When deciding whether to start using a psychotropic medication such as an antidepressant, there is often concern over whether this choice will become a life-long sentence and what the consequences could be if the medication is later discontinued. Learn more about the risks and benefits of psychotropic medications, as well as what science knows about the long-term outcomes of their use:
There are very real reasons to start taking psychotropic medications
Often if a person is considering using a psychotropic medication it is because they have significant symptoms that are impairing their functioning and decreasing their quality of life. At least that is the way it used to be. Now, it is becoming increasingly common for people to start taking medications without first attempting other approaches such as therapy or holistic treatments as those treatments are harder to access and take more time and money.
For many people, therapy and holistic treatments could be sufficient to help them learn the skills they need to address the problems underlying their anxiety or depression and improve their functioning. Yet some people prefer to use medications or do not have access to other treatments.
Medications should be used when symptoms are so severe that quick relief is needed. At times, the nature of the symptoms could mean that therapy cannot be adequately utilized, such as in cases of Schizophrenia with active symptoms or severe depression that makes it difficult to think clearly. Psychotropic medications are also recommended when other treatment approaches have been exhausted with insufficient relief.
While psychotropic medications can provide relief from many different disorders, the results can vary. Sometimes, the initial benefits seen may be the result of a “placebo effect” (essentially due to a person’s belief that it will work). Even with relief of symptoms, there can be a risk of side effects that will vary depending on the medication. For example, antidepressants can cause emotional numbing, fatigue, and sexual side effects.
Discontinuing psychotropic medications
Psychotropic medications work by affecting the neurotransmitters in the brain. When someone chooses to discontinue a psychotropic medication, they should do so under medical care and monitoring. To suddenly stop the use of many medications can cause withdrawal symptoms or relapse of the original underlying condition for which the medication was started. A psychiatrist or psychiatric nurse practitioner can recommend the best way to gradually taper off from medications so that any withdrawal risks are minimized. Basically, the brain needs time to readjust to not having the medication, so best not to rush.
In recent years an article in the New York Times brought a lot of attention to the issue of stopping medications and indicated the discontinuation of antidepressants often results in withdrawal symptoms (what is called “discontinuation syndrome”).
Many factors influence whether someone will have withdrawal symptoms. Research indicates it seems to occur more often in people who have engaged in long-term use of a medication. Unfortunately, the problematic withdrawal symptoms sometimes force people to maintain use for longer than they actually intended or want to use the medication. Maybe they no longer need the medication, yet they cannot stop it due to severe withdrawal symptoms.
As the New York Times article illustrates, the reality is that most antidepressants were approved for short-term use in research studies that lasted approximately two months on average. There is little research on what happens when medications are stopped after long-term use.
Withdrawal symptoms are quite common with serotonin reuptake inhibitors (SSRIs). While the recommended approach has been to taper people off such medications slowly, for long-term use there is no clarity about just how slowly we should be tapering. I see that some of my patients can taper off in a month while for others it takes years to taper off certain antidepressants. In my clinical experience tapering off duloxetine (Cymbalta), paroxetine (Paxil), and venlafaxine (Effexor) is accompanied by the most severe withdrawal side effects. I very rarely prescribe these medications now, as I know that once someone is on those medications it may be very difficult to stop.
The medications that are more difficult to discontinue often have a shorter half-life (which means they quickly leave the body). Common withdrawal symptoms include nausea, headache, and dizziness. Some people experience electric shock sensations in the brain and paresthesia (tingling sensations in the body). Symptoms often last for weeks or longer. Research suggests symptoms may be the result of a stress response in the brain towards the chemical changes.
How to minimize withdrawal symptoms
To avoid such intense withdrawal symptoms some people are turning towards micro tapering so that they can slowly stop using the drug. Online resources may advise on this process and your psychiatrist can send a prescription to a compounding pharmacy to compound gradually smaller dose of the medication. Certain long acting medications cannot be compounded unfortunately as they come in special capsules. While online resources that advise on this can help you get oriented, they cannot replace the advice of a psychiatrist who can respond to your unique needs and monitor your health throughout the process.
Before starting the process of tapering, you can do a few things to protect yourself against the effects of withdrawal. Essentially, people need to prepare their body and brain for the change they are about to experience. To prepare the body, it is helpful to address diet and nutrition. Many people with mental health problems have blood sugar that is out of balance, immune system dysregulation, and internal inflammation that causes or at least exacerbates their symptoms. A history of eating overly processed foods can lead to problems in the gut/brain axis.
So before you start tapering from long term SSRIs you may want to tune up your body through embarking on a three month health protocol of clean eating, taking supplements (a high quality multivitamin and others as guided by your doctor based on your lab results), exercise, good sleep and addressing any other issues that need your attention and drive stress in your life. Also in this time develop a mindfulness or relaxation practice to support your nervous system during the taper. Additionally, conditions such as adrenal fatigue can interfere with a taper and so need to be addressed. Essentially, the body needs a check-up and tune-up before starting the process of tapering off of long-term psychotropic medications.
Beyond preparing the body, the mind must also be prepared for the shift off psychotropic medications. Often, the initial mental health problems started as a result of dealing with stressors, life changes, challenges, and setbacks. To prepare the mind for the discontinuation of psychotropic medications, therapy can help to increase the ability to manage stressors and to increase the skills you need to be resilient in the face of difficult life events.
Final recommendations
Most SSRIs are prescribed by primary care doctors. While this can be appropriate for short-term use, it is less ideal for long-term treatment. If you are struggling with stopping an SSRI or another medication, you may want to see a mental health specialist such as a psychiatrist or psychiatric nurse practitioner.
If you can access an integrative psychiatrist or integrative mental health provider they will be able to guide in the use of diet, lifestyle and supplements that may be helpful as you taper off medications. An integrative provider can take a holistic approach which may include therapy, nutrition changes, supplements, and psychotropic medications as needed. Psychiatrists will be able to pick up on major issues that come up during discontinuation and offer treatment options.
If you are currently on medications and want to taper, set yourself up for success. It is also a good idea to consult with a mental health provider to assess your unique situation, help determine whether discontinuation is appropriate, recommend a safe process for discontinuation, monitor any symptoms of withdrawal, and help you to maintain your mental health throughout the process.
Ultimately, each person’s situation is unique, as to whether they may benefit from the short or long-term use of medication. What is universal is that everyone wants to live a life that is healthy and happy. Several prescribers at Mind Body Seven and Integrative Mind specialize in supporting patients in coming off medications safely.
Mind Body Seven clinicians offer treatment in Brooklyn and via teletherapy for adolescents and adults. If have not worked with us and want to get started please contact us here, so we can set you up with the clinicians that best suit your individual needs. If you are an existing patient get in touch with us here to set up your next appointment.
