdrawal outcome.
Learning how to minimize withdrawal outcomes through natural interventions.
Learning how to treat the underlying causes of the original illness.
Integrating the treatment process for each unique patient during their healing journey.
Life is a process. Becoming a holistic psychiatrist is a process. And today, I want to share an indispensable truth about the process of medication withdrawal—preparation. Without proper preparation, patients will experience "protracted withdrawal," which is simply a euphemism for an unsuccessful withdrawal.
How to avoid this? Read on to find out.
What to do Before Lowering Medications
Avoiding "protracted withdrawal" through proper preparation
I've been observing Jose remodel my two bathrooms over the past four months. Remodeling a bathroom involves a careful, methodical process. For example, he spends a lot of time preparing the floor with Durock before laying down the tiles. For the shower, he spends a lot of time layering cement before installing the pebbles on top.
If only psychiatrists put as much thought into preparing patients for the withdrawal process as Jose does with laying tiles. Most of the time, psychiatrists simply tell patients to lower their dosage slowly. Of course, "slowly" is a relative term. Who knows how slowly?
Within three months of stopping their medications after a "slow withdrawal", most patients feel awful. Usually, the clinician believes that this outcome is due to the underlying "chronic and untreatable" illness. Who can say otherwise? And where's the proof they may be wrong?
I can say otherwise. And I can prove that they're wrong. How? Well, I've observed in my practice that patients who withdraw from their medications properly don't relapse after three months. In order to help patients get off their medications, however, preparation is necessary. And if I do a good job, patients fully recover from their "untreatable chronic" mental illness and don't need to be patients anymore.
The necessary preparation comes in two areas: 1) healing underlying causes (inflammation and oxidative stress) and 2) supporting specific medication withdrawal effects. For example, psychotropic medications affect the neurotransmitter system, so building more neurotransmitters would be necessary before the taper. But nowadays, psychotropic medications don't just affect neurotransmitters. They affect a wide variety of different receptors, such as histamine.
After being on medication for months or years without removing the underlying causes of the illness, it is unreasonable to expect a healthy outcome when the buffering agent (medication) is removed. A healthy outcome will occur if health is present. A medication can be lowered safely if there are proper levels of the endogenous chemicals/molecules present.
At the 2016 IMMH conference, Dr. Marty Hinz, MD, shared that studies show the use of selective serotonin reuptake inhibitors (SSRI's) depletes the total releasable storage levels of serotonin in the platelets by 80% after 3 weeks of use. The platelets contain 90% of releasable serotonin stores. He wrote, "reuptake inhibitors deplete the monoamines serotonin, dopamine, norepinephrine, and epinephrine in all subjects not ingesting adequate amounts of balanced nutrients; when depletion is significant enough, the point is reached where the effects of the drug and/or the placebo effect are no longer observed."1
After using an SSRI for many years, it is necessary to restore serotonin storage levels before tapering it. The conventional approach that avoids serotonin building supplements along with the use of SSRI's (due to a fear of serotonin syndrome) undermines the patient's ability to come off these medications during the tapering process. Such an approach creates dependency on these SSRI's.
When I help patients lower their SSRI's, I usually prepare them by building serotonin with a supplement (like SeroPlus by Pure Encapsulations). Initially, I will start with one capsule at bedtime. After four days, I can usually go up to two capsules at bedtime. And after two more weeks, I can usually start lowering the SSRI by about 10% every 10 to 14 days. Symptoms of higher levels of serotonin are vivid dreams, more active (gurgling) bowels, distractibility, and sometimes a flattening of mood. A compounding pharmacy or liquid form of the medication can simplify the tapering process.
During withdrawal, I always try to support the patient's health through nutritional supplements and natural interventions that lower infectious sources and decrease oxidative stress. Generally, I try to strengthen the patient's condition in eight different nutritional areas: vitamins, minerals, essential fatty acids, amino acids, GI function, anti-oxidants, and anti-inflammatories.
Some nutritional companies talk about "protracted withdrawal" as if it's an unavoidable part of medication withdrawal. That is not the case. Often a protracted withdrawal is due to a partial focus on medication withdrawal without enough emphasis on healing the underlying causes of mental illness. The two must go together in order for the patient to have a successful withdrawal. With enough support, and if the medication is withdrawn at the right pace, protracted withdrawal can be avoided entirely.
Another thing I learned over the years is that these principles apply to all medications, not just to psychotropic medications. Whether it's coming off an anti-inflammatory (NSAIDs), anti-histamine, or thyroid medication, if a patient has been taking it for months or years, preparation/healing will be necessary prior to lowering the medication.
I hope that sharing my empirical experiences will help you with a safer withdrawal process!
1 - See this article for more information: Monoamine depletion by reuptake inhibitors (Marty Hinz, MD, 2011)
Ruth Asawa Sculpture at the De Young Museum
San Francisco, California
(This sculpture reminded me of a part of T. S. Eliot's poem)
"It is impossible to say just what I mean!
But as if a magic lantern threw the nerves in patterns on a screen:
Would it have been worth while,
If one, settling a pillow or throwing off a shawl,
And turning toward the window, should say:
'That is not it at all,
That is not what I meant, at all' "
(lines 104-110 of The Love Song of J. Alfred Prufrock by T. S. Eliot)