Ten Practical Considerations During Psychotropic Medication Withdrawal

While there are different approaches to psychotropic medication withdrawal and much left to be discovered, it is helpful to provide an overview and some key considerations that are central to a smooth medication withdrawal process, from beginning to end.  The following points may be taken as clinical notes on this broad and complicated topic, from a holistic psychiatrist, who has helped patients withdraw from psychotropic medications since 2003.  It is not meant to replace competent medical supervision and care, but to heighten awareness of key issues associated with withdrawal.  During psychotropic medication withdrawal, some practical considerations include:

1. Duration of the withdrawal process:  The withdrawal process does not end when the patient has stopped taking the psychotropic medication.  Rather, adaptation to a medication-free condition continues long after the last pill has been taken.  At a minimum, the need for vigilance for possible relapse should continue for three to six months after stopping a medication.  During this time, the patient would benefit from continued healing through proper nutritional support, therapy, and stress reduction strategies.  Many factors play a role in the ease of withdrawal.  Some factors that may shorten or ease the withdrawal process (beside proper medical care) include: a) mild symptoms when ill, b) short duration of using the medication, c) healthy history, d) a whole foods diet, e) low stress levels, f) positive and open attitude, g) strong social supports, and h) exercising regularly.       

2. Areas that need to be healed and supported during medication withdrawal: a) withdrawal symptoms due to a lower medication dosage, b) underlying health problems, which led to a need for medication, c) traumatic experiences that undermine stress resilience, and d) deterioration of health in the intervening period since initiating medication.  How a patient presents (symptoms and complaints) does not determine how difficult the withdrawal will be.  A patient, who seeks treatment after taking a medication for just a few weeks, experiencing many side effects after exposure to the medication, may be able to withdraw from the medication very easily, especially if the underlying problem has all but healed.  

Medications have varying abilities to harm the body, some being harsher than others.  As patients use these medications over time, this damage is likely to accrue over time.  This damage is in addition to the emotional and psychological tolerance and dependence on psychotropic medications.  Being aware that the amount of time a patient has been on medications will allow for a more accurate estimate of how difficult the withdrawal process will be.  

Abruptly discontinuing medication can also be harmful to the body.  Withdrawal side effects, from an inappropriately rapid taper, signal that the body is struggling biochemically and physiologically.  The longer this continues without proper intervention, the more stress and harm the body endures.  Waiting for withdrawal symptoms to stop on their own, may result in prolonged damage to the body that can make future medication withdrawals more difficult, if not impossible.    

3. Factors that determine the rate of withdrawal:  The advice I was given, as a psychiatric resident, is to withdraw “slowly.”  However, a slow withdrawal is often relative to: a) how the patient is supported through orthomolecular and energy medicine, b) the person’s state of health and diet, c) the toxicity and addictive nature of the medication, d) psychosocial stressors during withdrawal, e) duration of medication exposure, and f) how many receptors are being affected simultaneously by the medication.  Patients will be able to withdraw more easily if they receive appropriate support and healing before, during, and after stopping their medication.  

I have found that it is important to provide support and healing before attempting to lower a medication, wait for mild signs of the medication being too strong, and then lowering dosages just enough to return the patient back to a state of balance once again.  Signs of overmedication or the medication being “too strong” may include feeling tired, sleeping longer at night, or feeling apathetic/flat.  When these symptoms appear, it is not a signal to add another medication, but to reduce the dosage of the medication that is creating excessive side effects.  I avoid lowering medications when the patient is feeling balanced on the medications, because it will initiate withdrawal symptoms and stress the patient, if I do so.    

Also, my clinical experience has been that medications, which simultaneously affect multiple receptors, will be more difficult to withdraw than medications that affect only one receptor.  My assumption is that one taper of a multi-receptor medication would be the equivalent of lowering multiple single-receptor medications simultaneously.  It would be more demanding on the body and more difficult to support both nutritionally and enzymatically.

4. What is “protracted withdrawal”?  The term “protracted withdrawal” has been used to indicate that a medication is to blame for prolonged or recurring withdrawal symptoms, regardless of how adequately supported a patient has been.  I believe, however, that prolonged withdrawal symptoms occur when the patient’s withdrawal/healing process has been incomplete.  In other words, perhaps the healing has been incomplete due to some deficiency in nutritional support, detoxification, or amelioration of underlying causes (infection, social stressors, genetic mutations, or leaky gut etc.).  

Taking a psychotropic medication is like covering one’s eyes when one is afraid of the dark.  It gives one a sense of safety, while still remaining in the dark.  A successful withdrawal is like an enlightening process that lessens the need to cover one’s eyes.  If the room remains dark and creepy, removing one’s hands only leads to prolonged fear and discomfort.  An incomplete withdrawal is like uncovering one’s eyes, before light has been fully restored.  If a patient is adequately supported during their withdrawal, the patient will be able to move into the light of consistent health, without experiencing protracted withdrawal.    

5. Limitations to supplementation.  Although nutritional supplements are crucial for a successful withdrawal, there are limits to what they can do.  Over the years, I have come to rely on many other forms of support for my patients.  I have also come to appreciate the ability to collaborate with other holistic and integrative health practitioners, rather than trying to do everything on my own.  

A supplement cannot change the curvature of a patient’s spine, replace a wholesome diet, or stop disruptive social stressors.  It cannot replace proper sleep and exercise.  Sometimes, despite the patient’s need for nutritional support, the most important thing may be to listen compassionately and silently.  It would be premature to plant palm trees, if the island is drifting towards the Antarctic.  When approaching medication withdrawal, it is helpful to be open to other tools that have the ability to heal root causes.

6. The proper order for the withdrawal process:  In the rush to get off medications, patients may start their taper first and seek for medical expertise after withdrawal symptoms emerge.  This puts the cart before the horse and creates unnecessary difficulties during the withdrawal process.  To make the withdrawal process less painful, it is best to heal the body, increase stress resilience, and lessen stressors before one attempts to lower a medication.  Then, as the body gets stronger and more fully functional, the medications will naturally feel too strong for the patient’s physiological needs.  When that happens, ease down on the medication to a point of balance and comfort.  Wait for further healing to occur, before the dosage is reduced, due to the medication being too strong again. 

For patients who stop a medication abruptly, the effect of lowering a medication may follow this formula:

(original illness + underlying, undetected, untreated, and evolving illness + deterioration of underlying health due to aging + level of dependency of medication’s function) x years of medication use = degree of suffering.

This can lead to a surprising degree of discomfort.  Often, the best remedy for premature withdrawal is to get back on a medication dosage that would rebalance the patient’s biological system (rather than change to another medication), initiate proper supports, and then reduce the medication at the proper point in the patient’s healing process.  

7. The role of mind-body/energy medicine:  While supplements provide the body crucial components for healing, energy medicine can provide the blueprint for the healing process.  Both are equally important for recovery.  Even before I start to lower a patient’s medication, I will ask my patients to listen to the “Minimizing Withdrawal Problems” track on my Infinite Intention CD (see the products section to download this useful track).  They listen to the track once per week, using guided visualization, to support focused intention and the relaxation response, and to facilitate greater ease with withdrawal.  When patients do this regularly, they have a smoother, easier withdrawal process.  I believe this meditation track supports the body’s ability to quickly reduce the number of unblocked receptors, during withdrawal, by supporting the consciousness of the body’s response system.       

8. The role of detoxification: Some patients have such a high toxic load that nutritional supplementation will not be able to create significant improvement in enzymatic functioning.  Many supplements significantly support detoxification, such as methyl donors found in B vitamins, liposomal glutathione, or liver extract.  However, in special situations–for example, in individuals who have a large number of genetic mutations that interfere with detoxification, or who have high levels of mercury or lead–adding nutritional supplements may only help modestly.  In such a situation, it may be best to initiate treatment by detoxifying through homeopathic methods, eliminating food sensitivities, decreasing dysbiosis/leaky gut, or reducing viral or bacterial load.  Heavy metal chelation may be a crucial piece of recovery.  It is, however, necessary to remove any remaining metal fillings in one’s mouth before the chelation process. 

9. How to support recovery through nutrition: At a minimum, general dietary and nutritional supplement support should adequately cover the following areas: vitamins, minerals (macro and micro), essential fatty acids, amino acids, G. I. support, anti-inflammatories, antioxidants, and detoxification.  In order to heal, an individual would need to meet their total nutritional needs for the day plus have extra.  The extra nutrients are then used to move health to a higher level.  Once these basic areas are covered, additional supplements that mimic the beneficial effects of the medication to be withdrawn should be selected and used.  For example, Sanesco makes a product called “Prolent,” which provides a combination of supplements that support serotonin production.  I use it to help my patients gradually lower their need for an SSRI such as Prozac, Zoloft, Celexa, and Lexapro.  I also suggest the use of germinated brown rice, called GABA rice, to help with creating calmness during withdrawal from tranquilizing or anxiolytic medications. 

Supplements need to be carefully selected for absorbability and comprehensive coverage of physiological needs.  With higher absorbability, the amount of nutritional supplementation lessens.  Supplements that are highly absorbable often come as liquids or powders.  Whole food supplements may seem to lack the amount of nutrients found in fractionated supplements, but because of their high rate of absorbability, their effect may be many times more potent.  Sometimes, glandular supplements or protomorphogens may be helpful in supporting the liver, pineal gland, thyroid, or adrenals.  An anti-inflammatory diet is important to the recovery process.  This often means that the patient will need to reduce their consumption of wheat, dairy, and white, refined sugar.

10. Beyond biology.  Repairing the body is like repairing a radio.  Just because the radio is repaired, doesn’t mean that it will choose to play beautiful music.  We are more than our biology.  Healing our neurotransmitters and hormones, thyroid and adrenals are a wonderful way to proceed, but they only allow the person to be happy.  They do not make a person happy.  We may wish to find happiness from within a bottle, when happiness cannot be “found,” because it exists as a side effect of living life masterfully.  Healing the whole person will often require healing from past traumas that block one’s ability to embrace love and happiness.  Real growth takes place as we take tentative steps toward greater wisdom, love, forgiveness, and compassion.  Before creating a state of well-being, there is a learned aspect of being that has to be reassessed and realigned.  The road to health and well-being is paved with life’s lessons.  Some of those lessons lead to self-mastery, some to spiritual strength, and some to forgiveness.  In the end, healing leads to recognizing the journey as the blessing it has always been.