Need help coming off psychiatric medication without withdrawal? Talk with a holistic psychiatrist

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I worked with a patient who had been on the antidepressant Effexor for over 10 years. She had also been on other psychiatric medications, including Seroquel, Lamictal, and Remeron. By the time she saw me, she had successfully come off those three and was looking for help coming off Effexor.

She told me she’d tried to come off Effexor many times in the past, but each time she did, she became physically ill. Each time, she had to visit ERs and miss work due to vertigo, tinnitus (ear ringing), feeling electric zaps in her head, headache, inability to think straight (brain fog), and nausea. The ER would give her some anti-nausea and anti-vertigo meds and send her on her way, barely feeling better. These symptoms would only stop when she restarted the Effexor. We worked together using a holistic approach to come off it with minimal discomfort.

Another patient, also on Effexor for almost a decade, came to me wishing to try coming off it again. With a prior doctor, she had decreased the dose over time and felt well, but after stopping the lowest dose, she developed withdrawal symptoms. She had a headache, ear ringing, sweating, and nausea and went to an urgent care. They diagnosed her with an ear infection, and she took an antibiotic for days without any improvement in her symptoms. She finally called her previous psychiatrist, who told her it was likely not due to an infection but rather to stopping the Effexor. She instructed her to go back on the Effexor, which did stop the symptoms but didn’t help her achieve the goal of coming off of it. We worked together using a holistic approach to come off it with minimal discomfort.

This is what withdrawal from psychiatric medications often looks like.

Here’s a list of possible antidepressant withdrawal symptoms:

• Flu-like symptoms, dizziness, drowsiness, impaired balance, fatigue, weakness

• Rapid heartbeat, shortness of breath

• Electric shock sensations, tingling or numbness, itch, tinnitus, blurred vision, altered taste

• Muscle tension, muscle pain, nerve pain, tremor, poor coordination

• Sweating, flushing, chills, poor temperature regulation

• Diarrhea, abdominal pain, poor appetite, nausea, vomiting

• Premature ejaculation, genital hypersensitivity

• Insomnia, nightmares, vivid dreams, excessive sleep

• Confusion, disorientation, amnesia, poor concentration

• Irritability, anxiety, agitation, tension, panic, depressive mood, impulsivity, sudden crying, outbursts of anger, mania, increased drive, mood swings, suicidal thoughts, derealization, depersonalization

• Visual and auditory hallucinations

Although many doctors tell their patients that most psychiatric medications can’t be stopped suddenly, they don’t typically go into detail about why. This is because it’s not life-threatening (thus a lower priority in a busy doctor’s brain) and because it’s barely taught in medical school.

Only one group of medications, the benzodiazepines like Xanax and Klonopin, has a life-threatening withdrawal with the risk of seizure and death. (The same goes for alcohol because they work very similarly in the body.) Since withdrawal from psychiatric medications (except benzos) is not life-threatening, it’s glossed over in medical school and residency, which leads to doctors omitting this information when prescribing them.

Even though stopping psych meds isn’t life-threatening, it leaves most people feeling awful. It’s impossible to predict who will experience withdrawal, what their symptoms will be, and how severe. Some meds result in withdrawal more consistently than others. Nevertheless, it’s a real risk and is very disturbing to those experiencing it.

Why isn’t this talked about more?

Coming off psychiatric medications is not discussed much in medical school, nor much in residency (4 years of medical training after medical school). The problem is twofold. First, there are no clear guidelines for how long someone should stay on a psych med once they’ve started it. Research on medications is done over short time frames, typically 8-12 weeks, not the decades that many people are on them.

Second, the general consensus is that once you start a psych med, you’re on it for life unless you get side effects or it stops working (at which point your doctor will suggest you switch to a different psych med). Since this is the approach, there’s not much information on when to stop them, let alone how to best stop them to avoid withdrawal symptoms.

Even more concerning is that withdrawal from antidepressants, which includes anxiety and depressed mood, often looks like mental health disorders. This leads doctors to tell their patients, “Clearly, you need the medication since you’re depressed/anxious off it.” This leads patients into a spiral of shame and self-doubt, asking themselves whether they’ll need to be on this medication forever and what that means about them.

If you do find a psychiatrist who takes on the task of helping you come off medications, since they haven’t gotten much training on it, their main advice will be to decrease the dose gradually over time. If you feel unwell on a lower dose, they’ll increase the dose and tell you to wait longer before trying to lower it again. They might give you some anti-nausea or dizziness medication. They might try to switch you to another antidepressant that has a lower risk of withdrawal symptoms. If you keep feeling unwell as the dose gets lower, they’ll likely tell you that there are no other options and you’ll need to stay on the medication indefinitely.

There is some good news, though. There are psychiatrists who have dedicated their careers to helping their patients come off psych meds while avoiding withdrawal symptoms. They are few but mighty and include Dr. Greenblatt, Dr. Gupta, and Dr. Horwitz. These psychiatrists tend to take a whole-body approach, using treatment options outside of just medication to help people feel better.

There are also psychiatrists who have chosen to go beyond what was taught in medical school and residency. They saw how the conventional medicine treatment approach fails patients and searched to find other medical frameworks like functional, integrative, nutritional, lifestyle, orthomolecular, and mind-body medicine. They’ve sought out the books, articles, and lectures given by the above psychiatrists and others to learn from them so they can help their patients in ways outside of prescription medication.

If you’re trying to come off psychiatric medications and are finding it difficult, seek out a holistic, integrative, or functional psychiatrist. These terms have slightly different meanings, but they generally convey that the doctor has studied medical frameworks outside of conventional medicine and uses treatment methods outside of just medication.

This is what you’re looking for. You need someone who will offer you treatment tools other than medication so you can get out of the “decrease the dose, feel crappy, increase the dose back up” loop.

Here’s what holistic psychiatrists know about coming off psych meds that conventional doctors don’t:

• It’s a three-step process:

  • Using hyperbolic tapering instead of linear tapering to avoid withdrawal symptoms as much as possible

  • Addressing specific medication withdrawal symptoms

  • Addressing underlying contributors

• Hyperbolic tapering leads to less withdrawal symptoms than linear tapering does

  • In hyperbolic tapering, the reduction starts quickly and then slows down over time. This results in a smooth, continuous transition rather than an abrupt change, leading to less withdrawal symptoms. This is in contrast to linear tapering where initial dosage reductions might not be noticeable but as you continue, the brain starts feeling the difference more acutely which is more likely to lead to withdrawal symptoms.

• There are likely underlying reasons that your body is having a hard time coming off the med that need to be tested for and addressed. These were likely there all along. They include:

  • Low amino acids

  • Blood sugar imbalances

  • Inflammation

  • MTHFR genetic variants

  • Low Omega 3 fatty acids

  • Low Vitamin B12

  • Low Vitamin D

  • Pyrroluria

  • Gut microbiome imbalance

  • Low magnesium

  • High copper

  • Celiac disease, leading to nutrient deficiencies

• There are supplements and nutrients that ease withdrawal symptoms. These include:

  • NAC

  • EPA/DHA

  • Nutrient repletion

  • Inositol

  • Magnesium glycinate

  • Low dose nutritional lithium orotate

  • Free form amino acids

  • 5-HTP

Holistic psychiatrists take the best of their conventional medical training (4 years of medical school + 4 years of psychiatry residency) and combine it with non-conventional treatments like root cause analysis, individualized nutrient therapy, diet, movement, sleep, supplements, and wellness coaching. They do this to help you feel better now and long-term.

I created Brain Body Psych to bring you better mental health treatment through holistic psychiatry.

If you

• are having difficulty coming off psychiatric medication

• have tried and failed in the past but want to try again

• have not received the support you need from doctors you’ve worked with in the past

the team at BrainBody Psych is here to help you achieve your goal.

If you’re interested in this approach, I am very excited to work on this together.

With care,

Dr. Luisa Cacciaguida

Disclaimer:

This blog post is intended to be informative and does not replace individual medical advice. Always consult with your healthcare provider or a professional for any personal medical decisions or concerns you may have. Everyone's health situation is unique and should be evaluated by a healthcare professional.

This blog post is designed as a general guide. This is not a substitute for personalized medical advice, nor is a patient-physician relationship established in this blog post.