Coming off medication

This is an article I have written for Mental health today
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Coming off medication

There are two main reasons for coming off medication – you no longer need it, or you are finding the side effects outweigh any benefits from taking it. In that case you are likely to be changing your medication either at the suggestion or at least with the approval of your consultant.

Coming off medication because you feel you no longer need it is trickier. And it is here the opinion of the “patient” or “service user” most often differs from that of their consultant or mental health team. “Patients” or “service users” are all too often told that he or she needs to take medication for life.

You may feel you no longer need medication because you have sorted out the difficulties that led to your mental health problems and your circumstances have changed. Nonetheless most mental health problems occur against a background of poor health in other areas.

Coming off medication safely means everything else has to be right. This includes being in the right surroundings or environment; being physically as healthy as possible, exercising, not smoking or drinking; having supportive relationships at home, and in the workplace; having good strategies to manage whatever life throws at you, having enough challenges but not excessive stress; and being able to be true to you. Under these circumstances the mind can heal, and with healing comes the possibility of a life without medication.

The nuts and bolts of coming off.

Make sure your life is as good as it can be and that your original problems have resolved.

Psychiatric medications are powerful chemicals that affect the brain. Over time the brain gets used to the presence of medication and adapts. This adaptation means that medication may become less effective and that person needs either more or a different medication to get the same benefit. Nonetheless, even if a medication no longer has an affect, it is in the clockwork and you need to take this into account.

If the supply of medications suddenly stops, the brain is affected. Therefore whatever you decide to do, do not suddenly stop your medication.

Psychiatrists and mental health teams are gradually coming round to the idea that people can come off medication. Not all of them but I am hearing of more psychiatrists who suggest people take for example, antipsychotic medication for “a couple of years” rather than lifelong. Before starting to come off your medication, it is best to talk to your psychiatrist and mental health team to see where they stand and what advice they can offer.

There are three main ways medication affects people
Drugs that are addictive. These cause cravings and severe difficulties when you come off them. These include benzodiazepines, such as Valium (diazepam), lorezepam, zopilclone, and most sleeping medications. They also include barbiturates and heroin or morphine based drugs such as pethidine, codeine and tramadol. Also in this group are for heavy drinkers, alcohol.

The choice with addictive drugs is whether to stop suddenly going “cold turkey” or gradually the dose over time. If you want to go “cold turkey” it is best if you do this under medical supervision because “cold turkey” can cause significant medical problems.
The alternative is to reduce the drug gradually. The difficulty with this approach is the cravings continue as long as you are taking the medication and for some time afterwards. Physically, gradually reducing the dose, is less demanding.

Drugs may have a “Withdrawal Syndrome”. This is less severe than for an addictive drug but is nonetheless unpleasant. Drugs with “Withdrawal Syndromes” include antidepressants, such as fluoxetine, paroxetine, cipramil and venlaflaxine, as well as atypical antipsychotics such as quetiapine. In these cases, it is best to reduce the dose slowly, over a few weeks and again, you are best to do this with the help of your psychiatrist

Finally there are drugs that do not fall into either group, yet still need to be treated with respect. Lithium is the most widely used example. No one craves lithium! But stopping lithium suddenly is dangerous. Up to 80% of people will have a sudden relapse within three months. The pioneering work on this subject was done by Balderassini in the 1980s where he showed that people who came of lithium suddenly were at greater risk of relapse than those who came off gradually. The difference in relapse rate between those who stopped suddenly and those who tailed off over six weeks were still there three years later.

Personally, I believe that if you want to come off lithium you must prepare to do so over at least three months, and ideally a year. Lithium more than any other drug gets into the clockwork and has its effect on the RNA of the cell (that is almost at the level of the DNA). Such a drug needs to be treated with respect and under almost no circumstances should you stop it suddenly.

In conclusion, brains have been around for millions of years, very few mental health conditions are due to of a lack of medication. Nonetheless, medication can help get us through bad times. If you want to come off medication, everything else in your life needs to be right from your physical health to being happy within yourself. Ideally, the more people you have to help you the better, and listen to their advice. Talk to your psychiatrist about it and whatever you do, take it slowly and carefully.

www.lizmiller.co.uk
www.moodmapping.com