Medication Tapers

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What is a psychiatric drug taper?

At Witt-Doerring Psychiatry, we specialize in the process of gradually reducing the dose of psychiatric medications for our patients.

In our clinical experience, a substantial number of patients have a very difficult time coming off of psychiatric medications. In addition, patients are often overwhelmed with conflicting advice on how to best taper, further complicating what can inherently be a confusing and overwhelming experience. 

To mitigate the severity of withdrawal symptoms, a gradual, flexible, patient-led taper is key. 

By collaborating with us on your taper, you can rest assured that you are receiving comprehensive care that is personalized to you and your unique situation.  

We can help you taper:

  • Antidepressants
  • Antipsychotics
  • Benzodiazepines
  • Mood stabilizers
  • Z-Drugs (aka “sleeping pills”)

Why might you reduce a psychiatric drug?

If you find that the medication you are currently taking is no longer providing the desired benefits or if you are uncertain about its effectiveness, we can assist you with medication tapers. There are various reasons why a medication taper may be necessary. For instance, you may be experiencing emergent adverse effects such as weight gain, emotional blunting, sexual dysfunction, dizziness, or inter-dose withdrawal symptoms. Alternatively, the stressors that initially led to your need for medication might have resolved, or you may have doubts about the accuracy of the initial diagnosis for which the medication was prescribed. Some individuals also wish to explore life off medications to discover their baseline well-being, while others are concerned about polypharmacy and whether they are taking too many drugs. Our expert team can guide you through a safe and personalized medication tapering process, addressing your specific concerns and helping you achieve the desired outcomes.

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What to know about psychiatric drug withdrawal

Though there are no hard and fast rules, we typically recommend 5-10% dose reductions (from the current dose) every 2-4 weeks, typically slowing the rate of the drops towards the end of the taper. This is called a hyperbolic taper, meaning that the steps by which the dose is lowered are made smaller and smaller as the dose decreases. This method allows the central nervous system to readjust between reductions and minimize or avoid destabilization and more severe withdrawal symptoms. Patients that are particularly sensitive to reductions may wish to employ a micro taper (reducing by microgram amounts daily versus the 5-10% cut-and-hold method).

Whatever method is chosen, continuous feedback from the patient guides adjustments to rate and speed. It is important to remain flexible; everyone is different. Some patients can complete a taper over the course of several months. Others may require several years, and that’s OK.

Those withdrawing report that a support system can be invaluable. This may include family, friends, peers also withdrawing, and/or a coach, in addition to a “withdrawal-wise” (or withdrawal-informed) therapist or medical professional.

 

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Why it is important to do a psychiatric drug taper with a “withdrawal-wise” medical professional?

  • Often official tapering guidelines are too fast for many.
  • Some medical providers are inflexible and use a “tough love” approach, which can potentially place someone at a greater risk of severe and/or protracted symptoms.
  • Validation that withdrawal syndromes are real and can cause significant disability.
  • To avoid misdiagnosis by accurately differentiating withdrawal symptoms from “relapse” and/or other medical conditions.

Clinical approach routinely used in our practice include:

  • Patient led-flexible tapers 
  • When necessary cross titration onto longer-lasting benzodiazepines (diazepam) to facilitate a more controlled taper 
  • Dose frequency adjustments to mitigate interdose withdrawal (worse symptoms occurring just before the next dose of your medication)  
  • The use of compounded prescription medications to allow smother and more personalized dosage reductions
  • The judicious use of supportive medications when appropriate, to manages significantly distressing pain or emergent psychiatric symptoms during medication tapering
  • Collaboration with specialized tapering coaches who are skilled in providing supportive counseling and specific psychotherapeutic strategies aimed at assisting patients through challenging withdrawal. 
  • Comprehensive medical and nutritional workup to ensure other medical problems or nutritional deficits are addressed to improve  
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