Rethinking Long-Term Psychiatric Medication Use with Confidence and Support
Written by: Dr. Amy O'Donnell
Did you know that long-term psychiatric medication use is on the rise?
Per the CDC, in 2011-2014, 25% of people over the age of 12 taking an antidepressant had been doing so for 10 years or more. Ten years! 68% had been doing so for two or more years.
In response to statistics like these, there is a movement happening in mental health care and psychiatry. It’s called de-prescribing. More and more providers are re-evaluating the benefits of long term use of psychiatric medications like antidepressants and as a result helping people come off or reduce their psychiatric medications.
How to decide if you should take psychiatric medications?
This is an incredibly personal decision. While psychiatric medications can be life-saving for many, careful and ongoing evaluation of dosage and the benefit versus risk of continuing them is necessary. It’s important to recall that while there are possible side effects to taking the medication there can also be risks to discontinuing them like relapse (return of the condition that made you take them in the first place) and withdrawal (physical and mental symptoms you experience after decreasing your dose which can last days to months or in severe cases years). The decision to continue your psychiatric medications or not depends on a careful balance of the risks, benefits and your personal preferences and values. It’s important to also note that your ‘why’ for taking medications can change over time. Perhaps why it made sense for you to take psychiatric medication in the past, isn’t as relevant now. Or perhaps you have a different or a continuing ‘why’ that still supports your decision to continue your medication. Regardless, ongoing evaluation of if a medication works for you is essential.
What are possible long-term side effects of psychiatric medications?
Like any drug, side effects are specific to the medication and dosage. In general, with antidepressants (like SSRIs, SNRIs and TCAs) there are possible side effects like long-term sexual dysfunction, metabolic changes (abnormal sugar levels, elevated fat levels, weight gain), as you age concerns like fractures, falls and hyponatremia (low sodium electrolyte) risk increase and there is emerging evidence of possible risk (although the evidence is mixed) of increased cognitive concerns and mortality. In antipsychotics, there can be metabolic side effects (typically worse than with antidepressants), movement changes (like parkinson's symptoms, restlessness or certain types of muscle stiffness), and in the elderly with dementia increased risk of death.
How can you safely stop your psychiatric medications?
You will want to find a psychiatrist, ideally specialized in de-prescribing, that can work with you to create a personalized tapering plan. Abruptly stopping your psychiatric medication if you’ve been on them for longer than a few months can cause a prolonged withdrawal syndrome and increase your risk for relapse.
You may want to consider a hyperbolic tapering strategy if you’ve been on your medication for over six months or are sensitive to medications. Hyperbolic tapering reduces medications based upon how they work in your brain rather than the number of milligrams on your pill bottle (they aren’t the same thing) in order to reduce risk of relapse and withdrawal.
Aside from the medication management, it’s important also to address the underlying reason why you took the medication in the first place. Are you using new strategies like nutrition, physical activity, psychotherapy, mindfulness, supplementation, substance use reduction etc to address your prior issues?
In my experience, the most successful clients who stop their psychiatric medications (and stay off them) are those who take a holistic and conservative approach of slow medication weaning along with changes to lifestyle and addressing their psychological response to distress.
Your pathway forward
De-prescribing psychiatrists, like myself, work with clients to help them reduce and even eliminate psychiatric medication usage. If you are considering reducing your medication, this is a great place to start. Additionally, creating a support team like dieticians, personal trainers, psychotherapists, and a supportive community like friends and family can help you start to develop a lifestyle of mental health resiliency. The more work you put into improving your mental health outside of medications, the easier it is to come off medications.
At Nature’s Flow Psychiatry, I practice an integrative approach to de-prescribing. This means that I can holistically address your mental health concerns with both traditional and alternative treatment options. This looks like considering options such as - supplementation, botanicals, nutrition, movement, mind-body-spirit connection, therapy, different medication taper approaches, sleep and stress optimization, lab work up, health technology, alternative medicine like acupuncture (and the list continues). The aim is to provide success in both the short and long term. To learn more about psychiatric de-prescribing and integrative mental health visit my blog or consider a free 15-minute meet-and-greet call to learn more about potentially working with me. Learn more at www.naturesflowpsych.com.
References:
‘Products – Data Briefs’. CDC. August 2017. https://www.cdc.gov/nchs/products/databriefs/db377.htm
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Burcu, M., Zito, J. M., Safer, D. J., Magder, L. S., Shaya, F. T., & Rosenthal, G. L. (2017). Association of antidepressant medications with incident type 2 diabetes among Medicaid-insured youths. JAMA pediatrics, 171(12), 1200-1207.
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Framer A. What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications. Ther Adv Psychopharmacol. 2021 Mar 16;11:2045125321991274. doi: 10.1177/2045125321991274. PMID: 33796265; PMCID: PMC7970174.
Groot PC, van Os J. Successful use of tapering strips for hyperbolic reduction of antidepressant dose: a cohort study. Ther Adv Psychopharmacol. 2021 Aug 27;11:20451253211039327. doi: 10.1177/20451253211039327. PMID: 34471516; PMCID: PMC8404667.
Horowitz, M. A. and Taylor, D. (2019) ‘Tapering of SSRI treatment to mitigate withdrawal symptoms’, The Lancet Psychiatry. Elsevier Ltd, 6(6), pp. 538–546. doi: 10.1016/S2215-0366(19)30032-X.
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