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 recurrence of the illness and 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, summarizing 15 years of clinical experience with antipsychotic withdrawal in an easily understandable format. The goal of this article is to provide a brief glimpse into this complex process, and to guide patients and their families toward a more informed approach to antipsychotic withdrawal.
Though psychosis is one of the hardest conditions to heal, and antipsychotics one of the hardest medications to taper, much can be healed and accomplished by just mastering the basics: healthy eating habits, exercise, and meditation.
David Perlmutter, MD, a holistic neurologist, pointed to two pieces of the puzzle for healing, when he said that the two main underlying causes for neurological disorders were oxidative stress and inflammation. His 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 put the puzzle pieces together, step by step, to solve the challenges involved in anticonvulsant and antipsychotic tapers. For patients to be successful, they would need to heal 1) the underlying causes of the illness, and 2) navigate the specific withdrawal challenges of each medication.
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.
In functional medicine, the tools that heal come in the form of whole and fractionated supplements, glandulars, diet, and detoxification. Its diagnostic component is functional lab tests.
The tools of energy medicine include meditation, thought field therapy (EFT and TAT), essential oils, bach flower essences, homeopathy, and psychotherapy. Muscle testing is 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 a group of clinical colleagues that can I refer patients to, who could provide expertise in: psychotherapy, 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 an improved chance of successfully withdrawing from their medications.
Regarding the neurobiology of antipsychotic withdrawal (a variety of classes of receptors being blocked), I generally do the following to help with the tapering process:
1. Overactive Dopamine receptors: GABA support with liposomal GABA, GABA capsules, GABA rice, Taurine, CBD oil.
2. Mixed effects on Serotonin receptors: L-tryptophan, 5 HTP, and its cofactors to help with creating serotonin (Prolent or SeroPlus) if needed.
3. Overactive Muscarinic receptors: Inositol.
4. Overactive Sodium Ion Channels (e.g. during Lamictal withdrawal): Potassium Chloride 99 mg per day.
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 react with an inflammatory response to a xenobiotic.
6. Underactive GABA receptors: more GABA nutritional support, additional taurine, and calming meditations.
7. Overactive Beta adrenergic receptors: herbals such as Carditone for BP management, Stress E-Z by Herbs Forever.
8. Overactive Alpha adrenergic receptors: Magnolia Bark Extract or Magnolia Stress Aid (Energy Tools), decreasing stress with meditation or EFT technique.
Additional products that help with antipsychotic withdrawal, which I have used are: CBD (cannabinoids) oil from hemp oil, Skull cap extract, passion flower extract, and valerian. These calming herbals support sleep, appetite, and mood stability. With CBD, or hemp oil, I am leaning towards those that carry a broad array of active cannabinoids rather than the more refined and processed products. Too much CBD oil, however, may cause increased anxiety, because not only does CBD decrease glutamate levels, but it also decreases GABA, and GABA is important for calming the nervous system.
With regard to glandular support, I usually pay attention to supporting the liver with liver extract, and the pineal gland, with pineal glandular support. For some patients, glandular support for the kidneys is critical.
With 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 nutritional health stays the same the next day. If they exceed their nutritional needs, they will have the extra nutritional support they need to move the body 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.
For all patients in my practice, a mix of energy and functional supports is integrated into a "regimen," which is updated weekly to match the patient's healing needs over time.
Many initial supplement regimens aim at healing underlying causes for oxidative stress and inflammation. Some supplements may also aim at lowering possible viral causes for inflammation. Lymph drainage (by Deseret Biologicals), glutathione, and liver extract, among other supplements, are often used to strengthen the patient's ability to detoxify. Antioxidant support is given through Goji powder, Acai powder, Moringa powder, or essential oils. The purpose of the early regimens is to build a strong foundation for recovery and resilience to stress.
A few weeks into the withdrawal process, additional supplements for withdrawal may be necessary, such as: Inositol, magnolia, Prolent, Taurine, Potassium Chloride, Li-Zyme Forte, liposomal GABA, Opsin II/Allqlear, or CBD oil, to help to lower medications safely (depending on the receptor profile of the medication). Often, after being on these additional natural supports for a week or more, patients will feel "overmedicated" and can lower their medications gradually (10% or less), without problems with anorexia or insomnia.
Sleep is one of the most sensitive indicators of the patient’s state of health. If a patient's sleep becomes disrupted during the withdrawal process, it indicates that something is off balance and need to be addressed immediately. Either go to a higher dosage of medication until sleep is restored, or integrate a natural support to relieve the imbalance and restore healthy sleep.
Working with withdrawal over the years has taught me that every one of the classes of receptors affected by a medication needs to be in a state of balance, if a patient is to successfully withdraw. For example, Abilify strongly affects five types of receptors and 17 subclasses of receptors that had been studied. All of these receptors need to remain in a state of balance, during the withdrawal process, for withdrawal 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 the mystery, is understanding that the benefits from medications are dose dependent, while hypersensitivity to the medication is not dose dependent.”
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.
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 buffering and 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.
Alice W. Lee, MD
Additional note: since this article was published, I have added support to help diminish stress from EMF stressors coming from electronic equipment. I hope that interventions that decrease harmful EMFs will ease stress for the sickest patients who are often the most sensitive to disturbances in light, sound, and vibrational frequencies.