Discontinuing Medications (From Second Opinion Society) 1998
Quitting psychiatric drugs
Introduction
A woman may have a variety of reasons for wanting to stop taking psychiatric medication. She may want to be free of the dulling effect that most psychiatric drugs cause, or of more serious side effects that she may be suffering. She may be worried about the long-term effects of the drugs, including tardive dyskinesia. Or she may be wanting to make a major change in her life by freeing herself from a dependence on powerful medication.
But whatever her motivation, she has a right to free herself from using medication. There may well be situations in which you don't agree with a woman who wants to stop taking psychiatric medication, or you may be scared that doing so will do her serious harm. But it is her right, and she probably has sound reasons for wanting to stop using the drugs. After all, she is the one who has to live with the effects of the medication, and she is the only one who knows how the medication really affects her.
You can support her by helping her make informed choices about her options. You can give her information about her medication and its effects. You can also give her information about getting off the drugs, and you can support her in carrying out her choice in a safe way.
That safety may be the most important support that you can provide. Remember, you have little influence over what she does after she leaves the transition house. She may stop her medication cold, without information or support, and put herself in serious danger. The symptoms of too-rapid withdrawal from psychiatric drugs include extreme nausea, anxiety, insomnia, restlessness, muscular reactions, and strange behaviour. In the case of minor tranquilizers and sedatives, the reactions to sudden withdrawal can be life-threatening.
You can support her in struggling with these issues and making an informed choice. But remember that you are dealing with something that is her right. If you pass judgement on her wishes, you won't be helping her find out what is really best for her. And she may simply stop her medication anyway, without the information and support she needs.
Finally, a woman who wants to stop taking psychiatric medication should have the support of a sympathetic doctor. By sympathetic we mean a doctor who is willing to accept a woman's right to choose her own path and work with her in getting off the medication. This is the best way, to have the active involvement of a doctor who can help plan and monitor a woman's withdrawal from psychiatric medication.
Note that many detox centres and drug abuse programs help people to stop taking minor tranquilizers and sedatives, but not neuroleptics and antidepressants.
What follows is an overview of the basics. It will help you and women you work with understand what's involved in the process, and how one goes about it.
The basic principles
There are some basic principles that a woman has to follow to stop taking psychiatric drugs safely. Familiarize yourself with them, and make sure that any woman you work with who wants to stop her medication is familiar with them, too.
- don't try to stop taking psychiatric drugs without support
- if at all possible, find a supportive doctor to supervise the process
- never stop taking psychiatric drugs abruptly -- going "cold turkey" can lead to serious withdrawal symptoms and can be life-threatening
- the best way to stop is to reduce the dosage gradually; by withdrawing gradually and carefully it may be possible to minimize withdrawal symptoms
- withdrawal from sedatives and minor tranquilizers can be extremely dangerous
- withdrawal symptoms don't necessarily start immediately; they may begin anywhere from 8 hours to several days after quitting
- the time it takes for withdrawal symptoms to set in and their severity varies from person to person, and depends on how long you have been taking the drugs, your dosage, your overall health, your body weight, and so on.
1. Find a supportive doctor who will work out a withdrawal schedule with you and monitor your progress. Other psychiatric survivors or a survivors' group might be able to suggest a doctor.
2. Have a living situation that is as stable as possible.
3. Organize support from friends, family, survivor groups, the local women's centre, and/or counsellors.
4. Withdraw from the drugs as gradually as you can.
5. Find out as much as you can about the process so that you will be prepared for the withdrawal symptoms.
6. Don't expect to feel much difference in the first few days.
7. Realize that your body and mind are going through a difficult experience.
8. Make sure you get enough sleep. Difficulty in sleeping is a common problem; it's important that you get at least 6 hours of sleep a night. Use herbal remedies for sleep, and try yoga, meditation, massage, etc. But if nothing else helps, it's worth taking sleeping pills just for this short period.
9. Stop using stimulants like coffee, sugar, chocolate, alcohol, or street drugs.
10. Eat the healthiest diet you can to help your body purify itself. Vegetables, fruit, nuts, and grains are important; eat as little red meat as you can, and avoid junk food.
11. You will have more physical energy as your body gets away from the drugs. Physical exercise will help you stay calm, and will be very helpful if your energy seems to be getting out of control. Try to start exercising, swimming, hiking, or bicycling. But start gradually.
Setting a schedule
Remember, psychiatric drugs should never be stopped abruptly! The more slowly you can withdraw, the less bad effects you will suffer. The best plan is to work out a schedule with your doctor that best suits your situation.
Standard practice is to reduce your dosage by 10 percent per week, monitoring your progress at every step. The first week, you would reduce your dosage by ten percent. Try that for the first week, and then see how you are doing. If you feel OK, reduce the dosage by another 10 percent. Try that for a week, and see if you feel OK.
If you reach a point where you don't feel OK, don't reduce your dosage by another 10 percent. Stay at the same reduced level for another week, or until you do feel fine. Then reduce by another 10 percent and continue with the process. Some steps might be more difficult than others; take your time.
For example, if you are taking 200mg of Chlorpromazine a day, reduce by 10 percent -- 20mg -- to 180mg per day. Try that level for a week. The next reduction would be to 160mg a day for a week (or longer), then 140mg a day, and so on.
If you are taking more than one medication at a time, it's best to stop them one by one. If you are taking a neuroleptic (major tranquilizer) and an anticonvulsive drug (anti-Parkinsonian) at the same time, which is common, withdraw from the neuroleptic first. However, if you are taking more than one medication, this is a situation where it is definitely best to have a doctor working with you.
Withdrawal effects by drug class
If you are working with a woman who wants to stop taking psychiatric drugs, it's important to be familiar with the typical reactions or symptoms of withdrawal. These vary, depending on the person, how long she's been taking the drug, her dosage, and the type of drug.
Different classes of drugs bring on different withdrawal reactions. Some of these reactions may be disturbing and hard to witness but not really dangerous. Others may be life-threatening.
A familiarity with drug withdrawal reactions will help you in working with any woman who is taking psychiatric medication. Many patients don't take their medications as prescribed; they will alter their dosage, increasing or decreasing the amount they take. Or they will miss a day's medication, and then catch up by taking twice as much the next day. By mistakenly taking too little medication, they may bring on the early stages of withdrawal. Mysterious physical and emotional complaints may actually be signs that they are not taking their medication as prescribed.
Even when a woman is taking her medication as prescribed, she may experience the beginnings of a withdrawal reaction as a dose begins to wear off. For example, a woman who is taking a minor tranquilizer may find herself feeling agitated and restless before she is to take her next prescribed dose.
In both cases, these signs are the results of the early stages of withdrawal. It may seem like the agitation, anxiety, or physical discomfort are signs of a woman's "mental illness" or a sign that she really does need the medication she's taking. However, her complaints may actually be due to the physical effects of the beginning stages of drug withdrawal.
Listed below are the main classes of psychiatric medication, along with the withdrawal reactions that are most common with each of them.
Antidepressants and neuroleptics
- flu-like syndrome with headache, muscle aches, chills, nausea, vomiting, diarrhea, and loss of appetite
- muscular reactions such as uncontrollable rhythmic movements and tremors (these are more severe with neuroleptics)
- insomnia, emotional distress, feeling like one is "going crazy"
Lithium
- less side effects generally than other classes
- insomnia, anxiety, irritability
Minor tranquilizers, sedatives
- sudden withdrawal can result in life-threatening seizures; withdrawal must be very gradual
- seizures common in early stages of withdrawal
- other reactions can include flu-like syndrome (see above), muscle tics, restlessness, and anxiety
- withdrawal symptoms usually take a few days to develop, but can occur immediately and get worse during the first week
1. Respect the woman's right to make her own choices.
2. Be informed about the process of withdrawing from psychiatric drugs.
3. Be familiar with the withdrawal symptoms so that you can stay clearheaded and not panic.
4. Help keep people who disapprove of what the woman is doing from interfering in the process.
5. Remind the woman to get enough sleep.
6. Make sure she gets enough to eat. Help her prepare food, as she may be too nervous to cook on her own.
7. Help her get in touch with other people who will support her.
8. Don't be misled by the withdrawal symptoms, thinking that they are signs of her "illness." Be patient; it takes time to withdraw from the drugs and adjust to life without them.
http://www.walnet.org/llf/drugs/psychdrugs1.html#tableofcontents