A Guide to Supported Psych Med Tapering

I never meant to find myself on psych meds for 7 years. Starting wasn’t the wrong choice, but staying on them, at some point, stopped being a choice. I just remember being told I wasn’t supposed to stop. And this is why I’m actually grateful for the progressive worsening of my depression in those years…stay with me. If things hadn’t gotten worse, I never would have sought out a naturopathic doctor that had the training to support me in coming off my medications in a safe and supported way. And I wouldn’t have been inspired to accept the torch myself to be able to share this information with others like me.

The goal of any taper is harm reduction – balancing the risk of extreme mental states with the harm of adverse drug side effects and disempowering diagnoses. Complete discontinuation is not a success and remaining on medication is not a failure. The only success is a collaborative, individualized approach where my client feels informed and empowered.

When is the right time to taper off meds…and why?

The right time to taper is a highly individualized decision. Many people might wait for a time when life events have stabilized and they have a solid grounding to start making a big shift. For some, that stability feels like it never comes. I do believe that with the right support, it is still possible to begin a taper when life is moving fast and crazy. That doesn’t mean I outright recommend it, but I will still support people who make this choice for themselves. Ultimately, I think the “right time” doesn’t exist (for med tapering, yes, but also as a life mantra…). In my experience, it comes down to personal why’s and professional how’s. In other words, having strong reasons and stronger support.

The most obvious reason for people wanting to taper or discontinue psych meds is undesired side effects. You may be surprised, but this is actually not the most common reason I see in practice. Typically, people just aren’t feeling better or better enough on their meds and wonder after a certain time whether they are even doing anything at all. It’s the unfortunate consequence of the “for life” prescribing approach in the psychiatry world. Psych meds are most useful in the acute phases of psychosis, mania and sometimes in severe depressive episodes. But their role in long-term maintenance doesn’t stack up. In research studies, the “number needed to treat” of the antipsychotic medication Zyprexa (or Olanzapine), for example, is about 8. This means that out of every 8 people who remain on the medication, 7 would have been similarly stable on placebo.

Many people may also decide, whether or not they believe their meds are helping them feel better, that they want to heal on a deeper level. That after a certain period of time, they realize symptom suppression with medication doesn’t align with an internal drive for higher self-actualized authenticity. For many, it’s about starting to listen to that inner voice asking if we truly are who we are.

What is psych med withdrawal?

In all cases, psychiatric medications cause neurochemical brain changes. Your brain gets used to the changes overtime and has a hard time adjusting when the medication is removed. Depending on the individual and the medication, these withdrawal symptoms can include anxiety, insomnia, brain zaps, dizziness, flu-like symptoms, nausea, headaches, changes in appetite, issues with movement/balance, and more.

Whether or not you experience withdrawal symptoms and to what degree depends largely on individual sensitivity. As does how you respond to and benefit from naturopathic treatments. This sensitivity builds the framework for the approach I take to supporting you on your med taper journey.

My supported approach to med taper

1. Support first, taper second.

Psych meds save lives. They can also help us function in societies that don’t make enough space for humanness and healing. But they don’t treat mental health disorders. Depression is not an SSRI deficiency. Anxiety is not a benzodiazepine deficiency. Mental health disorders are, almost always, persistent survival states in response to some form of trauma. And just as we would never remove a cast before a broken bone heals, I don’t condone pulling away the medication before we begin to treat the underlying dysfunction it is covering. My rule of thumb is you should feel consistent improvements for 3 months with naturopathic treatment before we begin to taper.

I use homeopathic remedies for this first step because there are no interactions with medications. Most people coming to me on medication still have their original symptoms present to some degree, so we have enough information to make an accurate homeopathic prescription. In other cases where symptoms are significantly or completely suppressed, we do our best to support first and then make the smallest dose reduction possible.

I worked with a young woman who had been on moderate doses of antipsychotic and antidepressant medications for nearly 10 years but was still experiencing debilitating anxiety. I started her on a homeopathic remedy that helped her significantly with anxiety and panic attacks for months. At the time, she wasn’t ready to taper off her medications out of fear from terrible experiences when trying to do so in the past. Not all of my clients on psychiatric medications come to me with the goal of tapering, and I respect that. My only agenda was to support her in reaching the goals she set for herself. But after over a year of working together, it started to feel like we were on this rollercoaster of several good months, followed by several difficult months, and so on. When I notice this happening, I know we are missing an element of depth in the case. We made the decision together to start very slowly tapering off her meds. As we did, we started to uncover symptoms she had not experienced since she was a child and were able to progressively treat her anxiety and depression on a deeper and deeper level. She is still on a very low dose of her antipsychotic medication which is where she may stay, but she has reached a much more resilient state and is no longer surfing the wave of ups and downs.

2. Go as slow as possible.

When psychiatrists do agree to help their patients taper off medications, it’s generally by the 2-week rule with slight variations depending on number and dose of medications. Basically, “white knuckle it for 2 weeks then you’ll be fine.” I can assure you this does not work for the vast majority of people. Either it leads to such severe levels of suffering that the medication needs to be restarted or to protracted withdrawal symptoms that last much longer than 2 weeks. 

It's okay if your taper takes months or years. I always find the slower, more gradual tapers to be the most successful. There is no one way to start but some people do well with a 10% or less reduction in their original dose every 2-3 weeks or longer until half of the original dose is reached. I give this example so you can appreciate how this compares to 25% every 3-4 days.

A supported taper also means we’re allowing time for deeper healing to take place at the same time. In other words, not just allowing ourselves to return to neurochemical baseline prior to starting meds but actually rewiring our nervous systems to respond to the world in a more adaptive way. I hope you can appreciate the scale of work this takes our bodies to accomplish and the grace required for it to happen.

No one-size-fits-all

Rarely if ever, as long as the taper is done slowly enough, will true withdrawal symptoms actually present. In some cases, when a faster taper is medically necessary due to severe side effects, certain naturopathic supplements such as nutritional therapies to help rebuild neurochemistry, may be supportive in reducing the intensity of withdrawal symptoms. Most people who are tapering will benefit from some sort of supported detox, as taking psychiatric medications overtime compromises detox pathways. But this could be as simple as daily bowel movements, hydrating electrolytes and exercise to break a sweat – the foundation I always start with.

Psych med taper is a delicate dance between you, your body and your provider(s). The takeaway? Don’t do it alone. I didn’t have to, and now I’m here so you don’t have to either.

With love,

Dr. Kayla Amin

https://mcimh.com