Do you want to successfully withdraw from antipsychotics?
Everyone, who has ever been prescribed an antipsychotic, has yearned for the day when they would no longer need it. Unfortunately, many who attempt to slowly lower their antipsychotic medication on their own, experience debilitating anxiety, insomnia, lack of appetite, and psychosis. Stopping the medication often leads, in 1-3 months, to a renewed reliance on an antipsychotic to recover from relapse. Basically, once you take this class of medication, it is extremely difficult to figure out a way to get off of it.
This article is a clinical review of antipsychotic withdrawal, using a patient’s case history to help organize the material. It summarizes 15 years of clinical experience with antipsychotic withdrawal in an easily understandable format. The goal of this article is to provide a glimpse into this complex process, and to guide patients and their families toward a more successful approach to antipsychotic withdrawal.
Kay was a lovely 39 year-old woman with large blue eyes and a ready, musical laugh. She wrote in her intake form, “My main goal of treatment through holistic psychiatry is to minimize the chemical dependency and utilize a naturalistic method of treatment for my disease.” She had been prescribed Abilify and Lamictal for the past nine years for her diagnosis of bipolar disorder with psychotic symptoms.
Beneath her laid-back, youthful appearance and demeanor, Kay’s desire to be free from her need for medications was supported by a firm foundation of faith, determination, and courage that went far beyond her years.
She felt the medications’ effects on her mind and body, blunting her thoughts and feelings, and she just couldn’t accept it any longer without a fight. She wanted to find a way back to herself—a way back to real health.
She had attended a retreat in March, a month before, where the leaders attempted to taper her off her Lamictal and Abilify through improved nutrition, detoxification, and energy medicine. The withdrawal was unsuccessful, and she was hospitalized for mania and psychosis. However, after her hospitalization, she was able to feel stable on Lamictal 50 mg upon discharge, rather than her usual dosage of 200 mg.
Though psychosis is one of the hardest conditions to heal, and antipsychotics one of the hardest medications to taper, Kay had the advantage of having mastered the basics. She had healthy eating habits, valued the role of supplements, and regularly meditated. Most importantly, she was open, humble, and willing to do whatever was needed to heal her condition. After being discharged from the hospital, in March, 2017, she continued her search for a safe medication taper and found my practice online.
What Kay wanted was someone who could put together all the puzzle pieces of the withdrawal process. Clearly, the puzzle pieces for her withdrawal involved more than what the leaders of the retreat provided on detoxification, nutrition, and energy medicine. David Perlmutter, MD, a holistic neurologist, pointed to a piece of the puzzle, when he said that the two main underlying causes for neurological disorders were oxidative stress and inflammation. This insight is just as applicable to psychiatric disorders. Another puzzle piece is hidden in the psychopharmacological profile of each medication, easily found in Wikipedia, which lists the medications’ effects on each receptor class and subclass.
After 15 years of working with those who sought help for medication withdrawal, I have worked hard to try to put all the puzzle pieces together, step by step, to solve the challenges involved in anticonvulsant and antipsychotic tapers. I knew that for Kay to be successful, she would have to 1) heal the underlying causes of her illness, and 2) navigate the specific withdrawal challenges of each medication. These were two separate issues, and just one of them could cause a recurrence of her disease.
To help patients with medication withdrawal, I have learned the value of integrating two additional fields of healing: functional/orthomolecular medicine and energy medicine. Each of these fields has a healing as well as a diagnostic component.
Over the years, I have learned to use whole and fractionated supplements, glandulars, diet, and detoxification, as healing components of functional/orthomolecular medicine and the functional lab tests as its diagnostic component.
In addition, I have learned to use meditation, thought field therapy (EFT and TAT), essential oils, homeopathy, and psychotherapy, as healing components of energy medicine, and muscle testing as its diagnostic component.
From my psychiatry medical training, I have learned the importance of analyzing the receptor and neurotransmitter profile of each medication (they are summarized in Wikipedia, under the psychopharmacology section), and match them with a natural nutritional or herbal support that mitigates the effects of the medication taper.
Finally, if needed, I have colleagues that can I refer my patients to, who could provide expertise in: homeopathy, chiropractic medicine, naturopathic medicine, biological dentistry, neurofeedback, nutritional guidance, acupuncture, cranial sacral therapy, and other helpful clinical interventions.
With this combination of knowledge and resources, patients have a much better chance of successfully withdrawing from their medications.
Regarding the neurobiology of antipsychotic withdrawal (a variety of classes of receptors being blocked) and Lamictal withdrawal (GABA enhancer, NaCl ion channel blocker), I generally do the following to help taper from the different classes of receptors:
1. Overactive Dopamine receptors: GABA support with liposomal GABA, GABA rice, Taurine, CBD oil.
2. Mixed effects on Serotonin receptors: 5 HTP and its cofactors to help with creating serotonin (Prolent) if needed.
3. Overactive Muscarinic receptors: Inositol.
4. Overactive Sodium Ion Channels: Potassium Chloride.
5. Overactive Histamine receptors: natural antihistamines like Allqlear by Integrative Therapeutics, Histaplex A-B by Biotics Research, or Opsin II by DesBio. Avoid xenobiotics for antihistamine support, such as Benadryl, because the body will retaliate with an inflammatory response to a xenobiotic.
6. Underactive GABA receptors: more GABA nutritional support.
7. Overactive Beta adrenergic receptors: herbals such as Carditone for BP management
8. Overactive Alpha adrenergic receptors: Magnolia Bark Extract or Magnolia Stress Aid (Energy Tools)
With regard to glandular support, I usually pay attention to supporting the liver with liver extract, and the pineal gland, with pineal glandular support.
With regard to nutritional support, I provide highly absorbable supplements to help the patient exceed their daily nutritional needs. If the patient meet their daily nutritional needs, their health stays the same the next day. If they exceed their nutritional needs, they will have the extra nutritional support they need to move towards healing.
The eight areas of nutritional support are: vitamins, minerals, amino acids, essential fatty acids, G.I. support, antioxidants, anti-inflammatories, and detoxification.
Looking at the whole picture, it is important for the patient to lower their stress in five different areas of functioning: spiritual, mental, emotional, physical, and social. Lowering stress in one area will help to lower stress for the patient as a whole.
Everything is interconnected
Putting a mix of energy and functional supports together, I created Kay’s first of many nutritional supplement regimens. Her regimen was updated weekly to match her healing needs over time.
Many of Kay’s initial supplement regimen went toward healing underlying causes for oxidative stress and inflammation. Some of her supplements lowered possible viral causes for inflammation. Lymph drainage, glutathione, and liver extract, among other supplements, strengthened her ability to detoxify. Antioxidant support was given through Moringa powder and ThionExtra. The purpose of her first regimen was to build a strong foundation for medication withdrawal.
A few weeks into her withdrawal process, additional supplements for withdrawal were added, such as: Inositol, Prolent, Taurine, Potassium Chloride, Li-Zyme Forte, liposomal GABA, Allqlear, and Endoca CBD oil, to help her to lower her medications safely. After being on her supplements for 2.5 months, her dosage of Abilify had gradually lowered from 10 mg to 3 mg, and her Lamotrigine had gone from 50 mg to 10 mg. She did not notice any negative withdrawal symptoms during this phase of her withdrawal.
However, three weeks after stopping all her medications, she began to experience problems with sleep. Her sleep had a strange pattern of being good one day and bad the next, in an alternating pattern. We went back up on her Abilify to 1 mg, and then upped it to 2 mg after a week, but she continued to struggle with insomnia. Kay reported that her mind felt clear and calm, but her body felt like she had flu-like symptoms. She did not experience mania, psychosis, or delusions.
Sleep is one of the most sensitive indicators of the patient’s state of health. When Kay’s sleep became disrupted, I knew there was something off balance, and I had to find out what it was ASAP.
Using the diagnostic techniques that I had learned from energy medicine, I dug deeper to find the cause of her insomnia. I found that her alpha-adrenergic receptors were not adequately blocked. She had too many of these receptors, creating a state of imbalance. Histamine levels, however, were great after stopping her medications, but it wasn’t enough to help her overcome her withdrawal.
While looking at possible options, I re-discovered Magnolia, a supplement I had used about 10 years ago, which appeared to target the alpha-adrenergic receptors. I added magnolia bark extract and Magnolia Stress Aid to Kay’s regimen, and her sleep immediately normalized, even though she followed my recommendation and stopped taking Abilify 2 mg, without tapering. Soon after adding Magnolia, Kay’s regimen began to simplify, and she no longer needed to do the meditation called, “Minimizing Medication Withdrawal Problems” on a regular basis.
Testing showed a rapid decrease in her need for detoxification and immune support. Given the way medications increased a patient’s toxicity and inflammation, because it was a xenobiotic (foreign substance), that made sense. Other supplements involved with helping with medication withdrawal also quickly reduced.
Working with Kay taught me that every one of the classes of receptors affected by Abilify needed to be in a state of balance, if a patient was to successfully withdraw. Abilify strongly affected five types of receptors and 17 subclasses of receptors that have been studied. Who knows how many receptors it affected that have not been studied. All of these receptors needed to remain in a state of balance, during the withdrawal process, to flow smoothly.
Another important aspect of medication withdrawal sheds light on the difference in difficulty between the beginning vs. the end of medication withdrawal. Almost always, it is more difficult for patients to withdraw at the end than at the beginning of the withdrawal process.
The exciting key, to unraveling this mystery, is understanding that the benefits from medications are dose dependent, while hypersensitivity to the medication is not dose dependent. Hypersensitivity to medications increases over time, and a small amount of medication can create a immune cascade reaction, similar to a vaccine, pollen, or other antigen/foreign substance. At the tail end of medication withdrawal, the dose dependent benefits from the medication are at their lowest, and the hypersensitivity reaction to the medication is at its highest.
Histamine goes up due to the hypersensitivity reaction. Histamine is a neuromodulator of the adrenals. The adrenals release adrenalin in response to increasing histamine. The patient then moves into the “fight or flight” mode, with adrenalin causing increasing anxiety and insomnia.
The longer a patient takes a medication, the stronger the immune reaction to that product. Since inflammation is one of the key underlying causes for both neurological and psychiatric problems, it is understandable why, over time, medications can evolve from a helpful, to an ineffective or even harmful intervention.
Kay began her withdrawal in April, 2017. She was able to safely stop her Lamictal and Abilify in July. With the addition of Magnolia Bark Extract, her short period of insomnia completely resolved.
Her healing will need close monitoring over the next three to six months. The most vulnerable period of time during withdrawal is the first 6 months after stopping a medication. During that time, environmental and personal/relationship stressors can more easily create a relapse without the numbing effects of the medications. It is a transitional phase when the body is getting acclimated to longer periods of time without the medication. My hope is that, over time, more will be learned about the intricacies of the medication withdrawal process.
[In my next article, I will explain the importance of integrating energy medicine techniques into the withdrawal process. When I first started my work in medication withdrawal, I thought that energy medicine interventions were adjunctive supports for the withdrawal process. But, just like a lamp, energy is as vital to medication withdrawal as electricity is vital to the lamp giving off light.]
Alice W. Lee, MD