Ten Practical Considerations During Medication Withdrawal

While there will never be an end to improving my knowledge about medication withdrawal (unfortunately), there are a few things here and there that I have picked up over the past few years, which have far surpassed my “training” on this topic during my psychiatric residency. In fact, I believe that in all my years of training, I have never heard anyone ask about medication withdrawal except me. It was over a decade ago, but I recall the Attending physician mentioning two things: first, go slowly, and second, do it after the patient had been on the medication (antidepressant) for at least three years. The three years rule was due to some research study that showed improved outcome in patients who waited that long before withdrawing from antidepressants.

So, I was not well prepared to deal with this important aspect of psychiatric care upon graduating from a decade of psychiatric training. The sorry thing was, I didn’t even realize I had a black hole in my training, nor do many other physicians, given our total concentration on putting patients ON medications and the assumption that going off would more than likely result in a relapse of the illness.

The truth of the matter is that there are ways to get off medications safely and comfortably. But it does require stepping out of the box, changing our paradigms about healing, and learning new material. Because to do so is not easy. However, to refuse to do so, when the information is available, is negligent of our duty as physicians.

There are many important considerations when undertaking medication withdrawal, and the following list provides only a few of these considerations. It would be helpful to consider this list as simply informal, clinical notes on this broad and complicated topic, but even so, I believe it can be of help to those who are interested in this topic. It is not meant to replace competent medical supervision and care, but to heighten awareness of the common pitfalls and problems associated with withdrawal.

When helping a patient through medication withdrawal . . . .

1. Realize that there are at least THREE areas that need to be healed and supported: a) withdrawal symptoms, b) underlying health problems, which led to the patient’s need for medications, and c) damage done to the patient from using a xenobiotic (medication) over time. The naive assumption that, if patients are stable, all there is to do is help them lower their medication(s) will result in some surprising outcomes. Being aware of three areas and not just one when tackling withdrawal allows a better assessment of what will happen during the withdrawal process. For example, if a patient had a difficult to treat underlying problem that began in utero or from early childhood, had been taking medications for decades, many of which were highly damaging to the body, then, even if the patient comes in looking sweet as a rose before medication withdrawal, you will be opening a Pandora’s box when you do so. How a patient presents (symptoms and complaints) does not determine how difficult the withdrawal will be. A patient who comes in after taking a medication for just a few weeks, complaining of a great many symptoms after taking the medication, may be able to withdraw from the medication very easily, especially if the underlying illness has all but healed.

Medications do have varying abilities to damage the body, some being harsher than others. As patients use these medications over time, this damage will accrue over time. This damage is in addition to the emotional and psychological dependence to psychotropic medications, which generally increases over time. Being aware that the amount of time a patient has been on medications will allow a more accurate estimate of how difficult the withdrawal process will be.

2. The rate of withdrawal depends on a lot of factors. So, “slowly” is quite relative to: a) what the patient is taking with respect to orthomolecular and energy medicine support, b) the person’s state of health and diet, c) the toxicity and addictive nature of the medication, d) the psychosocial stressors during withdrawal, e) how long the patient has been on the medication(s), f) whether or not nutritional support is the best way to ameliorate the effects of the medication or heal the underlying illness, and g) how many receptors are being affected simultaneously by the medication. The better the support, the more quickly patients can withdraw from their medications. So, slowly is not a hard and fast rule in medication withdrawal. However, if patients without any knowledge about the intricacies of medication withdrawal were told by an ignorant physician to do it on their own (slowly), not knowing that nutritional support would be critical, it may be impossible for them to go slowly enough to avoid the pitfalls of withdrawal, and they may end up with chronic health problems despite their best efforts.

My clinical experience has been that medications which affect multiple receptors will be more difficult to withdraw than medications that only affect one receptor. My assumption is that one taper of such a multi-receptor medication would be the equivalent of simultaneously lowering multiple single-receptor medications. It would be more demanding on the body and more difficult to support both nutritionally and enzymatically.

3. “Protracted Withdrawal” happens when something hasn’t healed during the withdrawal process. It could be the immune system, the gall bladder, the hormones, the liver, or some other part of the body. During withdrawal, if all three areas are not healing well, some aspect of the patient’s illness will become evident as the medication, which had suppressed the expression of clinical symptoms, is tapered. As a consequence, the less one knows about how to help a patient heal the three areas of health, the more the patient will suffer from “protracted withdrawal.” Sometimes, patients end up with “protracted withdrawal” that is very debilitating for years when they try to withdraw on their own, not knowing that their “psychotropic” medications not only had a profound impact on their nervous system, but also their hormones, immune system, liver, etc. “Protracted withdrawal” should not be used to place blame on the medication’s mysterious and nefarious machinations, for clinicians who handle withdrawal very well will struggle less with protracted withdrawal.

4. Supplements can only do so much. Although the patient may be taking highly absorbable, comprehensive, and highly supportive supplements during withdrawal, there are still limits to what supplements can do. A supplement cannot eliminate a patient’s hypersensitivity and allergic responses to the supplements, nor can it work when the basic enzymes and structures for handling supplements are no longer operable, nor will it change the curvature of a patient’s cervical spine. Sometimes, despite the patient’s desparate need for nutritional support, the first line of action may be detoxification, elimination of wheat and dairy, or a chiropractor. Sometimes, the patient needs energy medicine to heal a problem with “massive reversals,” a condition that is suggested by the patient’s repeated patterns of self-destructive choices and relationships, despite best laid plans for well-being. The best analogy would be that of a house in the process of being repaired. If the house is just suffering from old wall paper and out-of-date furniture, then one can go in and spruce up the place with a few well chosen touch-ups. If , however, the house in question lacks electricity and plumbing, the roof is caving in, and the foundation is sagging half off the cliff, then a few rolls of wallpaper and a new sofa just won’t do the job. When approaching a patient who wants to withdraw from medication(s), consider what is really underneath the superficial layer of medication induced function. Be open to other tools to help with withdrawal in addition to nutritional supplements.

5. Don’t put the cart before the horse. In the rush to get off medications, patients will often taper first and ask questions later. That is not wise. As the knight would say in the movie Indiana Jones and the Last Crusade, “He chose . . . poorly.” In just about all cases of medication withdrawal, it is important to take time to heal the body, strengthen its systems, and increase resilience before one attempts to lower a medication. If, however, a person chooses to lower a medication before healing occurs, at the very least, the person will return to the original state of illness prior to starting medication(s). For many patients, the effect of lowering a medication after taking it for several years follows the following formula:

(original illness + underlying, undetected, untreated, and evolving illness + worsened health due to damage done by the medications used + withdrawal effects) x years of medication use and health neglect = degree of abysmal misery.

As this formula begins to unfold in all its amazing enormity, the patient then calls the orthomolecular physician for assistance. At this point, the withdrawal may have resulted in gastrointestinal dysfunction, hormone imbalance, and insomnia. The healing process will be quite difficult at this point in the patient’s treatment. However, physicians who take the time to help such patients may still be able to remedy the situation. But it would be helpful to explain to the patient the reason why their recovery may be more difficult to manage and a collaborative effort could be established between the physician and patient.

6. Keep a close watch on how healing progresses after the medication(s) have been stopped. Withdrawal and the need for vigilance will last beyond the last pill taken. The longer the patient has been taking medications, the higher the dosage of the medication taken daily, and the more pervasive the effect of the medication, the longer the withdrawal process required before the task is done. This needs to be explained to the patient beforehand, so that they don’t stop treatment prematurely, thinking that they are all done with their recovery when they may still have 20% of the journey left to go.

7. Never underestimate the power of energy medicine. If you happen to be a supplement kind of person, then this may come to you as a surprise. But of all the tools in my arsenal for helping patients with withdrawal, the one I value most is energy medicine–yes, even above the wonderful effects of nutritional supplements and herbal remedies. I call energy medicine, “the quantum physics of healing.” The reason I find energy medicine so valuable is because it helps with the formation, information, and transformation of health at the subatomic level. Here is where little things (energy, vibration, and thoughts) result in moving mountains, not slowly even, but miraculously. As many of the testimonials in my newsletters mention, almost casually, energy medicine is very helpful during the withdrawal process. Patients like it. An eleven-year-old can learn to do it. I taught EFT to a six-year-old once, and he was able to learn it without difficulty. And as one of the follow up testimonial attests, at least one of my patients remained well with just using energy medicine despite having a diagnosis of bipolar disorder with psychotic symptoms–even when she stopped all orthomolecular nutritional supplements (believe me, she did it while my back was turned).

Energy medicine is a vast and burgeoning field. To go from orthomolecular medicine to energy medicine requires a mental leap, just as physicists had to make that leap years ago when they went from Newtonian physics to quantum physics. Consider this: if all matter is made of energy, and we are made of matter, than we are also fundamentally made of energy. The laws of quantum physics are not simply applicable to technology. They hold just as many helpful truths about the matter between our ears.

8. Supplements and detoxification have different levels of immediacy in different patients. Some patients are so toxic that they can’t handle the work of healing in addition to detoxification. It is like a river that is completely plugged up with boulders, adding more water to the river will not help it to flow. The boulders must be removed first. Detoxification must be done in a way that would not cause the patient additional stress. It is far easier to detox through the skin (epsom salt baths) or lymph system (detox foot pads), than taking supplements that cause toxins to be dumped into the blood, causing the exhausted liver and adrenals more grief.

9. Supplements need to be carefully selected for absorbability and comprehensive coverage of physiological needs. I tell patients that at a minimum, they need support in the following areas: vitamines, minerals (macro and micro), essential fatty acids, amino acids, glycoproteins, antioxidants, gastrointestinal support with probiotics and digestive enzymes, and detoxification. Once these basic areas are covered, additional supplements will generally be necessary to help specifically with the type of withdrawal being done. For example, amino acids that calm (L-theanine, taurine, and tryptophan) will likely be needed when withdrawing from a calming, sedating medication such as an antipsychotic. These amino acids along with vitamins and minerals will be converted by the body to neurotransmitters that will support the medication taper. Supplements that are highly absorbable give themselves away by appearing as liquids or powders. Whole food supplements may seem to lack the amount of nutrients found in fractionated supplements, but because of their high rate of absorbability (urine doesn’t turn bright yellow for example), their effect may be a hundred times more potent. Sometimes, glandular supplements or protomorphogens may be helpful in supporting the liver, pineal gland, or adrenals. A healthy diet is important for the recovery process. Unfortunately, this often means that the patient will need to abstain from wheat, dairy, and white, refined sugar. Sometimes, when the burden of supplements exceeds what the patient can do (due to age, level of debility, vegetarian/Kosher habits, and/or sensitivities), I have used energy medicine techniques to help the patient nutritionally and to support withdrawal.

10. A person is more than biology. When all is said and done, repairing the body is like repairing a radio. Just because the radio is repaired, doesn’t stop it from playing bad music. Healing our neurotransmitters and hormones, liver and adrenals is all very good, but they only ALLOW the person to be happy. They do not MAKE the person happy. Nothing does, short of real growth in wisdom, love, forgiveness, and compassion. I have had patients who suffered from severe abuse or childhood neglect who were able to heal their bodies long before they are able to feel a consistent state of well-being. There is a learned aspect of being that has to be reconfigured. A person has to learn to heal from real traumas and heartaches. The road to well-being is paved with lessons. Skipping lessons does not lead to well-being. Some of those lessons lead to self-mastery, some to spiritual strength, and some to forgiveness. Unfortunately, happiness cannot be bought in a bottle, but is a side effect of living life masterfully.