Psychiatric medication is one of the most common medications prescribed — such as Prozac, Well-butrin, Celexa, Lexapro, Cymbalta, Xanax, Paxil, Effexor, etc. While these medications are commonly prescribed; weaning off of a psychiatric medication can be extremely challenging. In fact, research is lacking in the tapering off of psychiatric medication. At this time, most of what prescribing doctors know about discontinuing psychiatric medication is anecdotal and based off of what they hear their patients report.
There is a plethora of research literature that examines the withdrawal effects of other psychoactive substances such as tobacco, caffeine, stimulants, and illicit drugs. Unfortunately, research is lacking studies that observe the withdrawal effects of psychiatric drugs.
In discontinuing psychiatric medication, the current practice is to gradually withdraw drugs as Prozac and Celexa. Cases suggest that even with slow tapering, some patients will develop some discontinuation symptoms or may be unable to completely discontinue taking the prescribed medication.
Symptoms most consistent with withdrawal reactions of psychiatric medications include dizziness, fatigue/weakness, nausea, headache, myalgias and paresthesias. The occurrence of withdrawal was not reported to be related to dose or treatment duration. Symptoms generally commenced 1–4 days after drug discontinuation, and persisted for up to 25 days. Any of the SSRIs can produce withdrawal symptoms. If a patient is wanting to discontinue use of their psychiatric medication, they should be tapered over 1–2 weeks to minimize the possibility of discontinuation symptoms or withdrawal. At this time, there is no method to predict or know which patient is at a greater propensity to experience discontinuation symptoms or withdrawal. Some patients with a greater chemical sensitivity may require a more extended tapering period. Treatment for severe withdrawal symptoms entails re-institution of the antidepressant with subsequent gradual tapering as tolerated by the patient.
Currently, the U.S. Food and Drug Administration (FDA) does not require pharmaceutical companies to conduct withdrawal studies in order to empirically observe a drug’s impact when it’s time to discontinue it. It only requires a safety evaluation, and measurement of the drug’s effectiveness. The FDA is concerned about adverse events while a patient is taking the drug — not adverse events when the drug is discontinued. It would be beneficial for the FDA to require pharmaceutical companies to conduct analysis on a drug’s discontinuation profile, so that prescribing doctors and patients can have a greater understanding of the risks associated with discontinuation of a drug.
People are prescribed a psychiatric medication because it is used to help alleviate the symptoms of a mental illness. Not taking the medication is often not an option — at least until the symptoms are relieved (which often can take months, or even years). Psychotherapy can often help with the symptoms of mental illness, the stressors contributing to the mental illness and as a coping mechanism during medication withdrawal.
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Find a genuine, caring and competent psychiatrist who is going to discuss the risks and benefits of the medication. Source: By JOHN M. GROHOL, PSYD at PsychCentral.com
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