Deprescribing and Tapering Antidepressants, Anti-Psychotics, Anxiolytics, and other Psychotropic Medications
Deprescribing psychotropics is a systematic, collaborative process of reducing or discontinuing medications. It is particularly important for children and adolescents due to the health risks and limited evidence for the use of drugs in children. It is also essential in older adults due to the increased risk of adverse effects and drug interactions associated with the use of 5 or more medications at one time, known as polypharmacy.
Deprescribing has the clear goal of improving patient outcomes. It is an essential process because many individuals are placed on medications for years with no further review or adjustment, or they are prescribed medications by general health practitioners and not specialists. Often, people are prescribed multiple medications, which cause side effects like loss of libido, weight gain, metabolic syndrome, and insomnia.
Over time, psychotropic medications can simply stop working. They may also become unnecessary as individuals’ circumstances and lifestyles can change over time. By helping patients off unnecessary medications, you can greatly improve their well-being.
The Integrative Approach to Deprescribing and Tapering
The integrative approach to tapering psychotropic medications looks at the client’s needs as a whole person. The protocol should include an individualized, hyperbolic taper schedule and incorporate foods, nutrients, herbs, bodywork, and natural detoxification strategies. Effective therapies and solutions outside of pharmaceuticals nourish the brain and ease the tapering process.
There is a High Demand For Expert Support With Deprescribing and Tapering
Deprescribing and tapering psychotropic medications are not taught to clinicians in training, unfortunately. Time and specialized knowledge are required to guide clients through the process. The demand for skillful deprescribers is very high.
As one recent study (Read, 2023) showed, 71% of respondents who were tapering off medication felt their doctors’ advice regarding how to stop taking an antidepressant was unhelpful.
Doctors often recommend a reduction rate that is too quick, were not familiar enough with withdrawal symptoms to give advice, or suggested that stopping antidepressants would not cause withdrawal symptoms!)
Countless individuals on psychotropic medications want to learn how to take greater control of their health.
If you are interested in helping your clients taper, I offer a leading-edge course on this area for integrative practitioners: Tapering Off Psychotropic Medications: Integrative and Naturopathic Strategies.
3 Essentials for Deprescribing and Tapering Success
An Integrative Approach
An integrative approach to deprescribing and tapering off psychotropic medications is essential, as it views the body and mind as one, recognizing that every patient is different. This strategy addresses the client’s physical and emotional needs and creates a personalized plan for them.
Readiness to Taper
Readiness to taper is crucial, as it goes beyond merely stopping psychotropic medication and coping with side effects. A successful taper must address the individual’s physical health and long-held beliefs and fears, ensuring a smoother transition.
Social Support
The support of friends, family, and health providers is essential, as mental illness involves disrupted attachment either as a primary or secondary outcome. Providing support for attachment behaviors during this time is essential for success.
Deprescribing and Tapering
Deprescribing and tapering are related but distinct processes when it comes to discontinuing psychotropic medications. Tapering is a component of deprescribing, especially for medications with a risk of withdrawal symptoms or discontinuation syndromes.
Tapering refers specifically to the gradual reduction of a medication dosage over time. Tapering is adjusted to the physical and emotional needs of the client, based on shared decision-making, including how long they have been using the medication, their current symptoms, the degree of self-care and social support, and other medication use.
I review the research findings on tapering in my research post, How to Help Your Clients Safely Step Off the Treadmill of Pills.
The Benefits of Deprescribing
- Misdiagnosis often drives and maintains medication use, obscuring solutions that address the true roots of the problem and ease clients’ suffering.
- Lack of prescriber knowledge about describing and tapering keeps individuals on medications that may be harmful, lead to side effects, and impede their biological and psychological resilience.
- Fewer medications can lead to better adherence to truly essential medications, as clients are less overwhelmed by complex protocols.
- Reducing medication use can improve individuals’ overall well-being, including better physical and mental health.
- Stopping unnecessary medications can decrease the risk of adverse drug reactions, side effects, and drug interactions, potentially extending clients’ lifespans.
- Evidence suggests polypharmacy, particularly in people over 65, is especially dangerous and leads to falls and early mortality. Studies (Monteiro, 2023) estimate the prevalence of the use of potentially inappropriate medications (PIMs) among older adults between 30% and 70%.
- Deprescribing can lower health care costs by reducing the number of medications purchased as well as secondary health problems.
Deprescribing can also be deeply empowering for clients as they find holistic methods to address their health challenges at a causal level. Often, emotional holding patterns that have been created through the long-term use of psychotropic medication can be released in a gradual way through the course of tapering, and a process of deepening insight and maturation can occur naturally.
“Dr. Korn has the knowledge of an encyclopedia (or two!), and also has the heart of a teacher and mentor.”
Ilyse Keeley, LCSW, CMHIMP
The Best Approach to Successful Tapering is Hyperbolic
The most effective approach to tapering is a slow process called hyperbolic tapering. Hyperbolic tapering reduces the dosage of a drug following a hyperbolic curve, which minimizes withdrawal symptoms and other adverse effects associated with discontinuing the medication.
The method involves a progressively smaller reduction in dosage as the tapering process continues in order to avoid abrupt changes that might trigger withdrawal symptoms. Research shows this type of reduction schedule appears to be the most promising strategy for psychiatric drug discontinuation (Eserian, 2023).
Enroll in Tapering Off Psychotropic Medications: Integrative and Naturopathic Strategies to learn how to help clients taper off unnecessary medications.
A Taper Plan Involves Creating a Taper Team™
It takes a village to taper! We work together to define and develop your Taper Team, which is defined as your taper support group. Depending on your network, your team consists of you, your prescriber and therapist, and any family members, friends, colleagues, or other social supports who agree to support you in specific ways at specific times during your taper. Your support team will also include your dog(s), cats, or other animal friends.
We also collaborate to develop the taper calendar, which defines the pace of your taper and reduction of medication (it is always flexible), along with supports such as the delivery of meals, social visits, therapy sessions, getting a massage or pedicure, exercise buddies, etc.
Tapering takes time. The failure of tapering is not that it cannot be done, but that it is most often done too quickly.
A slow taper schedule minimizes withdrawal symptoms and potential rebound effects associated with the discontinuation of psychotropic medications.
Deprescribing Guidelines
Using integrative approaches, we work with our clients or patients to…
- Mentally prepare, which may include the exploration of the history and meaning of the onset of medication use, and current fears and concerns about reducing or stopping medication use.
- Enact a robust self-care program that applies the Brainbow Blueprint® principles.
- Slowly taper the medication(s) for an easy withdrawal by using foods like fats and proteins, amino acids, and other Neurotransmitter-nourishing supports.
- Incorporate foods, nutrients, herbs, and exercise, which can ease the process of tapering by reducing neurotransmitter receptor hypersensitivity.
For example, tapering anti-psychotics can prompt dopamine hypersensitivity and lead to a rebound effect, erroneously leading the client and support team to think the symptoms are returning. In fact, hypersensitivity occurs as a response to antipsychotic medications that increase or sensitize neural receptors – a condition that can persist after discontinuation. - Create a thoughtful, individualized plan that addresses this hypersensitivity and the whole-person needs of the individual.
If you are interested in helping individuals taper, I offer a leading-edge course on this area for integrative practitioners: Tapering Off Psychotropic Medications: Integrative and Naturopathic Strategies.
If you are in the process of tapering, I recommend you use my book, Nutrition Essentials for Mental Health, to give yourself the full “Brainbow” of nutrients you need to make the process more successful.
Do you need help with tapering off psychotropic medications? You can contact me directly to book an appointment.
