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How to Stop Taking Psychiatric Drugs

(And How Not To!)


Psychiatric drugs are prescription narcotics: drugs that are prescribed by doctors to alter feelings, behavior, mood, perception, or sleep. No doctor calls them prescription narcotics. They may be called psychiatric medicines, psychoactive drugs, antipsychotics, neuroleptics, sedatives, anxiolitics, antidepressants, sleeping pills, and various other names. Drugs prescribed for neurological conditions such as epilepsy and Parkinson’s disease are closely related to prescription narcotics, and some are also used in psychiatry.

It is extremely dangerous to abruptly stop taking these drugs after long-term use. How long is long-term? That depends on the type of drug, the dose, how many drugs are taken simultaneously, and the individual’s responses. Some people succeed at stopping a certain drug after a month or two, others already cannot stop safely after two or three weeks. Unfortunately, one cannot know in advance to which category he belongs.

These drugs “work” by suppressing or stimulating the central nervous system, just like illegal (street) drugs do. And like illegal drugs, after a short while, the body becomes addicted. Abruptly discontinuing the drugs can have catastrophic effects on the body, including seizures and death. No less dangerous are the effects of abrupt discontinuation on behavior. In extreme cases the withdrawal effects cause people to commit murder or suicide.

Behavior and feelings are regulated, among other ways, by the brain. Brain cells, called neurons, communicate with each other through certain chemicals called neurotransmitters. Prescription (as well as other) narcotics change neurotransmission. The brain tries to neutralize this change. For instance, so-called antipsychotics reduce transmission of the neurotransmitter dopamine by blocking dopamine receptors. To compensate, the brain steps up production of dopamine. When the antipsychotic is abruptly withdrawn, the blockage is suddenly removed, allowing the brain to become flooded with dopamine. The effect is similar to taking a shot of cocaine. Cocaine stimulates dopamine (among other neurotransmitters) in the brain.
   
Withdrawing from psychiatric drugs is almost never mentioned in medical literature. That is because such literature is almost always funded directly or indirectly by the manufacturers of the drugs. They have no interest in researching safe ways of stopping the use of the drugs. They want us to always continue taking them, of course!

Physicians rarely agree to cooperate with efforts at reducing the use of psychiatric drugs. Therefore they have little experience with it. They do sometimes agree to change the prescription from one drug to another. This can be helpful when the other drug is easier to use in deviant doses. When a physician agrees to cooperate with drug reduction, he usually advises to start by cutting the dose in half. Such a drastic reduction is doomed to failure.
   
Withdrawal effects cannot always be completely avoided, but often they can be kept manageable by reducing the dose very gradually. Below are some suggestions that may help you reduce your intake of psychiatric drugs:
  1. Ideally, your psychiatrist or family doctor should cooperate. Set up a written schedule together, to help keep the goal in sight. 
  2. Involve a family member or friend with whom you are in contact daily, and who supports your efforts to stop using the drugs. This person can let you know when s/he sees signs that something is going wrong that you yourself don’t notice.
  3. Obviously the problems you had before you started using the drugs will still be there when you stop. They may even hit you harder, because the drugs made you more sensitive to stress. Therefore, plan in advance how you will deal with these problems. Examples: If you hear voices, a mutual support group for voice hearers may be helpful to you. If you are lonely, you may want to find volunteer work in an area that has your interest. If you have sleeping problems, plan how to cope with being awake, such as reading or watching TV in bed.
  4. If you use more than one drug, reduce only one at a time. Choosing the "antipsychotic" first may be a good idea, as it is the most harmful of the drugs. On the other hand, it may also be the most difficult to reduce.
  5. If you receive your drug in slow-release or depot form (all shots and some pills), first switch to a daily pill of the same drug. To do so you will need the cooperation of a physician, as s/he will have to write the prescription for you. Once you have switched, don’t begin reducing for several months yet, until you are sure that the daily pill is doing the same to you as the depot.
  6. Reduce in small decrements, not more that 5% of the original dose at a time. Allow several weeks per decrement. For example, if you have been taking 2 mg Risperdal per day for the last year, now take 1.9 mg. Continue taking 1.9 mg three or four weeks before reducing further. If you have no special problems during those weeks, make the next dose 1.8 mg and again keep this up three or four weeks, etc. If you have been using the drug longer than a year, intervals of six to eight weeks between dose reductions may be necessary.
  7. Don’t skip any step. Don’t try to rush it. You have probably guessed already that it may take years, particularly if you are on more than one drug.
  8. If something bad happens in your life, suspend your efforts to reduce the dose until matters around you stabilize again.
  9. Your pharmacy can turn pills into capsules of any dose if your doctor provides the prescription. This way you can take pills in doses that deviate from the ones that the manufacturer provides. Some drugs, like Haldol and Risperdal, are also available in liquid form, which is much easier as you can control the dose drop by drop yourself. If you use a liquid, make sure you don’t leave drinks with the drug in them where someone else may unwittingly find them.
  10. Don’t forget to eat properly and take plenty of gentle exercise, like strolling or cycling.

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