Circa 1990 White Light Communications produced a Psychiatric Survivors video episode on:
Going Off Psychiatric Medications
with guest Howie the Harp1 and interviewer Paul Dorfner
The Psychiatric Survivors series was produced entirely by psychiatric survivors through White Light Communications. Since this video is no longer available and White Light Communications is no longer in existence, I2 have taken notes from the video and am distributing these notes in an attempt to keep the information available.
Howie the Harp said that people often are unhappy about taking psychiatric medications and that this is real scary for MH professionals. Usually people have a good reason for wanting to go off psychiatric medications and will do so regardless of what others around them say. There's not a lot of medical literature about going off psychiatric medications. All psychiatric drugs create a physical and psychological dependency. Some are outright addictive. Howie the Harp didn't encourage or discourage people to go off psychiatric medications. Instead, he felt that it's important that they make an informed decision and if they go off, that they do it safely and successfully.
When someone goes off cold turkey, they usually experience the following symptoms:
1) Extreme nausea (especially with the major tranquilizers and lithium) or difficulty eating. Often the person stops eating.
2) Trouble sleeping - The person has an explosion of energy (sort of like the lid on a pressure cooker being removed before it has cooled down.)
3) Anxiety - The person may be so nervous that they are unable to prepare food or sleep. It is important that the person not rely on a junk food diet.
If anyone goes too long without eating and sleeping they will go crazy. Unfortunately, this craziness is mistaken for decompensation and is used as evidence that the person needs to be on medications.
This could be prevented if the person went off the medications gradually and followed some guidelines.
How To Go Off Of Psychiatric Medications:
1) Don't try to do this yourself - get support. Find a psychiatrist who will work with you. They can prescribe smaller dose pills that make it easier to taper off and/or they can prescribe alternative psychiatric medications. Sleeping pills may be prescribed to help with the difficulty sleeping. Please be aware that sleeping pills are highly addictive and should be used very sparingly and not every night.
Many psychiatrists are unwilling to help patients go off psychiatric medications, so be sure to at least have peer support or a Peer Counselor. A good counselor is non-judgmental and accepting of all your emotions. Emotions are a natural reaction to a bad situation. It's important to problem-solve the situation rather than medicate the feelings away.
Howie the Harp has acted as an advocate with a person's psychiatrist to get help /support in going off. Often a compromise is to change or reduce psychiatric medications.
People have depression for very real reasons. When you're depressed you feel you can't do anything except stay in bed. Other people's "should" about what you should do only add to your sense of guilt. A good counselor affirms your experiences. For example, if you need to sleep all day, perhaps your body and mind are telling you that you need more rest. Extreme depression is disabling. Once someone is able to accept his or her depression, it doesn't last as long.
Hearing voices is often connected to trauma, abuse and oppression. Howie the Harp doesn't think that voices are necessarily bad unless they are telling you to hurt yourself or someone else. Native Americans saw people who had hallucinations as shamans. Voices can be caused by the medications. While it is rare it does occur and is called tardive dysmentia. Usually when people's voices are helped by the psychiatric medications, they don't want to stop taking them. But they might want to change or reduce their psychiatric medications.
2) Have a stabilized housing situation - A place that you're happy with and could remain for 4-5 months. When you're going off psychiatric medications your body goes through a lot of changes and it's not a good time to be homeless.
3) Plan to go off gradually over a long period of time, at least several months. If you don't have a psychiatrist to prescribe lower dose pills, you can gradually reduce by decreasing the number of times a day you take the psychiatric medications. If you usually take it 4 times a day, you might reduce a dose every other day (4 times one day, 3 times the next.). Periodically evaluate how you're doing - are voices or symptoms becoming intolerable? Even if you can't go all the way off, less is better.
4) Avoid stimulants - caffeine, chocolate, white sugar, street drugs or alcohol. This will help the sleep problem. 2-3 weeks after stopping you begin to feel the effects and you will need extra sleep. You will need at least 6 hours night.
5) Eat healthy. Eat a higher nutrition diet with lots of fresh fruits and vegetables. Stay away from red meats and if possible, all meats.
6) Alternatives - Most people take psychiatric medications because of behaviors/symptoms that were uncomfortable to them or others. As the psychiatric medications leave your system, these symptoms and behaviors will be unmasked. Try other methods to reduce these symptoms and behaviors. Some alternatives are yoga, biofeedback, herbs, Sleepytime tea, chamomile tea, valerian root (which is stronger than chamomile for sleep), stress tabs (vitamin B complexes plus vitamin C), tryptophan (an amino acid) and meditation.
A lot of people have anniversary breakdowns - so it's important to identify these times and be prepared for them. Mania can often be helped by following the guidelines above for withdrawing from psychiatric medications.
Howie the Harp had psychiatrists review the above guidelines, some felt they didn't help but they all felt these guidelines couldn't hurt.
Some people can successfully go off cold turkey but for most people it could take 1 -6 months to reduce their psychiatric medications to zero depending on how long they were on, their body weight, their dosage and other factors. But it can take up to 2 years or longer to adjust to your new body chemistry and be free of the effects of the psychiatric medications.
If you don't have the drug to control the negative symptoms, you will have to learn to control them yourself.
Many of the effects of psychiatric drugs are not listed in the PDR (Physicians Desk Reference) so, often patients aren't believed when they describe symptoms. For example, thorazine syndrome or dry mouth wasn't listed in the PDR but dentists were aware of it. People with dry mouth take lozenges and their teeth suffer.
Another side effect is tardive dyskensia, irreversible brain damage that wasn't listed in the PDR - people had to file a lawsuit before it was acknowledged.
AA, Alcoholic Anonymous is highly skilled in helping people with alcohol problems. Self help works. Remember not to do this alone, we all need help.
1Howie the Harp was one of the legendary founders of the psychiatric survivor movement in the United States.
2Notes taken by Carol Patterson, August 2000