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Psychiatric Drug Withdrawal Peter R Psychiatric Drug Withdrawal Peter R. Breggin, MD conducts a private practice of psychiatry in Ithaca, New York, where he treats adults, couples, and families with children. He also offers consultations in the fi eld of clinical psychopharmacology and often acts as a medical expert in criminal, malpractice, and product liability suits. His professional website is www.breggin.com. A lifelong reformer in the fi eld of mental health, Dr. Breggin has been Dr. Breggin’s weekly talk radio show, “The Dr. called “The Conscience of Psychiatry.” He Peter Breggin Hour,” is live and archived on and his wife Ginger recently founded the the Progressive Radio Network. He blogs on Center for the Study of Empathic Therapy the Huffi ngton Post. Also follow Dr. Breggin on (a nonprofi t organization; 501c3), which his public Facebook page and follow him and holds an annual conference of leading his wife Ginger on Twitter: @GingerBreggin. fi gures in the fi eld who critique biological psychiatry and offer empathic psychoso- cial approaches (http://www.EmpathicTherapy.org). Dr. Breggin is the author of more than 40 peer-reviewed scientifi c articles and more than 20 mass market and professional books. His two most recent books are Brain- Disabling Treatments in Psychiatry: Drugs, Electroshock, and the Psychopharmaceutical Complex (2008) and Medication Madness: The Role of Psychiatric Drugs in Cases of Violence, Suicide, and Crime (2008). Earlier books include Toxic Psychiatry (1991), Talking Back to Prozac (1994, with Ginger Breggin), Talking Back to Ritalin (revised, 2001), the Antidepressant Fact Book (2001), and the Ritalin Fact Book (2002). The Heart of Being Helpful (1997) deals with how to help people through psychotherapy and other human services and Reclaiming Our Children (2000) examines the Columbine High School shooting tragedy and addresses the needs of America’s school children. Dr. Breggin’s background includes Harvard College, Case Western Reserve Medical School, a 1-year internship and a 3-year residency in psychiatry, including a teaching fel- lowship at Harvard Medical School. After his training, he accepted a 2-year staff appoint- ment as a full-time consultant at the National Institute of Mental Health (NIMH). He has taught at several universities, including the Johns Hopkins University, Department of Counseling and most recently, State University of New York (SUNY) Oswego in the Department of Counseling and Psychological Services. He founded a scientifi c journal, Ethical Human Psychology and Psychiatry and is on the board of others, including the International Journal of Risk and Safety in Medicine. He has testifi ed before Congress, addressed numerous federal agencies, acted as a consultant to the Federal Aviation Agency (FAA), and given hundreds of seminars and conferences for professionals. His views have been covered in nearly all of the major media from Time, Newsweek, Wall Street Journal, and New York Times to Oprah, 20/20, Nightline, 60 Minutes, and dozens of network and cable news shows. Dr. Breggin’s reform work has brought about signifi cant changes within the pro- fession. In the early 1970s, he conducted a several-year-long successful international campaign to stop the resurgence of lobotomy and newer forms of psychosurgery. His reform efforts and his testimony in the Kaimowitz case in Detroit led to the termination of lobotomy and psychosurgery in the nation’s state mental hospitals, National Institutes of Health (NIH), the Veterans Affairs (VA), and most university centers. A public educa- tion campaign surrounding his 1983 medical book, Psychiatric Drugs: Hazards to the Brain, led the Food and Drug Administration (FDA) to require a new class warning for tardive dyskinesia in 1985. In the 1990s, he was the single scientifi c expert for more than 100 combined Prozac suits against Eli Lilly and Company. In 1994, his public education campaign led the NIH to reform some of its research policies and to end the Violence Prevention Initiative, a potentially racist program aimed at studying the genetics and biol- ogy of inner-city children. His work initiated the reform that led to the FDA’s recognition of numerous adverse reactions caused by the newer antidepressants. The FDA warnings in 2004 about suicidality in children and young adults and about a dangerous stimulant profi le involving agitation, akathisia, hostility, aggression, and mania, closely followed the language of observations made and publicized by Dr. Breggin over the prior 10 years. Psychiatric Drug Withdrawal A Guide for Prescribers, Therapists, Patients, and Their Families Peter R. Breggin, MD Copyright © 2013 Springer Publishing Company, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, LLC, or authorization through payment of the appropriate fees to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, [email protected] or on the Web at www.copyright.com. Springer Publishing Company, LLC 11 West 42nd Street New York, NY 10036 www.springerpub.com Acquisitions Editor: Sheri W. Sussman Production Editor: Joseph Stubenrauch Composition: Absolute Service, Inc. ISBN: 978-0-8261-0843-2 e-book ISBN: 978-0-8261-0844-9 12 13 14 15 / 5 4 3 2 1 The author and the publisher of this Work have made every effort to use sources believed to be reliable to provide information that is accurate and compatible with the standards generally accepted at the time of publication. Because medical science is continually advancing, our knowledge base continues to expand. Therefore, as new information becomes available, changes in procedures become necessary. We recommend that the reader always consult current research and specifi c institutional policies before performing any clinical procedure. The author and publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance on, the information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs for external or third-party Internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Library of Congress Cataloging-in-Publication Data Breggin, Peter Roger, 1936- Psychiatric drug withdrawal : a guide for prescribers, therapists, patients, and their families / Peter R. Breggin. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8261-0843-2 — ISBN 978-0-8261-0844-9 (e-book) I. Title. [DNLM: 1. Psychotropic Drugs--adverse effects. 2. Substance Withdrawal Syndrome—preven- tion & control. 3. Risk Assessment. 4. Substance Withdrawal Syndrome—therapy. WM 270] 615.7’88—dc23 2012026397 Special discounts on bulk quantities of our books are available to corporations, professional associations, pharmaceutical companies, health care organizations, and other qualifying groups. If you are interested in a custom book, including chapters from more than one of our titles, we can provide that service as well. For details, please contact: Special Sales Department, Springer Publishing Company, LLC 11 West 42nd Street, 15th Floor, New York, NY 10036-8002 Phone: 877-687-7476 or 212-431-4370; Fax: 212-941-7842 E-mail: [email protected] Printed in the United States of America by Gasch Printing. For my wife Ginger Breggin, a partner beyond all expectations and imaginings Contents Foreword Kathleen Wheeler, PhD, APRN, FAAN xv Preface xix Acknowledgments xxi Introduction: Hazards of Psychiatric Drug Withdrawal xxiii The Center for the Study of Empathic Therapy xxvii Related Books by the Author xxix Endorsements xxxi 1. A Person-Centered Collaborative Approach to Psychiatric Drug Withdrawal 1 Relationship Between Prescribers and Therapists 2 The Person-Centered Collaborative Approach 4 Exploring the Patient’s Feelings 4 An Approach to Helping Patients in Need of Additional Support or Guidance 7 Key Points 7 PART I: REASONS TO CONSIDER PSYCHIATRIC DRUG WITHDRAWAL OR DOSE REDUCTION 2. Cautions in Assessing the Risks Associated With Psychiatric Drugs 11 A Rose by Any Other Name 12 Does FDA Approval Indicate a High Degree of Safety? 13 Drug Company Suppression of Critical Data 14 Relying on False or Misleading Information 15 Examples of Delayed Recognition of Serious Psychiatric Drug Adverse Effects 15 vii viii Contents Does It Take Weeks for the Drug to Work? 16 Listening to Family Concerns 17 The Importance of Varied Sources of Information 17 Key Points 18 3. Chronic Brain Impairment: A Reason to Withdraw Patients From Long-Term Exposure to Psychiatric Medications 19 Basic Defi nitions 21 Symptoms and Characteristics of Chronic Brain Impairment 21 Confounding Factors 23 Comparison to Dementia and Organic Brain Syndrome 24 Illustration: He Was Afraid That He Had Alzheimer’s 26 How to Diagnose and Assess Chronic Brain Impairment 27 Other Psychoactive Substances 29 Frequency of Psychiatric Drug Chronic Brain Impairment 30 Biochemical Imbalance or Genuine Medical Disorder 31 What Causes Chronic Brain Impairment—Mental Disorder or Medication? 32 Treatments for Chronic Brain Impairment 34 Recovery From CBI 35 Key Points 37 4. Antipsychotic (Neuroleptic) Drugs: Reasons for Withdrawal 39 Chronic Brain Impairment 41 Cellular Changes 41 Structural Brain Changes 41 Tardive
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