This guide brings together the best information we’ve discovered and lessons we’ve learned at The Icarus Project and Freedom Center. It is not intended to persuade anyone to stop taking psychiatric medications, but instead aims to educate people about their options if they decide to explore going off.

In a culture polarized between the pro-medication propaganda of pharmaceutical companies on the one hand, and the anti-medication agenda of some activists on the other, we offer a harm reduction approach to help people make their own Harm Reduction Guide to decisions. We also present ideas and information for people who decide to stay on or reduce their medications. Coming Off Psychiatric Drugs Many people do nd psychiatric drugs helpful and choose to continue taking them: even with the risks, this may be a better option given someone’s situation and circumstances. At the same time, psychiatric drugs carry great dangers and can sometimes do terrible harm, even becoming bigger problems than the conditions Published by they were prescribed to treat. Too often, people who need help getting off The Icarus Project and Freedom Center psychiatric drugs are left without guidance, and medication decisions can feel like nding your way through a labyrinth. We need honest information that widens the discussion, and we hope this guide helps people trust themselves more and take better care of one another. www.theicarusproject.net www.freedom-center.org

Second Edition, revised and expanded. ISBN 978-0-9800709-2-7

Health Professional Advisors, continued

Renee Mendez, RN Michael Smith, MD, Licensed Acupuncturist Windhorse Associates National Acupuncture Detoxi cation Association

Dawn Menken, PhD Susan Smith, Intrinsic Coach Process Work Institute Proactive Planning Harm Reduction Guide to Arnold Mindell, PhD Claudia Sperber, Licensed Acupuncturist Author, ProcessMind: A User’s Guide to Coming Off Psychiatric Drugs Connecting with the Mind of God Linda Star Wolf Second Edition Venus Rising Association for Transformation Joanna Moncrieff, MD Author, The Myth of the Chemical Cure: A Critique of Peter Stastny, MD Psychiatric Drug Treatment International Network Towards Alternatives for Recovery Pierre Morin, MD, PhD Lutheran Community Services Sandra Steingard, MD

Matthew Morrissey, MFT Ted Sundlin, MD Co-Editor, Way Out Of Madness: Dealing Jefferson Behavioral Health With Your Family After You’ve Been Diagnosed Philip Thomas, MD With A Psychiatric Disorder Co-author, Post-, Mental Health in a Sharna Olfman, PhD Postmodern World Author, Bipolar Children: Cutting-Edge Controversy, Krista Tricarico, ND Insights, and Research Toby Watson, PsyD Catherine Penney, RN Associated Psychological Health Services Dante’s Cure: A Journey Out of Madness Barbara Weinberg, RN, Licensed Judith E. Pentz, MD Acupuncturist

Maxine Radcliffe, RN Charles Whit eld, MD Action Medics Author, Not Crazy: You May Not Be Mentally Ill

Myriam Rahman, MA, DiplPW Damon Williams, RN, PMHNP-BC Process Work Institute Laughing Heart LLC Lloyd Ross, PhD Paris Williams, PhD Written by Will Hall Judith Schreiber, LCSW Author, Rethinking Madness: Towards a Paradigm Published by The Icarus Project and Freedom Center Soteria Associates Shift in Our Understanding and Treatment of

52 Health Professional Advisors While not co-authors, the following health care professionals are experienced with helping people come off psychiatric drugs. They reviewed this guide for its usefulness, and we thank them for their involvement: Ed Altwies PsyD Chris Gordon, MD Massachusetts General Hospital David Anick MD, PhD The Icarus Project Freedom Center Marino Center for Integrative Health Jen Gouvea, PhD, MSW www.theicarusproject.net www.freedom-center.org Engaged Heart Flower Essences [email protected] [email protected] Ron Bassman, PhD Author, A Fight To Be: A Psychologist’s Experience Mark Green MD The Icarus Project is a website community, network of Freedom Center is an award-winning support, advocacy from Both Sides of the Locked Door Westbridge Community Service local groups, and media project created by and for people and activism community based in Western Massachusetts. struggling with mad gifts commonly labeled as “mental Run by and for people labeled with mental disorders or Alexander Bingham, PsyD Nazlim Hagmann, MD illnesses.” We are creating a new culture and language that who experience extreme states of consciousness, Freedom resonates with our actual experiences of madness rather Center works for access to holistic alternatives, compas- Lee Hurter than trying to t our lives into a conventional framework. sionate care, and an end to forced psychiatric treatment. Patrick Bracken, MD Co-author, Post-Psychiatry, Mental Health in a NADA Certi ed Acupuncturist Postmodern World Gianna Kali Christopher Camilleri, MD Publisher, Beyond Meds website Second edition, June 2012. Your input and ideas are welcome for future versions of this guide. Los Angeles County Department of Mental Health Written by Will Hall. Published by The Icarus Project and Freedom Center. Michael Cornwall, PhD Editor, Coming off Psychiatric Drugs: Successful Thanks to: Ben Abelow, George Badillo, John BanisterAmy Bookbinder, Dave Burns, Kent Bye, Mick Bysshe, Monica Cassani, Oryx Withdrawal from Neuroleptics, Antidepressants, Cohen, Colin, Mary Kate Connor, Laura Delano, Jacqui Dillon, Dionysia Dionysius, Marc Dinacola, Dianne Dragon, dreamer, Sascha David Cohen, PhD Lithium, Carbamazepine and Tranquilizers DuBrul, Empties, Steve Fenwick, Marian B.G., Vikki Gilbert, Richard Gilluly, Rhiannon Grif th, Chaya Grossberg, Molly Hardison, Gail Co-author, Your Drug May Be Your Problem Hornstein, Lee Hurter, Jenna, Jonah, Julie, Marianna Kefallinou, Ed Knight, Inez Kochius, Peter Lehman, Paul Levy, Krista MacKinnon, Bruce Levine, PhD Jacks Ashley McNamara, Tsuyoshi Matsuo, Pheepho, Suzanne Richardson, Olga Runciman, Alex Samets, Sarah Seegal, Seven, Janice Sorensen, Lauren Spiro, Bon re Madigan Shive, Stacco, Jessica Max Stein, Terramuggus, Amy Upham, Agustina Vidal, Dorea Vierling- Celine Cyr Author, Surviving America’s Depression Epidemic: Claassen, Robert Whitaker, Health Professional Advisors, and many other collaborators and allies. Gaining Autonomy with Medication How to Find Morale, Energy, and Community in a Cover art: Jacks Ashley McNamara. World Gone Crazy Art design: Carrie Bergman ( rst edition); Seth Kadish, Ivana Klement, and Cheryl Weigel (second edition). Patricia Deegan, PhD Contributing artists: Fly, Gheena, Will Hall, Miss Led, Jacks Ashley McNamara, Erik Ruin, Janice Sorensen, and Bec Young. CommonGround Bradley Lewis, MD, PhD This Guide is available as a free le download at the Freedom Center and Icarus Project websites, Author, Narrative Psychiatry in online and printer-ready versions. Also available in Spanish, German, Greek, Italian, Japanese, Bosnian Jacqui Dillon and other translations. UK Krista Mackinnon Creative commons copyright 2012: http://creativecommons.org/licenses/by-nc-nd/3.0/. Practice Recovery You have advance permission to print, copy, share, link, and distribute as many copies as you like, as Kelley Eden, MS, ND long as you include source attribution, do not alter content, and there is no commercial nancial gain. Please Daniel Mackler, LCSW contact us for other uses. Neil Falk, MD Director, Take These Broken Wings Cascadia Behavioral Healthcare Medical Disclaimer: Rufus May, Dclin Daniel Fisher, MD This guide is written in the spirit of mutual aid and peer support. It is not intended as Evolving Minds Bradford, UK medical or professional advice. While everyone is different, psychiatric drugs are power- National Empowerment Center ful, and coming off -- especially suddenly or on your own -- can sometimes involve risks Elissa Mendenhall, ND Mark Foster, MD greater than remaining on. Clear Minds 51 Evelyn Pringle “Soteria and Other Alternatives to Acute Psychiatric www.opednews.com/author/author58.html Hospitalization: A Personal and Professional Review” Contents Loren Mosher Journal of Nervous and Mental Disease. 1999; Psychiatric Drugs 187:142-149 Dr. Caligari, 1984 Author’s Note ...... 5 “Pay Attention: Ritalin Acts Much Like Cocaine” “Psychiatric Drugs as Agents of Trauma “ Charles L. Vastag, B. 2001. Journal of American Medical Association, 286, Introduction ...... 6 Whit eld, The International Journal of Risk & Safety in Medicine 905-906 Harm Reduction For Mental Health ...... 7 22 (2010) “Clinical Risk Following Abrupt and Gradual Key Resources For Further Learning ...... 9 “Psychiatric Drug Promotion and the Politics of Withdrawal of Maintenance Neuroleptic Treatment” Looking Critically At “Mental Disorders” and Psychiatry...... 10 Neoliberalism” by Joanna Moncrieff Viguera, AC, Arch Gen Psych.54:49-55, 1997 The British Journal of Psychiatry. 2006; 188: 301-302. doi: Universal Declaration of Mental Rights and Freedoms ...... 11 10.1192/bjp.188.4.301 “Withdrawal Syndromes Associated with Antipsy- chotic Drugs” G Gardos, et al. Am J Psychiatry 1978; 135 How Dif cult Is Coming Off Psychiatric Drugs? ...... 12 “Psychosocial Treatment, Antipsychotic Postpone- Politics of Withdrawal ...... 12 ment, and Low-dose Medication Strategies in First Episode Psychosis” Bola, J. R., Lehtinen, K., Cullberg, J., Principles Of This Guide ...... 13 & Ciompi, L. (2009) Psychosis: Psychological, social and How Do Psychiatric Drugs Work? ...... 14 integrative approaches, 1(1), 4-18 Do Psychiatric Drugs Correct Your Chemistry? ...... 15 “Are There Schizophrenics for Whom Drugs May be Who’s To Blame? Yourself? Your Biology? Neither? ...... 17 Unnecessary or Contraindicated?” M. Rappaport, International Pharmacopsychiatry 13, 100-11, 1978 How Do Psychiatric Drugs Affect the Brain? ...... 18

“Prejudice and Schizophrenia: a Review of the Why Do People Find Psychiatric Drugs Helpful? ...... 19 “Mental Illness is an Illness Like Any Other” Facts You May Not Know About Psychiatric Drugs ...... 20 Approach” Read, John el al. www.vermontrecovery.com/ les/Download/foramanda.pdf Health Risks of Psychiatric Drugs ...... 21 How Withdrawal Affects Your Brain and Body ...... 25 Rethinking Psychiatric Drugs: A Guide for Informed Consent Why Do People Want To Stop Using Psychiatric Drugs? ...... 26 Grace Jackson AuthorHouse Publishing, 2009 Staying On Medications and Harm Reduction ...... 27 “Review of ‘The First Episode of Psychosis: A Guide I Want to Come Off But My Doctor Won’t Let Me: What Should I Do? ...... 28 for Patients and Their Families’” by John Bola and Will Hall. Best Practices in Mental Health: An International Journal, Before You Start Coming Off ...... 29 6(2), 138-142. (2010) Working With Fear ...... 32

“Five-year experience of rst-episode nonaffective Intermittent Use: Taking Psychiatric Drugs From Time To Time ...... 32 psychosis in open-dialogue approach: Treatment What are the Alternatives to Using Psychiatric Drugs? ...... 33 principles, follow-up outcomes, and two case studies” Seikkula, J, Psychotherapy Research 16(2): 214-228, 2006 Coming Off: Step by Step ...... 35 I Think Someone is Overmedicated, What Should I Do? ...... 38 “Schizophrenia, Neuroleptic Medication, and Mortality” Joumkaa, M., et. al(2006) British Journal of Looking To The Future ...... 39 Psychiatry, 188, 122-127, http://bit.ly/KIGxyu Afterward: Special Considerations ...... 40 “Serotonin and Depression: A Disconnect between Resources ...... 45 the Advertisements and the Scienti c Literature” J.R. Lacasse and J. Leo PLoS Med. 2005; 2(12): e392 doi:10.1371/ Health Practitioner Editorial Advisors ...... 51 journal.pmed.0020392 50 3 “Factors Involved in Outcome and Recovery in MIND Coping With Coming Off Study Schizophrenia Patients Not on Antipsychotic Medica- www.mind.org.uk/NR/rdonlyres/BF6D3FC0-4866-43B5- tions: A 15-Year Multifollow-Up Study” Martin Harrow 8BCA-B3EE10202326/3331/CWCOreportweb.pdf and Thomas H. Jobe, Journal of Nervous & Mental Disease. or http://snipurl.com/MINDComingOffStudy 195(5):406-414 May 2007 http://psychrights.org/Research/Digest/NLPs/ “Rethinking Models of Psychotropic Drug Action” OutcomeFactors.pdf J. Moncreiff and D.Cohen, Psychotherapy and Psychosomatics 74:145-153, 2005 “Empirical correction of seven myths about schizo- phrenia with implications for treatment.” C. Harding The Myth of the Chemical Cure Acta Psychiatrica Scandinavica 384, suppl., 14-16, 1994 Joanna Moncrieff, Palgrave Macmillan, 2008. http://psychrights.org/research/Digest/Chronicity/myths.pdf “Needed: Critical Thinking About Psychiatric “The Vermont longitudinal study of persons with Medications” David Cohen, Ph.D www.ahrp.org/about/ severe mental illness, I. Methodology, study sample, CohenPsychMed0504.pdf and overall status 32 years later.” C.M. Harding, et al. American Journal of Psychiatry. 144: 718-28., 1987 “Gradual, 10% Dose Reductions Dramatically Reduce Antidepressant Discontinuation Symptoms: Presen- “Factors Involved in Outcome and Recovery in tation at the Canadian Psychiatric Association”Alison Schizophrenia Patients Not on Antipsychotic Medica- Palkhivala, Nov. 2007 http://www.docguide.com/gradual- tions: A 15-Year Multifollow-Up Study” Harrow,M. and 10-dose-reductions-dramatically-reduce-antidepressant- Jobe, T.H. The Journal of Nervous and Mental Disease.195:406- discontinuation-symptoms-presented-cpa 414, 2007 “Paper In New ‘Psychosis’ Journal Shows Many “Initiation and Adaptation: a Paradigm for Under- Patients Do Better Without Psychiatric Drugs” standing Psychotropic Drug Action” SE Hyman and EJ Medical News Today Mar 2009 Nestler Am J Psychiatry,153:151-162, 1996 “Physical Illness Manifesting as Psychiatric Disease. “Is it Prozac, Or Placebo?“ by Gary Greenberg Analysis of a State Hospital Inpatient Population” Mother Jones. 2003; http://bit.ly/MDUbQl Hall RC, et. al. Arch Gen Psychiatry. Sep;37(9):989-95. 1980

“The Latest Mania: Selling Bipolar Disorder” David “Predictors of Antipsychotic Withdrawal or Dose Healy PLoS Medicine. Vol. 3, No. 4, e185 Reduction in a Randomized Controlled Trial of Provider Education” Meador KG, J Am Geriatr “Long-term Antipsychotic Treatment and Brain Soc. Feb;45(2):207-10. 1997 Volumes” Beng-Choon Ho, et al. Arch Gen Psychiatry. 68, 2011 “Prevalence of Celiac Disease and Gluten Sensitivity in the United States Clinical Antipsychotic Trials of “Long-Term Follow-Up Studies of Schizophrenia” Intervention Effectiveness Study Population” by Brian Koehler Nicola G. Cascella. et al. Schizophr Bull doi: 10.1093/schbul/ http://isps-us.org/koehler/longterm_followup.htm sbp055 2009

4 49 Universal Declaration of Mental Rights and SCIENTIFIC STUDIES Author’s Note Freedoms www.adbusters.org “Are Bad Sleeping Habits Driving Us Mad?” Emma This is a guide I wish I had when I was taking Young, New Scientist, 18 February 2009 psychiatric drugs. Prozac helped me for a while, then Venus Rising Association for Transformation made me manic and suicidal. I was sick for days after www.shamanicbreathwork.org “Are Schizophrenia Drugs Always Needed?” Benedict coming off Zoloft, with counselors telling me I was Carey, The New York Times, March 21, 2006 faking it. Nurses who drew blood samples for my Voices of the Heart www.freedom-center.org/pdf/ www.voicesoftheheart.net/ NYT3-21-06AreSchizophreniaDrugsAlwaysNeeded.pdf lithium levels never explained it was to check for drug toxicity, and I was told the Navane and other Healing Schizophrenia: Using Medication Wisely “Atypical Antipsychotics in the Treatment of Schizo- anti-psychotics I took to calm my wild mental states by John Watkins, Michelle Anderson Publishing 2006. phrenia: Systematic Overview and Meta-regression were necessary because of faulty brain chemistry. Analysis” John Geddes, et al.,British Medical Journal. 2000; Wellness Recovery Action Plan 321:1371-1376 (2 December). Cited in “Leading Drugs for I used many different psychiatric drugs over several by Mary Ellen Copeland Psychosis Come Under New Scrutiny” Erica Goode, The years, but the medical professionals who prescribed www.mentalhealthrecovery.com New York Times, May 20, 2003 Through the Freedom Center I discovered them never made me feel empowered or informed. that I was denied a basic medical right: informed They didn’t explain how the drugs work, honestly Will Hall “Illness Risk Following Rapid Versus Gradual Discon- consent, having accurate information about my www.willhall.net discuss the risks involved, offer alternatives, or help tinuation of Antidepressants” RJ Baldessarini, American diagnosis and medication. I learned that mistreat- Journal of Psychiatry, 167:934–941, 2010 me withdraw when I wanted to stop taking them. ment like I went through is often business as Information I needed was missing, incomplete, or usual in the mental health profession. I came “Effects of the Rate of Discontinuing Lithium Mainte- inaccurate. When I nally began to learn ways to nance Treatment in Bipolar Disorders” RJ Baldessarini, across research ignored by the mainstream media, get better without medication, it wasn’t because of Journal of Clinical Psychiatry 57:441-8, 1996 including studies by the UK charity MIND and the the mental heath system, it was despite it. British Psychological Society, which con rmed my “The Diagnosis and Management of Benzodiazepine experience: most professionals are uninformed Dependence” Heather Ashton, Current Opinion in Psychiatry Part of me didn’t really want to be on psychiatric about coming off drugs, and even frequently stand in 18(3):249-255, May 2005 drugs, but another part of me desperately needed help. My suffering was very serious – multiple suicide patients’ way, sometimes ending up harming them. “Brain Volume Changes After Withdrawal of Atypical attempts, hearing persecutory voices, extreme The Freedom Center led me to work with the Antipsychotics in Patients with First-episode mistrust, bizarre experiences, hiding alone in my Schizophrenia” G. Boonstra, et al., J Clin Psychopharmacol. Icarus Project, and together these communities apartment, unable to take care of myself. Therapy Apr;31(2):146-53 2011 of mutual support have helped many people make hadn’t worked, and no one offered me other options. wiser decisions -- whether it is to stay on medica- I was under pressure to see my problems as “biologi- “The Case Against Antipsychotic Drugs: a 50 Year tions when they are useful or explore the possibil- Record of Doing More Harm Than Good” Robert cally based” and “needing” medication, instead of ity of coming off when they are not. Many of us are Whitaker, Med Hypotheses. 62: 5-13 2004 looking at medication as one option among many. living without psychiatric drugs that doctors told For a time medication seemed like my only way out. “Childhood trauma, psychosis and schizophrenia: a us we would need our whole lives, and despite a It took years to learn that the answers, and my hope literature review with theoretical and clinical impli- diagnosis of schizoaffective disorder schizophrenia I for getting better, were really within myself. cations.” J. Read, et al., Acta Psychiatr Scand 2005 have been medication-free for more than 15 years. Drug-Induced Dementia: A Perfect Crime When I nally left the hospitals, residential facilities, This guide brings together the best infor- Grace E. Jackson MD, AuthorHouse 2009 and homeless shelters I lived in for nearly a year, I mation we’ve come across and the most began to do my own investigating. I started judging important lessons we’ve learned at the “The Emperor’s New Drugs: An Analysis of Anti- my options more carefully, based not on mis– depressant Medication Data Submitted to the U.S. Freedom Center and the Icarus Project. It’s informed authorities telling me what to do, but on Food and Drug Administration” by Irving Kirsch, et. al.. not perfect, and I invite you to contribute your my own research and learning. That process led me Prevention & Treatment. July; 5(1) 2002 experiences and research for future editions, but it’s to co-found Freedom Center, a support community a guide that I hope can be helpful. “Is Active Psychosis Neurotoxic?” T. H. McGlashan in Western Massachusetts that brings together Schizophrenia Bulletin vol. 32 no. 2006 people asking similar questions. – Will Hall 48 5 Mad In America: Bad Science, Bad Medicine, and the GENERAL RESOURCES Enduring Mistreatment of the Mentally Ill Introduction: by Robert Whitaker, Perseus Publishing Alliance for Human Research Protection http://ahrp.blogspot.com/ Mad In America We live in a world that, www.madinamerica.com Alternatives Beyond Psychiatry when it comes to drugs, edited by Peter Stastny and Peter Lehmann Madness Radio: Voices and Visions From www.peter-lehmann-publishing.com/books/without.htm Outside Mental Health is quite crazy. www.madnessradio.com Daniel Mackler www.iraresoul.com/ MIND National Association for Mental Health (UK) On the one hand there is the War on Drugs, the risks that go along with emotional crisis and www.mind.org.uk which keeps some drugs illegal, over ows our madness. Combined with the confusing messages Manufacturing Depression: The Secret History of a prisons, and hasn’t ended drug use. Then there from society about drugs, the result is a lot of fear. Modern Disease The Mood Cure: The 4-Step Program to Rebalance Your by Gary Greenberg, Simon & Schuster 2010 www.garygreen- Emotional Chemistry and Rediscover Your Natural Sense are the acceptable drugs like alcohol and tobacco, Drugs become angels or demons. We need to stay bergonline.com/ of Well-Being advertised everywhere with promises of happiness on them at all costs, or get off them at all costs. We by Julia Ross, Viking Adult publishers, 2002. and success while causing widespread addiction, look only at the risks, or we’re too frightened to Harm Reduction Coalition disease, and death. Legal prescription drugs such look at the risks at all. There is no compromise: it’s www.harmreduction.org National Coaliton for Mental Health Recovery as stimulants, pain killers, and anti-anxiety pills black and white, all or nothing. www. ncmhr.org/ are just as addictive and risky as street highs, Hearing Voices Network www.intervoiceonline.org; ww.hearing-voices.org with a doctor’s seal of approval. And then there It’s easy to fall into absolutist thinking when it National Resource Center on Psychiatric Advance comes to psychiatric drugs. Pro-drug advocates Directives are neuroleptics, lithium, and anti-convulsant Hearing Voices Network USA www.nrc-pad.org drugs, which have very risky adverse effects but focus on the risks of psychosis and extreme www.hearingvoicesusa.org help manage and dampen consciousness when emotional states, while anti-drug advocates focus Open Dialogue people feel out of control, so we call them “anti- on the risks of taking drugs. But it is the belief The Heart and Soul of Change, Second Edition: Deliver- www.dialogicpractice.net psychotics” and “mood-stabilizers.” of this guide, and the philosophy of our pro- ing What Works in Therapy. Duncan, Barry et. al, eds. treatment choice work at the Freedom Center American Psychological Association, 2009. Peter Lehmann Publishing With drugs in the picture, lives are often at stake, and the Icarus Project, that either-or thinking www.peter-lehmann-publishing.com Law Project for Psychiatric Rights whether from addiction, adverse drug effects, or around drugs is a big part of the problem. www.psychrights.org Portland Hearing Voices www.portlandhearingvoices.net International Network Towards Alternatives and Recovery Practice Recovery www.intar.org www.practicerecovery.com

Philip Dawdy Ron Unger www.furiousseasons.com http://recoveryfromschizophrenia.org/

Pat Deegan Self-Injurer’s Bill Of Rights www.patdeegan.com www.sel njury.org/docs/brights.html

Emotional CPR Soteria Associates www.emotional-cpr.org/ www.moshersoteria.com

Factsheets and Booklets Soteria Alaska by MIND UK http://soteria-alaska.com/ www.mind.org.uk/Information/Factsheets Trauma and Recovery The Aftermath of Violence--from Foundation for Excellence in Mental Health Care Domestic Abuse to Political Terror www.femhc.org by Judith Herman, Basic Books, 1997

6 47 Effexor Activist MEDICATION RESOURCES http://theeffexoractivist.org/ Harm Reduction For Mental Health Halting SSRI’s Advice On Medications David Healy www.mind.org.uk/NR/rdonlyres/ by Rufus May and Philip Thomas Absolutist approaches to drug and sex education 59D68F19-F69C-4613-BD40-A0D8B38D1410/0/ www.hearing-voices.org/publications.htm teach abstinence, “just say no,” and one way for DavidHealyHaltingSSRIs.pdf everyone. They work for some people, but not Critical Thinking RX www.criticalthinkrx.org most, and if you don’t follow the model you can Med Free Or Working on It end up being judged, not helped. http://medfree.socialgo.com/ Depression Expression: Raising Questions Paxil and Withdrawal FAQ About Antidepressants “Harm reduction” is different: pragmatic, not www.paxilprogress.org/ www.greenspiration.org dogmatic. Harm reduction is an international movement in community health education that Protocol for the Withdrawal of SSRI Antidepressants “Drug Companies and Doctors: a Story of Corrup- recognizes there is no single solution for each David Healy www.benzo.org.uk/healy.htm tion” Marcia Angell, New York Review of Books, 2009 person, no universal standard of “success” or “failure.” Getting rid of the problem is not Psychiatric Drug Withdrawal Primer “Full Disclosure: Towards a Participatory and Risk- Monica Cassani http://bipolarblast.wordpress. Limiting Approach to Neuroleptic Drugs” Volkmar necessarily the only way. Instead, harm reduction com/2009/09/22/psychiatric-drug-withdrawal-primer/ Aderhold and Peter Stastny www.psychrights.org/Research/ accepts where people are at and educates them to Digest/NLPs/EHPPAderholdandStastnyonNeuroleptics.pdf make informed choices and calculated trade-offs Recovery Road - tranquilizer and anti-depressant that reduce risk and increase wellness. People need The Heart and Soul of Change dependency information, options, resources and support so they http://recovery-road.org/ http://heartandsoulofchange.com/resources/psychiatric- drugs/ can move towards healthier living – at their own Schizophrenia & Natural Remedies pace and on their own terms. Withdrawing Safely from Psychiatric Drugs “How do psychiatric drugs work?” Joanna Moncrieff and Dr Maureen B. Roberts www.jungcircle.com/schiznatural. David Cohen British Medical Journal 2009; 338 Applying harm reduction philosophy to mental htm www.mentalhealth.freeuk.com/howwork.pdf health is a new but growing approach. It means not always trying to eliminate “symptoms” or MIND “Coping With Coming Off” Study Surviving Antidepressants discontinue all medications. It recognizes that http://survivingantidepressants.org/ www.mind.org.uk/help/information_and_advice, www.portland- hearingvoices.net/ les/ people are already taking psychiatric drugs, The Icarus Project drug withdrawal forum MINDUKCopingWithComingOffPsychiatricDrugs2005.pdf already trying to come off them, and already living www.theicarusproject.net/forums/comingoffmeds with symptoms -- and that in this complicated My Self Management Guide to Psychiatric Medications reality people need true help, not judgment. It Association des Groupes d’Intervention en Defense des Tranquilizer Recovery and Awareness Place encourages balancing the different risks involved: www.non-benzodiazepines.org.uk/benzo-faq.html Droits en Sante Mentale du Quebec the harm from extreme states, as well as the Your Drug May Be Your Problem: How and Why to Stop Peer Statement on Medication Optimization and harm from treatments such as adverse drug Taking Psychiatric Medications Alternatives effects, disempowering labels, and traumatic Peter Breggin and David Cohen HarperCollins Publishers, 2007 http://bit.ly/h1T3Fk hospitalization.

Take These Broken Wings: Recovery From Schizo- Making harm reduction decisions means looking phrenia without Medication - lm http://www.iraresoul.com/dvd1.html honestly at all sides of the equation: how drugs might help a life that feels out of control, how risky those same drugs might be, and the role of options and alternatives. Any decisions become a process of experimentation and learning, including learning from your own mistakes and changing your goals along the way. Harm reduction accepts all this, believing that the essence of any healthy life is the capacity to be empowered. 46 7 staying on and the risks of going off, or we take multiple drugs and suspect we don’t need all of them. Others may want to go off but it’s not the right time, Resources or may have tried in the past, experienced a return of Everyone’s frightening symptoms, and decided to go back on for now. If you are looking for information about psychiatric drugs and mental disorders, consult the following sources and references we used to write this guide. Our paths to healing are unique. Some of us don’t experience is need to make any life changes, letting time and patience make change for us. Others may need to FREE DOWNLOADS and COMING OFF Medications make big shifts in nutrition, work, family life, or re– lationships; we may need to focus more on self-care, translations: SUPPORT different. expression, art, and creativity; adopt other approach- es like peer support, therapy, herbalism, acupuncture, This Guide is Creative Commons copyright and available free Alternative Therapies for Bipolar in several languags as a le download in online and printer- or homeopathy; or nd new life interests like going http://health.groups.yahoo.com/group/ALT-therapies4bipolar/ ready versions. You have advance permission to print, to school or connecting with nature. We may copy, share, link, and distribute as many copies as you Antidepressant Solution: A Step-By Step guide to Safely There is no formula for coming off psychiatric drugs. discover that the rst step is getting restful sleep; we like, as long as you don’t alter it or have nancial gain. Overcoming Antidepressant Withdrawal, Dependence, What there is, and what this guide presents, is some may need structure to help get us motivated; or to Key resources and ‘Addiction’ common experience, basic research, and important stop taking any recreational drugs or alcohol. Our by Joseph Glenmullen Free Press, 2006 information that can potentially make the process priorities might be to nd a home or a new job; we MIND “Making Sense of Coming Off Psychiatric Drugs” Benzo Buddies less dif cult. Many people successfully come off may need to establish stronger support networks of http://bit.ly/yPjusy www.benzobuddies.org psychiatric drugs, with or without guidance, while trusted friends; or it may be important to speak up Recent Advances in Understanding Mental Illness and others nd it very hard. Many continue on psychi- with greater honesty and vulnerability about what Benzodiazepines: Co-operation Not Confrontation Psychotic Experiences www.bcnc.org.uk atric drugs because the bene ts are greater than we are going through. British Psychological Society Division of Clinical Psychology www. the drawbacks. But many people end up staying on bps.org.uk www.freedom-center.org/pdf/ Benzodiazepenes: How They Work and How To Withdraw psychiatric drugs without ever exploring options, The process might feel mysterious and arbitrary, britishpsychologicalsocietyrecentadvances.pdf (The Ashton Manual) and an attitude of acceptance and patience is vital. by C. Heather Ashton just because they don’t know any other way. Coming Off Psychiatric Drugs: Successful Withdrawal Learning means trial and error. from Neuroleptics, Antidepressants, Lithium, Carbam- When we’ve relied only on doctors, television, Benzo.org azepine and Tranquilizers www.benzo.org.uk and mainstream sources, it might seem impossible Peter Lehmann, ed. to imagine dealing with our emotional extremes www.peter-lehmann-publishing.com Benzo Withdrawal Forum without psychiatric drugs. Maybe we’ve never Because each of us is unique, Anatomy of an Epidemic: Magic Bullets, Psychiatric http://benzowithdrawal.com/forum/ heard of anyone going through what we go through Drugs, and the Astonishing Rise of Mental Illness in America Benzo-Wise: A Recovery Companion without medications. Maybe a prescription was V. Baylissa Frederick 2009, Campanile Publishing the beginning of people taking our need for help it is as if we are navigating by Robert Whitaker, Crown Books 2010. seriously, and medications feel like the only way to Beyond Meds website www.beyondmeds.com Bristol & District Tranquilliser Project www.btpinfo.org.uk/ recognize that our problems are severe and out of through a labyrinth, “Addressing Non-Adherence to Antipsychotic Medica- control. And when everyone around us has come to tion: a Harm-Reduction Approach” Coming Off Psychiatric Drugs by Matthew Aldridge, Journal of Psychiatric Mental Health view medication as essential to our survival, consid- getting lost and www.comingoff.com ering a new path can feel too risky to even try. Nursing, Feb, 2012 http://bit.ly/wbUA6A Coming Off Psychiatric Drugs: A Harm Reduction Council for information on Tranquilizers, Antidepres- finding our way again, sants, and Painkillers Many of us get help from psychiatric drugs, but might Approach - video with Will Hall www.citawithdrawal.org.uk/ not understand how they really work or what the http://bit.ly/zAMTRF other options are. Some of us never found medica- making our own map Doing Without Drugs: A Guide for Non-Users and tions useful, or medications even made our problems Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and their Families Users 1991 Sylvia Caras, worse, and we are ready to try living without them. as we go. by Peter Breggin, Springer Publishing, 2012. www.peoplewho.org/documents/doingwithoutdrugs.htm Sometimes people are torn between the risks of

8 45 People do need help, but help should also do no sending signs and talking to you is a belief of many harm, and should be based on what the person world religions; and manic states can provide de nes help to be, not what others de ne for escape from impossible circumstances and contain them. From the outside, cutting, suicidal thoughts, deep spiritual truths. Even falling in love often feels or recreational drug use might seem like the most like going crazy. important issue, but the person themselves may These experiences are unusual and mysterious decide they need help with housing, an abusive - and can make it impossible to work or go to boyfriend, or access to health care. We need a school - but rather than just suppressing them mental health system based on voluntary services, with powerful drugs, can they be included as part compassion, and patience, not force, control, and of humanity’s mental diversity? Might they be worth paternalism. We also need communities taking exploring to discover their meaning and purpose? more responsibility to care for each other. Could they be like other human challenges in life, If people have a hard time communicating, they offering us opportunities to grow and transform have a right to supportive helper advocates who we are? who can bridge the gap between madness and Many cultures around the world have better rates “ordinary” reality. When people need help, of recovery when they welcome people in extreme gentleness, exibility, patience and acceptance states rather than excluding them; all societies usually work best. Because forced drugging should nd a place for anyone going through Key Resources For Further Learning claims to act in the patient’s best interest, madness. To rede ne normal, our communities “advance directives” can help people de ne need to talk more openly about emotional suffering MIND “Making Sense of Coming Off Psychiatric Drugs” for themselves what they want and don’t want. and the limits of psychiatric treatments. “Coming http://bit.ly/yPjusy Advance directives are like a living will for out” with our mental difference could lead the way crisis, where you give instructions on what to to social change. “Recent Advances in Understanding Mental Illness and Psychotic Experiences” do, who to contact, and treatment preferences Report by The British Psychological Society Division of Clinical Psychology (including leaving you alone) in case you are in http://bit.ly/fC7BGf crisis and having a hard time communicating. Advance directives are not legally binding (which Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and their may change through movement advocacy), but Families by Peter Breggin, Springer Publishing, 2012. do sometimes carry weight in how people are treated. Coming Off Psychiatric Drugs: Successful Withdrawal from Neuroleptics, Antidepressants, Lithium, Carbamazepine and Tranquilizers Redefining “Normal” edited by Peter Lehmann, www.peter-lehmann-publishing.com

What is the de nition of “normal?” New research Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing supports the harm reduction principle that it’s not Rise of Mental Illness in America by Robert Whitaker, Crown Books 2010. always best to just get rid of everything considered a “symptom.” Madness shouldn’t be indulged or Beyond Meds: Alternatives To Psychiatry website romanticized, but consider: Many people hear www.beyondmeds.com voices, for example, and learn how to live with “Addressing Non-Adherence to Antipsychotic Medication: a Harm-Reduction Approach” them; suicidal feelings are more common than we by Matthew Aldridge, Journal of Psychiatric Mental Health Nursing, Feb, 2012 http://bit.ly/wbUA6A realize, and can be part of a need for change; and depression might be a part of the creative process. Coming Off Psychiatric Drugs: A Harm Reduction Approach - video with Will Hall Sometimes paranoia is a message about abuse or http://www.youtube.com/watch?v=O4bdG601k4k, http://bit.ly/zAMTRF re ects sensitivity to nonverbal communication; self-injury is often a useful way to cope with overwhelming trauma; feeling the universe is 44 9 Looking Critically at “Mental Disorders” and Psychiatry “Insight” and Forced Drugging Forcing people to go into treatment and take drugs often traumatizes them and makes the The mental health system sometimes forces people situation worse, creating fear and avoidance Doctors put people on psychiatric medications for has to include psychiatric drugs. Once people have of help. It undermines a healing relationship, and to take psychiatric drugs against their will, with the experiences labeled “mental disorders:” extreme a diagnosis and start taking medication, it is easy to violates human rights and the right to integrity justi cation that they lack insight and risk harming emotional distress, overwhelming suffering, wild think of the medications as physically necessary for of mind and sense of self. Drugging and locking mood swings, unusual beliefs, disruptive behaviors, survival. themselves, harming others, or can’t take care of someone up because of “risk” is a double standard and mysterious states of madness. Currently themselves. In practice, the de nition of words that can deny someone’s freedom just because millions of people world-wide, including infants Not only is there is no solid science behind viewing like “insight” and “risk of harm to self or others” professionals are afraid of something they can’t and elders, take psychiatric drugs when they are mental disorders as simple malfunctions of biology is very blurry and subjective. It can depend on predict. While some people do feel helped by an diagnosed with bipolar disorder, schizophrenia, “corrected” by drugs, but many people with even the doctor you get, the facility you are in, or even involuntary hospitalization or forced drugging, the psychosis, depression, anxiety, attention de cit, the most severe diagnosis of schizophrenia or what your parents think is best, rather than any dangers of abuse and the infringements of rights obsessive-compulsive, or post-traumatic stress. The bipolar go on to recover completely without objective standard. Being in con ict, or acting in are too great, especially when alternative, voluntary numbers are climbing every day. medication. The experiences that get labeled mental ways others don’t know how to control, can lead approaches can be tried but aren’t. We need disorders are not “incurable” or always “lifelong:” to forced drugging, and force is often a convenience alternatives to the either-force-or-nothing trap. For many people, psychiatric drugs are very they are more mysterious and unpredictable. For for overworked staff untrained how to help in other Sometimes people seem to “lack insight” or be useful. Putting the brakes on a life out of control, some people psychiatric drugs are helpful tools ways. Sometimes people are forced onto drugs just unable to acknowledge their problems, but this is one being able to function at work, school, and in that change consciousness in useful ways, but they relationships, getting to sleep, and keeping a lid on for yelling, or for cutting (which is usually not a person’s opinion about someone, and not grounds to are not medically necessary treatments for illness. suicide attempt). Biological theories that say people label others with a medical disorder and take away emotional extremes can all feel lifesaving. The sense Once you acknowledge this, more options become of relief is sometimes dramatic, and the medications “need their medication” are used to support forced their basic rights. Trying and learning from mistakes is thinkable. And the potential risks of psychiatric drugging, and in many court settings, “lacking insight” how people grow. Even people who are in trouble and can stir very powerful emotions, and even feelings drugs come under greater scrutiny, because of salvation. At the same time, the help psychiatric amounts to disagreeing when a psychiatrist thinks making bad choices need the same opportunity as they are very serious -- including chronic illness, everyone else to discover and learn on their own. drugs offer many people can leave little room to see you are sick and should be medicated. mental impairment, dependency, worse psychiatric What someone else considers “self-destructive” more to the picture: others experience these drugs symptoms, and even risk of early death. The legacy of psychiatric treatment is violent and may be the best way a person knows how to learn as negative, harmful, and even life-threatening. As a abusive. Today, thanks to patients’ rights activism and cope, given other things they are struggling result, it is rare in society to nd a clear understand- and the psychiatric survivor movement, laws often with: forced treatment may be more damaging than ing of how and why these drugs work, or an honest do recognize the harm that can be done by forced someone’s “self-destructive” behavior. Sometimes discussion of risks, alternatives, and how to come off drugging, and there are protections that mandate the spiritual states of consciousness, nonconformist them if people want to. least intrusive, and least harmful, treatments be used. beliefs, con icts with abusive family members, or trauma are called “lack of insight,” but they deserve Many doctors and TV ads tell people that psychiat- These protections, however, are rarely fully followed, to be listened to, not made into illnesses. ric medication is necessary for a biological illness, and few alternatives receive funding. just like insulin for diabetes. They promote the idea that the drugs correct chemical imbalances and treat brain abnormalities. The truth is different, however. “Biology” and “chemical imbalances” have become simplistic sound-bites to persuade people to put their faith in doctors and quick xes. These words are in fact much more complicated and unclear. Biological factors (such as nutrition, rest, and food allergies) affect everything we experi- ence: biological “cause” or “basis” plants the belief that medication is the key to solving our problems. To say something has a biological cause, basis, or underpinning can give a message that the solution must always be a medical one and that “treatment” 10 43 Psychiatric medications have become a multi-billion dollar industry like big oil and military spending, Universal Declaration of and companies have incentive and means to cover up facts about their products. If you look more Mental Rights and Freedoms carefully into the research and examine closely the claims of the mental health system, you will That all human beings are created different. discover a very different picture than what pill 1 That every human being has the right to companies and many doctors lead us to believe. be mentally free and independent. Companies actively suppress accurate assessments of drug risks, mislead patients about how contro- That every human being has the right to versial mental disorder theories are, promote a 2 feel, see, hear, sense, imagine, believe or false understanding of how psychiatric drugs really experience anything at all, in any way, at work, keep research into alternative approaches any time. unfunded and unpublicized, and obscure the role That every human being has the right to of trauma and oppression in mental suffering. For 3 behave in any way that does not harm much of the mental health system, it’s one size others or break fair and just laws. ts all, regardless of the human cost: scandals are growing, and the fraud and corruption surround- That no human being shall be subjected ing some psychiatric drugs are reaching tobacco- 4 without consent to incarceration, restraint, industry proportions. punishment, or psychological or medical intervention in an attempt to control, In this complicated cultural environment, people repress or alter the individual’s thoughts, are looking for accurate information about possible feelings or experiences. risks and bene ts so they can make their own decisions. Too often, people who need help reducing and getting off these drugs are left without support about your options if you decide to explore going or guidance. Sometimes they are even treated off psychiatric drugs. like the desire to go off the drugs is itself a sign of mental illness – and a need for more drugs. Because of pro-drug bias, there has been very little research on psychiatric drug withdrawal. We based In discussing “risks” and “dangers,” it is important this guide on the best available information, including to understand that all life involves risk: each of us excellent sources from the UK, and worked with a makes decisions every day to take acceptable risks, group of health professional advisors (see page 51) such as driving a car, working in a stressful job, or including psychiatric doctors, nurses, and alternative drinking alcohol. It may not be possible to predict practitioners, all of whom have clinical experience exactly how the risks will affect us, or to avoid the helping people come off drugs. We also draw on risks entirely, but it is important to know as much the collective wisdom of an international network as we can about what the risks are. Looking at the of peer counselors, allies, colleagues, activists, and risks of drug treatment also means looking at the healers who are connected with the Freedom risks of emotional distress/ “psychosis” itself, and Center and the Icarus Project, as well as websites making the best decision for you. Maybe psychiatric such as Beyond Meds. We encourage you to drugs are the best option given your circumstances use this guide not as the de nitive resource and situation, or maybe you want to try to reduce but as a reference point to start your own or come off. This guide is not intended to persuade research and learning. And we hope that you you one way or the other, but to help educate you will share what you have learned with others and contribute to future editions. 42 11 How Difficult Is Coming Off Psychiatric Drugs?

In working with hundreds of people over many have the opportunity to explore this. The study by years, we have found there is no way to predict how MIND, the leading mental health charity in the UK, the coming off process will go. There is really no con rms our experience. MIND found that “Length way to know in advance who can and who cannot of time on the drug emerged as the factor that most do well without psychiatric drugs, who can do well clearly in uenced success in coming off. Four out of ve with fewer drugs or lower doses, or how hard it will people (81%) who were on their drug for less than six be. We’ve seen people withdraw successfully after months succeeded in coming off. In contrast, less than more than 20 years, people who decide to continue half (44%) of people who were on their drug for more to take them after being on for just a year or less, than ve years succeeded. (Just over half of people who and people who struggle with long term withdrawal. were on their drug for between six months and ve Because coming off is potentially possible years succeeded.)” Facing these unknowns means for anyone, the only way to really know is to remaining exible and learning as you go: coming try slowly and carefully, and see how it goes, off completely may, or may not, be right for you, but many pressures on families are economic and psychotics are a clear example. remaining open to staying on. Everyone should everyone can become more empowered. circumstantial, parenting skills classes and family therapy have proven effective and helpful, as are Medications lose their pro tability when their many other alternatives including diet, exercise, patents expire after a few years. It is in companies’ sleep, homeopathy, and being in nature. interest to pit new, expensive drugs against older, The Politics Of Withdrawal cheaper ones available generically, even when they Lawsuits have to deceive the public to do so. In some ways the issue of coming off psychiatric Instead of viewing the experiences of madness only drugs is deeply political. People of all economic and as a “dis-ability,” which can be a stigmatizing put If you have taken a psychiatric drug and Marketing new drugs amounts to social experi- educational backgrounds successfully reduce or go down, it is helpful to also view those of us who go experienced any negative effects, including dif culty mentation. There is huge potential for dangerous off their psychiatric medication. However, sometimes through emotional extremes as having “diverse- withdrawing, you may be eligible to le suit against negative effects and abuse. Like past drugs, economic privilege can determine who has access to ability.” Society must include the needs of sensitive, the drug manufacturer if they acted improperly. miraculous claims are likely to give way to scandal. information and education, who can afford alternative creative, emotionally wounded, and unusual people This is especially true about newer drugs. Over Choice and “Do No Harm” treatments, and who has the opportunity to make who make contributions to the community beyond the years thousands of people on psychiatric life changes. People without resources are often the standards of competition, materialism, and drugs have received settlements totaling billions of the most vulnerable to psychiatric abuse and injury individualism. To truly help people who are labelled Medication prescribers have a responsibility to dollars. Contact a reputable lawyer for information. from drugs. Health is a human right for all people: we mentally ill, we need to rethink what is “normal,” work collaboratively with clients and respect need a complete overhaul of our failed in the same way we are rethinking what Future Drugs their choices about treatments. At the same “mental health system” in favor of truly it means to be unable to hear, without time, prescribers are bound by the principle of effective and compassionate alternatives sight, or with limited physical mobility. Pharmaceutical companies plan to introduce a “do no harm.” This means that when there are available to everyone regardless of Universal design and accommodating income. Pushing risky, expensive drugs those of us who are different ultimately wide range of new drugs in the future. Many of signs of overmedication, adverse effects that aren’t as the rst and only line of treatment bene t everyone. We need to challenge these drugs will be marketed as improvements justi ed by usefulness, or if a client wants to take should end; priority should be on able-ism in all forms, and question the over past drugs. medications that are dangerous or only contribute prevention, providing safe places of wisdom of adapting to an oppressive to addiction, the prescriber cannot just go along. refuge, and treatments that do no harm. and unhealthy society, a society that The industry’s record should make us skeptical They should inform patients about why they Numerous studies, such as Soteria is in many ways itself quite crazy. A about these innovations. Repeatedly drugs are disagree, on grounds of medical ethics, and work House in California and Open Dialogue in Finland, social model of disability means accepting human brought to market as “new and improved.” Then to nd viable alternatives. Otherwise respect for show that non- and low-drug treatments can be very differences, and no longer treating poverty as a serious problems and toxic effects are revealed, choice can become an excuse for neglecting client’s effective and cost less than the current system. And medical problem. Our needs are intertwined with corruption is exposed, and lawsuits are led. The real needs. a medical product regulatory establishment that was the broader needs for social justice and ecological the next cycle begins, with “new and improved” honest about drug risks, effectiveness, and alternatives sustainability. drugs introduced once again. The “atypical” anti- would likely have never put most psychiatric drugs on the market to begin with. 12 41 Afterward: Special Considerations Drugs in Liquid Form, The exact extent of drug risks to children is Half-Life, and Compound unknown, and companies have not been honest. For example, it took years of pressure before Pharmacies anti-depressant packaging carried the “black box” warning that they could cause suicide, or warnings Switching to the liquid form of a drug gives you on ADHD drugs that they can cause addiction and greater control over reducing the dosage slowly; psychosis. ask your pharmacist, as some brands may have different potencies. You can also go to a “compound Child behavioral problems are very real, and pharmacy” (found on the internet) that will mix families do need help in dealing with them. your drug into doses of your speci cation. Some However, trying to solve these problems with pills can be dissolved in water, and a pill cutter can drugs raises serious issues. Unlike adults, children also be useful (time released and other pills should do not have the legal right to refuse drugs. The not be cut or dissolved, so ask a pharmacist). brains and bodies of children are still forming and exceptionally vulnerable. Child personalities are “Half-life” means how abruptly the drug washes out very in uenced by their surroundings and the of your system when you stop taking it. Shorter support they receive, making it even more dif cult half-lives means the drug leaves your body faster. Principles of This Guide: to assess the nature of behavioral problems. Withdrawal effects will likely be more dif cult Some families are under growing pressure to on drugs with shorter half-lives, so you may want compete and perform at school, including getting to switch drugs of equivalent dosage with longer Choice: Psychiatric medications affect the most intimate aspects of mind and the additional help that medication and a “special half-lives before reducing. That way you are taking consciousness. We have the right to self-determination: to de ne our experiences as we needs” status can provide. Labeling can bring the same dosage but on a drug that will leave your want, seek out practitioners we trust, and discontinue treatments that aren’t working for lifelong stigma and create an expectation that a system more gradually. us. We don’t judge others for taking or not taking psychiatric drugs: we respect individual child cannot change. autonomy. When people have dif culty expressing themselves or being understood by Children and Psychiatric others, they deserve accommodation, supported decision-making, and patience from caring Drugs Confusing matters more is that sometimes advocates, according to the principle of “ rst do no harm” and the least intrusion possible. children with behavioral problems get attention No one should be forced to take psychiatric drugs against their will. More and more young adults and children, and – punishment or different treatment – when they even infants, are being given psychiatric diagnoses do the very behaviors that are a problem, which Information: Pharmaceutical companies, medical practitioners, and the media need and put on psychiatric drugs. Most prescriptions can end up inadvertently reinforcing the behavior. to provide accurate information about drug risks, the nature of psychiatric diagnosis, how are stimulants for ADHD, but the number of anti- Children also sometimes become the “identi ed drugs work, alternative treatments, and how to go off psychiatric drugs. Medical ethics psychotic neuroleptics and other drugs is growing. patient” of a family system that itself need help to require practitioners to understand the treatments they prescribe, protect patients from This is a trend that re ects aggressive marketing by change. Child problems can re ect family problems. harm, and promote safer alternatives. pharmaceutical companies. Because of their youth, the relatively short time No long term studies exist on the impact of they are usually on drugs, their physical resilience, Access: When we choose alternatives to psychiatric drugs and mainstream psychiatric drugs for children. Some prescribed and the way their lives are supervised, children treatments, there should be programs, affordable options, and insurance coverage available. drugs are not even FDA approved for child use. are often very suited for reducing and going off Choice without access to options is not real choice. Community controlled services Only recently has psychiatry accepted diagnosing psychiatric drugs. Creating alternatives often should be available to everyone who needs help going off psychiatric drugs or struggling children with mental illnesses: in the past they means trial and error: addressing the needs of with extreme states of consciousness. We urge all health care practitioners to offer free were considered still developing with changing parents, working on family con icts, and changing and low-cost services to some of their clients, and for everyone with economic and social personalities, and not subject to the same criteria the circumstances the children are living in. While privilege to work to extend alternative treatment access to all. as adults. 40 13 Looking to the Future

Suffering can put diagnosis and medications at the Whether it’s coming off completely, reducing center of our identity. While attention to mental your medications to a better level, or just gaining health may be lifesaving for a time, we reach a point a greater sense of control, celebrate your new where we need to rejoin the larger community, and empowerment. Being human isn’t about living focus more on our gifts, talents, and positive contri- without hardship or scars: it is about following and butions. As you improve your relationship to your expressing your deepest truth. Even if you have a medications, ask yourself: How did crisis interrupt diagnosis, take medications, or have lived through my life, and what do I want to regain? What are my crisis, you are still a full and equal human being. Your future plans? Where do my dreams lead me? What suffering made you who you are today, and it might can I offer others? The lessens you learned are very even have made you wiser. valuable, so consider sharing your experience. You may want to write or video your story, and close one life chapter to begin a new one.

How Do Psychiatric Drugs Work?

Most people begin taking psychiatric medications Psychiatric medications act on the brain because they are “distressed and distressing.” They to alter mood and consciousness like any are either experiencing overwhelming states of other psychoactive substance. Because many emotional distress, or someone else is distressed medications can blunt or control the symptoms with their behavior and sends them to a doctor of emotional distress – by either tranquilizing a – or some combination of both. There are many person, speeding them up, numbing sensitivity, or labels for these states, like anxiety, depression, com- getting them to sleep – they can take the edge pulsiveness, mania, psychosis, voices, and paranoia, off extreme states. They help some people feel and labels change over time. Doctors tell people more capable of living their lives. It is important that their emotional distress is due to a mental to realize, however, that psychiatric drugs do not disorder which has a biochemical basis, that their change the underlying causes of emotional distress is dangerous and must be stopped (such as distress. They are best understood as tools or fears of suicide or claims of deteriorating illness), coping mechanisms that sometimes alleviate and that medication with psychiatric drugs is a symptoms and pave the way for change – but with necessary treatment. signi cant risks for anyone who takes them.

14 39 agitation, vomiting, muscle twitching, and psychotic longer to subside, and may need to be worked Do Psychiatric Drugs Correct symptoms that persist when you withdraw from through with active engagement and understanding. neuroleptic anti-psychotics. These symptoms usually There is no de nitive way to distinguish between Your Chemistry Or Treat Illness? diminish when the dose is increased again. Once you them, especially with the role of the placebo effect People are told that mental disorders mean brain feel better, start again with a more gradual reduction. and expectation. If the symptoms are unbearable or chemistry is “abnormal,” that illness is caused by genetic too disruptive, you may be going too fast. Consider Identifying Withdrawal “predispositions,” and that psychiatric drugs are needed increasing the dosage and trying again more slowly. to interrupt a disease process and correct imbalances. Symptoms and Returning However, this is not how medications work, and brain Emotions If the withdrawal symptoms remain intolerable, you may decide to remain on the medication longer disease theories have not been proven by studies to be true. Believing these claims can reinforce a sense Not all painful symptoms when coming off medi- term. Your body may have developed a dependency, and the risk of this dependence increases the of being a helpless victim of biology, and leave people cations are part of withdrawal: you may experience feeling there are no options other than medications. a return of dif cult emotions or extreme states longer you have been taking the drugs. Long term which the drug has been helping to suppress, or dependency tends to be more likely with Paxil, the new emotions. Withdrawal symptoms tend to begin benzodiazepines, and neuroleptic anti-psychotics. Despite decades of costly research, no chemical soon after a dosage reduction, and may ease over Stay at the same dosage for a while, and keep imbalances, genetic predispositions, or brain time as your brain adjusts: you may need to just focused on the bigger goal of improving your life. abnormalities have ever been found to consistently wait it out. Returning or new emotions could take cause a bipolar, depression, or schizophrenia diagnosis. The media report “promising” research that “needs further study,” but nothing conclusive has resulted. Even the ne print of drug company ads now typically says I Think Someone is Overmedicated, What Should I Do? that conditions are “believed to be caused by” chemical imbalances, rather than making de nitive statements. Sometimes people don’t realize they are over- medicated, or they have a hard time speaking up or Physical tests, such brain scan or blood draw, aren’t used having hope for change. And psychiatric drugs can for diagnosis like bipolar, schizophrenia, or depression, be very intoxicating, like someone who is so drunk and can’t reveal that your brain is abnormal. (Altered they don’t realize they are drunk. If you notice tremors, excessive sleeping, body stiffness, blunted states with clear physical causes, such as, for example, emotions, agitation, severe weight gain, slowness, concussion, dementia or alcohol delirium, are instead cognitive impairment, or other possible signs of called “organic psychosis.”) A baseline has never even overmedication, don’t just assume the doctor is been established for what constitutes a “psychologi- taking care of it. Be an active bystander. Af rm your cally normal” brain for all people. Three people with respect for the person’s decisions, but raise the the same diagnosis might have very different brain issue gently. Don’t judge or jump to conclusions, chemistry, and someone with similar brain chemistry just stick to what you notice and ask the person if might have no diagnosis at all. While many people face they notice it too. Ask whether they told their pre- physical problems like vitamin de ciency that a doctor scriber and what the response was. Start a dialogue or holistic practitioner can address, this might help about the risks and bene ts of their medication emotional problems -- or it might not. Medicine has not choices, and if the person is especially withdrawn or passive, consider approaching friends, family, or discovered the biology of mental illness the same way any professionals who work with them. Don’t let as tuberculosis, Down Syndrome, or diabetes. Emotional your own bias and fears get in the way -- you don’t distress and madness remain open to interpretation. know what it is like to be them -- but do become involved, and make sure what you observe is com- What about genetics? Mental diagnoses can seem to municated clearly. It can take people time to make “run in families,” but so do child abuse and poverty. real changes, but “choice” shouldn’t become an Because of shared environment, expectations, and excuse for neglect. Help the person get support to intergenerational trauma, family history can mean many speak up, and remind them they have options. things other than inescapable heredity. Studies claim 38 15 that twins tend have a slightly higher chance of the solved the mystery of the mind-body relationship What Will It Feel Like? The most common withdrawal effects are anxiety same diagnosis, but this research is often awed behind madness. and trouble sleeping. Other effects cover a wide and results exaggerated. Parents know that children Everyone is different, and it is important to keep your range, and can include but are not limited to: feeling have different temperaments even at birth, but Without clear answers from science, psychiatric generally ill, panic attacks, racing thoughts/obsessions, diagnosis is ultimately not a statement of fact but a mind open towards what you will experience. You prenatal experience has an in uence. Individual may not feel any withdrawal at all – or withdrawal headaches, u-like symptoms, depression, dizziness, doctor’s subjective opinion of a patient. The doctor traits like sensitivity and creativity only become may hit you like a ton of bricks. You might go through fatigue, tremors, dif culty breathing, memory inevitably relies on their own bias, assumptions, madness after very complicated social factors, such several rough weeks then even out, or you might problems, extreme emotions, involuntary movements, fears, and preconceptions. Doctors often disagree as trauma and oppression, have played a role. Even notice withdrawal effects long-term. muscle spasms and twitching, and nausea. Withdrawal sequencing the human genome has not revealed with each other, people sometimes have many can also trigger crisis, personality changes, mania, any keys to mental illness, and the idea of genetic different diagnoses over time, and discrimination Forty percent of people in the MIND coming psychosis, delusions, agitation, and other psychiatric “predisposition” remains speculative and unproven. based on class, race, and gender is common. off drugs study reported no signi cant problems symptoms. Symptoms associated with anti-depres- withdrawing. Sometimes, however, withdrawal can sants can include severe agitation, “electrical jolts,” In fact, the more neuroscience discovers about The decision to take psychiatric drugs should be so severe you may need to try to go back on the suicidality, self-harm such as cutting, and aggression. genes, behavior, and the brain, the more complicat- be based on the usefulness of the drug’s effects drug or raise your dosage. It appears that the longer Often people report the worst withdrawal effects at ed the picture becomes. “Epigenetics” shows that relative to the risks involved, not any false belief you have been on them, the more likely you will have the end of the coming off process, when they have instead of a “genetic blueprint,” the environment that the person “must” be on the drug because signi cant withdrawal. General health, good support, reduced their dosage to nearly zero. Be creative and interacts to turn genes on and off. Using genetic of biology or genes. coping tools, and a positive loving attitude can exible. science to oversimplify the diversity of human make you more able to tolerate withdrawal effects. behavior is a throwback to the discredited concepts The chemical changes in your brain can be still be Withdrawal from lithium and anti-seizure “mood stabilizer” drugs does not appear to act on of social Darwinism and eugenics. It portrays some dramatic, and everyone is vulnerable. Support your neurotransmitters, but on electrical and blood ow people as destined to be inferior, defective, and less body’s natural healing ability, and remember that time to the brain, which can lead to withdrawal effects than fully human. is on your side in any detoxi cation process. It’s key to prepare for possible problems, including how to similar to other drugs. Lithium can create much Every feeling and thought exists somehow in the deal with crisis. Don’t just expect the worst though: greater susceptibility to mania during withdrawal, and brain as an expression of biology, but society, mind, be open to what is happening. sudden withdrawal from anti-convulsant or anti- and learning intervene to make any causal relation- seizure medications can trigger seizures. Be especially ship impossible to establish. Stress, for example, is cautious with reducing these drugs. associated with brain chemistry, but one person can All of these effects may subside in a few days or thrive under stressful circumstances that are debili- weeks, so it is important to be as patient as you can. tating to another. The new science of “neuroplasti- Detoxing and emotional adjustment can last months city” shows the brain is constantly growing and that or even a year or more, as you learn to deal with learning can itself change the brain: for example, feelings and experiences that have been suppressed psychotherapy can reorganize brain structure, and by the drugs and as your brain and body recover. researchers found the brain regions associated with For many people the most dif cult part is after memorizing maps were enlarged in New York City you are off the drugs and struggling with your cab drivers. If learning can affect the brain in such a emotions and experiences, including long-term profound way, then we are not as limited by biology detoxi cation and healing. as was once believed. Neuroleptic malignant syndrome is a very serious Philosophers and scientists have debated for condition which can develop as an adverse effect and centuries over the “hard problem” of how con- sometimes during withdrawal. It can be life-threaten- sciousness arises from the brain and body. Is what ing and involves changes in consciousness, abnormal gets called ‘mental illness’ a social and spiritual movements and fever. If you have been on neuroleptic question more than a medical one? Is being called anti-psychotics and have any of these symptoms, it is ‘disordered’ a political and cultural judgement? important to discontinue the drug and seek medical Psychiatry can make no credible claim to have treatment. Tardive psychosis is a condition of extreme 16 37 • While gradual is usually best, some side • Benzodiazepines are highly addictive and Who’s to Blame? Yourself? Your Biology? Neither? effects are so serious, such as neuroleptic sometimes the most dif cult to come off of, malignant syndrome or lamictal rash, that abrupt especially towards the end. Abrupt withdrawal is If biology and brain chemistry aren’t to “blame” way that makes most sense to them. The resources withdrawal is considered medically necessary. dangerous. You may want to leave these to last. for anxiety, voices, suicidal feelings, mania, or other in this guide can open new possibilities. For example, Keep up with lab tests and communicate about distress, does that mean the blame is on you? Is it the British Psychological Society suggests some what’s happening. • It is very common for people to start the reduction process and then realize they either your brain’s fault or your fault? people might have greater stress vulnerability than others. The encourages us • After your rst reduction, monitor any are going a bit too fast. If withdrawal is un- A psychiatric diagnosis can be a huge relief if the effects carefully. Stay in close contact with bearable, too dif cult, or continues for too long, to accept and learn from unusual experiences, rather only other option is blaming yourself as lazy, weak, than just see them as meaningless symptoms to get your prescriber, a friend, support group, or increase the dose again. Give yourself two weeks or faking it. When you feel powerless and people rid of. Many views of madness and altered states are counselor. Consider keeping a journal of your or more and try again. If you still have dif culty, haven’t been taking your pain seriously, a doctor possible, such as trauma/abuse, spiritual awakening, experience, maybe with someone’s help. Remind raise the dose and then reduce more slowly, or saying you have a mental disorder can be validating. sensitivity, environmental illness, family dynamics, yourself that if things got worse directly after you just stay at the dosage where you are. Choosing to reduce or come off medication might holistic health problems, cultural differences, or the reduced the drug, they may be withdrawal effects seem like the wrong message, as if your suffering is • If you do end up in crisis, see it as one impact of oppression. Some societies even accept as and may pass. not that bad and you don’t really need help. And not normal the same experiences that other societies step in a larger process of learning and being able to come off can also feel shameful, like call abnormal. • Especially with anti-depressants and discovery, not a failure. If you can, resume you should just try harder and it’s all up to you. benzodiazepines, you can sometimes ease the minimum medication needed to regain your And if people ask, it’s your decision what to say or withdrawal by switching to an equivalent dose stability, rather than starting all over again. Keep This is unfair, either-or thinking that leaves people not say, such as “I’m a trauma survivor,” “I go though of a similar drug with a longer “half-life” – more in mind that your obstacle might be the drug helpless and trapped in the mental health system. extreme states,” or “I’m different than most people, gradual time leaving your system. Allow yourself withdrawal itself, not underlying emotions or Pharmaceutical advertising preys on this dilemma: and I’m still guring it out” -- or saying nothing time, at least 2 weeks or more, to adjust to your extreme states -- or a combination of both. if pain is really serious, it needs medication, if not, at all. Connecting with others who share your new drug, or longer if there is dif culty switching. you’re on your own. Empowerment means thinking experiences, such as peer support groups or the • Remember, you may nd it dif cult to go beyond a narrow view, and embracing broader ways internet, can be crucial as you explore who you are. • If you need very small or irregular doses, off completely, so accept this as a possibility of looking at things. use compound pharmacies, or change to and be exible with your goals. Include other Your suffering is real, whether you decide to take liquid form and a measuring cup or syringe to ways to improve your life and well-being, and Everyone needs support sometime: each of us has medications or not. Feeling powerless and needing control dosage. Ask your pharmacist, and some wait to try again when the time is right. parts of our lives where we feel powerless. We all help doesn’t mean you are a broken person or that need to learn how to balance personal responsibility brands may have different liquid potencies. you’re a passive victim of biology. Explanations like with asking for help. You don’t have to blame your trauma, sensitivity, or spirituality are as valid as any. • If you are taking anti-Parkinson’s or other brain to give yourself some compassion. You still deserve help even if you don’t believe your drugs for side effects, remain on them until you brain is abnormal and even if you think outside Because medical science doesn’t have answers, it is the language of “psychiatric illness” and “mental substantially reduce the anti-psychotic, then start up to each person to understand their lives in the to gradually reduce the side-effect medication. disorders.”

• If you are taking medical drugs along with your psychiatric drugs, dosages and effects might be interacting. Research the drugs, be especially careful and slow, and get good medical advice.

• If you are taking a drug as needed (“prn”), not on a set regular dosage, try to rely on it less, but keep it as an option to help you withdraw from other drugs. Then gradually stop using this drug as well. You may want to have it available for the future as a backup, such as for sleep.

36 17 How Do Psychiatric Drugs Affect The Brain?

Like any mind altering substance, psychiatric drugs are psychoactive and alter mind and behavior by affecting brain chemistry. Their usefulness, and risks, come from changing the brain/body and altering consciousness, including expectation and placebo.

Current medical theory is that most psychiatric drugs change the levels of chemicals called neurotransmitters (anti-convulsants, anti-epileptics, and “mood stabilizers” such as lithium appear to work by changing blood ow and electrical activity in the brain in general). Neurotransmitters are linked with mood and mental functioning, and all the cells of the nervous system, including brain cells, use neurotransmitters to communicate with each other. When neurotransmitter levels Coming Off: Step by Step change, “receptor” cells, which receive and regulate neurotransmitters, become more sensitive, and can Reducing Drug Dosage • Make a plan and revise it as needed. Some grow or shrink to adjust. Safely people may go slower or faster, but a good start is 10% or less reduction of your original dose SSRI anti-depressants (“selective serotonin The following are general considerations, and no every 2-3 weeks or longer. Do this until you re-uptake inhibitors”) for example are said to raise single pattern ts everyone: reach half the original dosage, then go down the level of the neurotransmitter serotonin in the by 10% of the new level. Make a chart showing brain and reduce the number of brain serotonin • Usually it is best to go slow and taper how much of each drug you will be taking. Get receptors. Anti-psychotic medications like Haldol gradually. Though some people are able pills of different size, a pill cutter (some pills lower the level of dopamine and increase the to successfully go off quickly or all at once, shouldn’t be cut though), or measuring cup number of dopamine receptors in the brain. This withdrawing from psychiatric drugs abruptly can for liquid. For example, if you started with 400 action on neurotransmitters and receptors is trigger dangerous withdrawal effects, including mg. daily, you could rst reduce the dose by the same as for any psychoactive drug. Alcohol seizures and psychosis. Benzodiazepines and 10 percent (40 mg.), to 360 mg. After 2 weeks affects neurotransmitters including dopamine and some antidepressants risk debilitating protracted or more if the feelings are tolerable, the next serotonin, and cocaine changes the levels of both withdrawal syndrome from going off too fast. 40 mg. reduction would take you down to dopamine and serotonin, as well as noradrenaline, As a general principle, the longer you were on 320 mg., and so on. If you got to 200 mg. and and alters receptors. the drug, the longer you may need to take going a further drop of 40 mg. was too dif cult, you could reduce by 10 percent of 200 mg. (20 mg.), While these chemical changes in your body take off of it. Some people take years to come off and then go down to 180 mg. etc. This is just a place, your consciousness works to interpret and successfully. general guideline, however, and many people do respond in your own way, Alcohol might relax you • Start with one drug. Choose the one that is things differently. Ask a pharmacist. or make you nervous; anti-depressants energize giving you the worst negative effects, the drug some people or make others less sensitive. you feel is the least necessary, the one that is • If you have been on a medication a very Because of the placebo effect and expectation, likely to be easiest to get off, or the one you are long time, you may want to start with an everyone is different. Your experience of medica- most drawn to start with. (Injections wear off even smaller reduction and then stay there tion may not be the same as other people, and will gradually only at rst, so consider adding another for a while. Be exible - coming off completely ultimately be uniquely your own. Trust yourself. drug.) might not be right for you. 18 35 health. Eat plenty of vegetables, protein, fresh • Hormones play a big role in emotional Why do People Find Psychiatric Drugs Helpful? fruit, and healthy saturated fats, and beware stability. If your menstrual cycle is irregular or of junk food (try switching foods you crave you have strong hormonal shifts, get support with healthier alternatives). Be careful about from a healthcare provider. Unlike their risks, the bene ts of psychiatric drugs • All drugs have a powerful placebo effect: just a vegetarian or vegan diet - it might help, or are widely promoted. The helpful aspects of the drugs, believing they work, even unconsciously, can • Some holistic practitioners such as ho- might make you weak and ungrounded. Some however, tend to be mixed in with misleading claims. make them work. Recovery from very serious meopaths, naturopaths, herbalists, and people are affected by arti cial sweeteners, The information below is an attempt to cut through illnesses is possible from taking a placebo sugar acupuncturists will assist people reducing preservatives, and other chemicals in processed the confusion and describe the basic ways that many pill or undergoing a “placebo surgery” believed psychiatric drugs. They can provide powerful, foods. Learn about food glycemic index if your people nd psychiatric drugs helpful. to be real. In clinical trials many psychiatric non-toxic alternatives that might help with blood sugar is unstable. If you take herbs or drugs have little proven effectiveness beyond anxiety, insomnia, and other symptoms. Try to medical drugs for physical illness, consult with an • Sleep deprivation is one of the single biggest placebo, because of this powerful mental effect. make recommended lifestyle changes such as herbalist about interactions with supplements, causes of, and contributors to, emotional crisis. The mind plays a central role in any healing, and diet and exercise. If money is an obstacle, be per- especially if you are pregnant or nursing. Short term medication use can get you to sleep. there is no way to determine whether effective- sistent: some providers have sliding scale. Find a ness for an individual comes from placebo or • Exercise such as walking, stretching, sports, referral from someone you trust, because some • Medication can interrupt and “put the brakes drug chemistry. swimming, or bicycling can dramatically reduce alternative providers are unreliable. If you do on” a dif cult extreme state of consciousness, anxiety and stress. Exercise also helps the body take herbs or supplements, check for side effects tranquilizing an acute time of crisis that feels out • Compliance also contributes to the placebo to detox. For some people, meditation is also or drug interactions (many doctors and main- of control. effect: sometimes people feel better with a clear very helpful for stress. stream sources exaggerate risks about herbs and of cial explanation of their suffering to believe supplements). • Drink plenty of fresh water (nothing added) • Many people feel medications protect them from in, and when they follow and get support from a throughout the day: water is crucial to your • A peer support group, therapist, body- emotional crisis so severe it threatens their doctor, family member, or other authority gure. body’s ability to detoxify. Each glass of alcoholic worker, or energy healer can be very stability and even their lives. Some report that Drugs tend to work better the stronger and drink, coffee, black tea or soft drink dehydrates helpful. Allow yourself time to settle in as a symptoms feel more manageable on medications, closer the relationship is with the prescriber. you, and needs to be replaced with an equal new participant or client. and keep them more grounded in ordinary reality. amount of water. If your tap water is not good Ongoing use can sometimes prevent or ease • Advertising, especially direct-to-consumer • For many people, spirituality helps endure quality, consider a lter. If you are overheated, episodes of mania or depression. television advertising (allowed in the US and suffering. Find a practice that is non-judgmental sweating, or become dehydrated, make sure to New Zealand), is extremely powerful and and accepts you for who you are. replenish sodium, sugar, and potassium electro- • Interrupting crisis and getting some sleep can in uences people’s experience to t their lytes. • Being in nature and around plants and reduce stress and settle you down, which can hopes and expectations. Newer drugs of any animals can help center you and give you a reduce life chaos and help you take better care • Chemical exposure and toxins in the en- kind, not just psychiatric drugs, tend to work bigger perspective on your situation. of yourself with food, relationships, and other better just because of the expectation involved. vironment can stress the body and cause basic issues. This can be much less stressful than physical and mental problems, sometimes • Art, music, crafts, dancing, and creativ- constant crisis, and might lay a groundwork for very severe. If you can, reduce your exposure to ity are powerful ways to express what greater stability and changes that might have is unreachable with words, and discover pollutants such as furniture and carpet fumes, been more dif cult otherwise. household cleansers, harsh noise, paint, carbon meaning in your ordeal. Even a crayon sketch monoxide, outdoor pollution, and uorescent in a journal or a simple collage with the theme • Medications can sometimes help you show up lights. Consider careful removal of mercury “What do I feel right now?” can be very helpful; for and function at work, school, and life, which dental llings. For some people, going off psychi- listening to compelling music, including with is especially useful if you cannot change your atric drugs might make them even more sensitive earphones, is a lifeline for many people. circumstances. Work may require you to get up to toxins for a while. • Consider on-line support networks in the morning, concentrate, and avoid mood • Take a close look at other medications you such as www.beyondmeds.com, and swings, and relationships may need you to avoid are taking for physical diagnoses. Some, such www.theicarusproject.net as an addition to, but if emotional sensitivity. as the steroid Prednisone, can themselves cause possible not replacement for, direct support. anxiety, sleep disturbance, and psychosis. • Continuing on some medications can itself prevent medication withdrawal effects.

34 19 Facts You May Not Know About Psychiatric Drugs What are the Alternatives to Using Psychiatric Drugs? Despite the medical principle of informed consent, • People are often told that adverse drug effects • Friendships -- with people who believe in used sparingly, but start rst with exercise; herbs doctors leave out important information about the drugs are due to an “allergic reaction” or “drug your capacity for empowerment -- can be such as valerian (occasionally), hops, and skullcap; they prescribe. The following is an attempt to include less sensitivity.” This is misleading: psychiatric crucial. Ideally these should be people who homeopathy and acupuncture; supplements known facts and provide a more balanced picture. drug effects do not function the way food or have seen you on your “bad days,” who you can including melatonin, calcium, and magnesium; or pollen allergies do. Calling drug effects “allergic be honest with, are there for you when you’re over-the-counter products. Address any stress reactions” or telling people “you’re sensitive” in trouble, and are prepared for the dif culties or con ict contributing to sleeplessness, and • Higher doses and longer use of psychiatric drugs treats the problem like it is in the person taking that can come from withdrawal. At the same consider eliminating caffeine such as coffee and often mean brain changes can be deeper and the drug, not the drug’s adverse effect itself, time, they should be friends who know the limits sodas. Even if you get enough hours, being asleep longer lasting. The drugs are then often harder which could affect anyone. of what they can offer and how to say “no” to earlier than 11pm is most restftul. Make you bed to come off and can have more serious adverse protect themselves from burnout. area peaceful, and give yourself “wind-down” time effects. However, the human brain is much more • Benzodiazepine addiction – Valium, Xanax, Ativan before bed, free of computers and stimulation. and Klonopin – is a huge public health problem. • Consider going off recreational drugs and resilient than was once believed, and can heal Take short naps if they don’t interfere with your Withdrawal can be very dif cult: benzodiazepines alcohol. Many people are more sensitive than and repair itself in remarkable ways. night schedule, and if you can’t sleep at all, resting are more addictive than heroin. Use for more others, so what affects your friends one way may quietly awake can still be of bene t. than 4-5 days dramatically increases risks. • Neuroleptic or major tranquilizer drugs are affect you more strongly. Abstaining from drugs claimed to be “anti-psychotic,” but in fact do and alcohol can improve your mental health, and • Wait it out. Sometimes time is on your side, • People are sometimes told they are on a “low even milder drugs like caffeine can undermine especially for withdrawal, and your natural healing not target psychosis or any speci c symptom dose” even though it can still have powerful or mental disorder. They are tranquilizers that health, stability, and sleep for some people. process just needs patience. adverse effects. Sugar (including sweet juices) and chocolate can diminish brain functioning in general for anyone • Nutrition can play a huge role in mental also affect mood, and some people even have who takes them. They are even used in veteri- • Psychiatric drugs are widely used in prisons to stability and overall health. Explore what reactions to blood sugar levels or caffeine that nary science to calm down animals. Many people control inmates, foster care to control children, foods you might be allergic to, such as gluten, get mistaken for psychosis. Be cautious about on these drugs report that their psychotic and in nursing homes to control the elderly. caffeine, and milk. Consider taking supplements marijuana: for some it might ease withdrawal symptoms continue, but the emotional reaction that many have found to nourish the brain and symptoms (especially CBD), while for others it to them is lessened. • Sleep medication like Ambien and Halcyon, help the body heal, such as vitamin C, sh oil, can contribute to depression or psychotic crisis. while sometimes useful in the short term, essential fatty acids, vitamins D and B, amino • The earliest drugs such as Thorazine and lithium can be addictive, worsen sleep over time, and • Rest. Find ways to ensure a healthy sleep acids (such as GABA, 5-HTP, tyrosine, and came onto the market before theories of cause dangerous blackouts and altered states of routine. Prescriptions might be a good backup if theanine), and pro-biotics to restore digestive chemical imbalance were suggested, not as a consciousness. result of those theories. Doctors were looking for “magic bullets” comparable to antibiotics, and • Because they work like recreational drugs, some saw the sedating effects of chemicals on labora- psychiatric medications are even sold on the street to get high. Stimulants like Ritalin and tory animals. sedatives like Valium are widely abused. Because • Newer anti-psychotic drugs called “atypicals” of their easy availability, illegal use of psychiatric drugs, including by children, is widespread. target a broader range of neurotransmitters, but they work in basically the same ways as older • The “War on Drugs” obscures the similarities drugs. Manufacturers marketed these drugs between legal psychiatric drugs and illegal (which are more expensive than older ones) as recreational drugs. Anti-depressant SSRIs better and more effective with fewer side effects, and SNRIs work chemically similar to slow- and they were hailed as miracles. But this has administered oral cocaine. Cocaine was in fact been exposed as untrue, with some companies the rst prescription drug marketed for “feel covering up the extent of adverse effects like good” anti-depression effects, before being made diabetes and metabolic syndrome, leading to illegal. Coca, the basis of cocaine, was even once multi-billion dollar lawsuits. an ingredient in Coca-Cola. 20 33 Working With Fear Health Risks of Psychiatric Drugs Making a decision about coming off psychiatric drugs means evaluating as best you can the risks and bene ts Many people who have come off psychiatric past stressors may no longer be present, and life involved, including important information often missing from mainstream accounts. Some risks may be worth drugs report that fear is the greatest obstacle to circumstances may have changed. And whatever taking, other risks may not be worth taking, but all risks should be taken into consideration. Because each person is beginning the process. You may worry about going dif culties you do have aren’t necessarily symptoms different and drug effects can vary widely, address the uncertainty involved with your own best judgment and with into the hospital again, losing a job, con icting with of a disorder or signs you need medication. observations of how your body and mind are responding. This list cannot be comprehensive, as new risks are still friends and family, stirring powerful altered states of being uncovered. consciousness, facing dif cult withdrawal, triggering It may be helpful to list your fears and get a friend • Psychiatric drugs are toxic and can damage extensively corrupted and fraud is widespread. suicidal feelings, or losing a tool you use to cope to help you examine what is real and what might the body. Neuroleptic “anti-psychotics” can There are few long-term studies, or studies of with underlying emotions and problems. And since be exaggerated, as well as anything you may not cause the life-threatening toxic reaction called how drugs combine together. The real extent there may be real risks, some fear makes sense. have thought about. Can you be realistic about your neuroleptic malignant syndrome, as well as of psychiatric drug dangers may never be fears and honest about the different possibilities? Parkinson’s disease-like symptoms and cognitive accurately known. Taking psychiatric drugs is in Beginning a medication reduction is like embarking What kind of preparations can you make? What impairment. Regular blood level tests are many ways society-wide experimentation, with on a trip or journey: the unknown can be an resources, tools, and supports do you have? Can required of some drugs such as lithium and patients as guinea pigs. exciting possibility or an intimidating threat. It is you nd room for hope – and transformation? Clozaril to protect against physical harm. Many • Mixing with alcohol or other drugs can dramati- important to acknowledge that you may be drugs can lead to obesity, diabetes, sudden heart a very different person now than when you The future doesn’t necessarily have to be the same cally increase dangers. as the past: don’t let a label of “disorder” or a dire attack, kidney failure, serious blood disorder, and rst started taking psychiatric drugs. You may general physical breakdown. Other toxic effects • Drug effects can lower the quality of life, have grown, developed new skills, and gained new prediction from a doctor convince you that change is impossible. are numerous, and include interfering with the including impaired sexuality, depression, understanding. You are handling things differently menstrual cycle, threats during pregnancy and agitation, and overall health problems. than when you were rst put on medication: breastfeeding, and life-threatening “serotonin • Drug-induced body changes such as restless- syndrome” from anti-depressants alone or ness, obesity, or stiffness can alienate you from mixed with other drugs. others and increase isolation. • Psychiatric drugs can injure the brain. The rate • Lithium interacts with salt and water in the of tardive dyskinesia, a serious neurological body, and when these levels change, such disease that can dis gure a person with facial Intermittent Use: Taking Drugs From Time to Time as from exercise, heat, or diet, potency can tics and twitching, is very high for long-term uctuate. Even with regular blood tests and patients on neuroleptic anti-psychotic drugs, Some drugs take time to build up effect in dosage adjustments, this means people taking and even short-term use carries some risk. the body, but others – especially to help with lithium are sometimes at risk of exposure to Anti-psychotics have been shown to cause sleep and episodes of distress – work right damaging levels. away. It might be wise to occasionally use brain shrinkage. Anti-depressants can also cause them to get rest, prevent crisis, or protect memory problems and increased susceptibility • ADHD drugs such as Adderall and Ritalin you when you start going into overwhelming to depression. Other effects can include brain can stunt growth in children, and present emotional extremes. Be exible but cautious injury and cognitive impairment. other unknown dangers to brain and physical in considering the middle ground between development. Like any amphetamines, they are • Pharmaceutical company effectiveness and daily use and intermittent, as-needed use. addictive and can cause psychosis and heart safety studies, as well as FDA regulation, are Many people who go off drugs do take them problems, including sudden death. again after some time, for example brie y using an anti-psychotic or a benzodiazepine when they feel the need. There is, however, little research on the possible risks of going off and then back on lithium, anti-depressants, or anti-convulsant medications.

32 21 Mental Health Risks • Pay extra attention to your health while experiences. You may become more sensitive withdrawing. This is a stressful detoxi cation and vulnerable for a time. Be patient with process. Strengthen your immune system with yourself and do the best you can, with support. Mental health risks are some of the least understood aspects of psychiatric medications, and can make drug plenty of rest, fresh water, healthy food, exercise, Remember that life constantly presents us with decisions and the withdrawal process very complicated. Here are some things that your doctor may not have told you: sunlight, visits to nature and connections with challenges: strong emotions are not necessarily • Psychiatric drugs can sometimes make • Once you are on the drug, your personality your community. Get wellness practices in place signs of crisis or symptoms in need of more psychotic symptoms worse and increase the and critical thinking abilities may be very before you begin. medication. It is okay to have negative feelings likelihood of having a crisis. Drugs can change changed. It might be dif cult to properly or altered states of consciousness sometimes: receptors for such neurotransmitters as evaluate the drug’s usefulness. You may explore your Attitude they may be part of the richness and depth of dopamine, making a person “supersensitive” need to get off the drug, but not realize to psychosis “rebound,” as well as increas- it because of how the drug is affecting who you are. Talk with others about what you Believe that you can improve your life. With the ing sensitivity to emotions and experiences your thinking. Overmedication, especially are going through, try to stay connected with in general. Some people report their rst with anti-psychotics, amounts to chemical right attitude you will be able to make positive sensations in your body, and gradually build up psychotic symptoms or suicidal feelings straitjacketing. changes, whether it is coming off, reducing your your skills. Tell people close to you what to say occurred after starting to take psychiatric medications, or increasing your well-being. Many and do that helps. drugs. Doctors sometimes respond by giving a • Psychiatric drugs can interrupt and impair people, even if they’ve been on high doses of more severe diagnosis and adding more drugs. the mind’s natural ability to regulate and heal psychiatric drugs for decades, have gotten off, and Plan Alternative Coping emotional problems. Many people report others have reduced drugs or improved their lives Strategies • Some drugs now carry warnings about the having to “re-learn” how to cope with dif cult in other ways. Af rm that you can take greater increased risk of suicide, self-injury and emotions when they come off psychiatric control of your health and life. Make sure people violent behavior. drugs. Being too medicated can make it more It’s not always possible, but if you can, create around you believe in your capacity to make dif cult to work through the feelings behind alternatives before you start reducing. You have change. • Many people experience negative personality your distress. been relying on the drug to cope, and you may changes, including not feeling themselves, Remember that just lowering your dosage need new coping mechanisms. There are many feeling drugged, emotional blunting, • Some people, even in the worst depths of can be a big step, and might be enough, so be alternatives, such as peer support groups, nutrition, diminished creativity, and reduced psychic/ madness, say that by going through their holistic health, exercise, therapy, spirituality, and spiritual openness. experiences rather than suppressing them, exible! The important thing is believing you can being in nature. Everyone is different, so it will take they emerge stronger in the end. Sometimes improve your life and take charge of your medica- some time to discover the “personal medicine” • People who take psychiatric drugs, especially “going crazy” can be the doorway to trans- tion choices. anti-psychotics, are sometimes more likely to formation. Artists, philosophers, poets, writers that works for you. You may want to gain some develop long-term problems and get stuck as and healers are often thankful for the insights Prepare to Feel Strong con dence in your new tools before undertaking mental patients. Some countries that use less gained from “negative” emotions and extreme Emotions drug withdrawal. Make sure your helpers know medication have higher recovery rates than states. Drugs might be helpful for some, but about your alternatives, and can remind you to use countries that use a lot of medication; and for others they may obscure the possible them. If you can, give yourself enough time to put When you go off psychiatric drugs you may have the Soteria and Open Dialogue projects show value and meaning of “madness.” alternatives in place rst. lower medication can prevent chronicity. to learn new ways to work with feelings and 22 31 cultivate Support treatment and medication preferences. Hospitals Other Drug Risks and Considerations and professionals look to your advance directive • Get help if you can. Develop a collaborative for guidance, and eventually they may be legally Understanding the coming off drugs process means taking into account many different factors you may not relationship with a prescriber if possible, enforceable like a living will. Remember, the have considered before: discuss with friends and family, and get support hospital is just a step in a larger learning process, • While not publicized widely, peer support, alter- • Psychiatric drugs can convey the false view that developing your plan. Explain that strong not a sign of failure. Check the National Resource native treatments, talk therapy, waiting, and even “normal” experience is productive, happy, and emotions might come up for you. Make sure Center on Psychiatric Advance Directives at www. the placebo effect can often be more effective well adjusted all the time, without mood shifts, they know that withdrawal might be rough, but nrc-pad.org. than psychiatric drugs, without the risks. bad days, or strong emotions. This encourages a that withdrawal symptoms do not necessarily false standard of what it is to be human. mean “relapse” or that you need to go back on • Get a comprehensive health evaluation by • Keeping up with taking pills every day is dif cult the drug. Make a list of people to call and stay a practitioner who can thoroughly assess your for anyone. Missing doses of psychiatric drugs • Medication can lead to viewing normal feelings with if things get dif cult. Lacking support is not well-being and offer restorative and preventive can be sometimes dangerous because of the as “symptoms” of illness to be stopped, which necessarily an obstacle to coming off drugs – ways to improve your health. Many people withdrawal effects, which leave you vulnerable if denies people the process of working through some people have done it on their own – but in with psychiatric diagnoses have unaddressed the drug is interrupted. and learning from dif cult emotions. general a supportive community is a crucial part physical health problems. Chronic medical/ of everyone’s wellness. dental issues, toxic exposure, pain, hormone • Doctors typically see patients infrequently for • Taking psychiatric drugs can put a passive hope in imbalance, and adrenal fatigue can all undermine short visits, making it dif cult to spot potentially a “magic bullet” cure rather than taking personal • List your triggers and warning signs. How your health and make it harder to reduce or go serious adverse drug reactions. and community responsibility for change. do you know you might be heading towards off your medications. Thyroidism, heavy metal crisis, and what will you do? Sleep, isolation, toxicity, carbon monoxide poisoning, anemia, • People with a mental disorder diagnosis often strong emotions, or altered states might show lupus, Celiac disease, allergies, glycemia, Addison’s have dif culty getting insurance, and their you need extra care and wellness support. and Cushing’s diseases, seizure disorders and physical health problems may not be taken other conditions all can mimic mental illness. seriously. • Create a “Mad Map” or “advance Take the time to work on your physical health directive,” which tells people what to do if you rst, including searching for affordable options. • Using psychiatric drugs often means giving up have trouble communicating or taking care of Consider seeing a holistic practitioner: many control to the judgments of a doctor, who may yourself. Include instructions on what to say to have sliding scale or barter arrangements. not make the best decisions for you. you, who to contact, and how to help, as well as • Medications can be expensive, keeping you stuck in work and insurance plans.

• Medication sometimes goes along with a dis- ability check, which can be helpful for a while but can also become a lifelong trap.

• Taking psychiatric drugs can mean being seen as mentally ill in society and starting to see yourself in that role. The stigma, discrimination, and prejudice can be devastating, and even create a self-ful lling prophecy. Diagnostic labels cannot be stricken from the record the way criminal histories can. Studies show that trying to convince people that “mental illness is an illness like any other” is a counterproductive strategy that actually contributes to negative attitudes.

30 23 Before You Start Coming Off Everyone is different, and there is no cookie- Timing cutter or standard way to withdraw from any psychiatric drug. When is a good time to start coming off? When is a bad time? The following is a general step-by-step approach that many people have found helpful. It is intended If you want to reduce medication, timing is very to be shaped to suit your needs. Be observant: important. It is usually better to wait until you have follow what your body and heart are saying, and what you need in place rst, instead of starting to look to the advice of people who care about you. come off unprepared (though sometimes the drugs Finally, keep a record of how you reduced your themselves make this dif cult). Remember, coming medications and what happened, so that you can off might be a long-term process, so you may want study the changes you are going through and teach to prepare just like you were making any major life others about your experience. change. Reducing and coming off drugs will likely not be a solution in itself, but the beginning of new Get Information About Your learning and challenges. Drugs and Withdrawal • Do you have stability in your housing, relationships, and schedule? Would it be better Prepare yourself by learning all that you can about to focus on these rst? withdrawing from your psychiatric drug. Read from mainstream sources as well as alternative sources, • Have you been putting off big problems or issues such as the website Beyond Meds. Meet with and that need attention? Are there worrisome things discuss reducing with others. List your adverse you should prioritize? Settling other matters effects, and make sure you are getting proper tests. might help you feel more in control. Additional resources are listed at the end of this guide. • Did you just come out of a hospital, or were you recently in a crisis? Is this a bad time to begin withdrawal, or is the drug part of the problem?

• Do you have hard anniversaries this time of year? Are you sensitive to the weather or darkness? Anticipate months where you might have the most dif culty.

• Do you notice worsening of drug effects, or have you been on the drugs for a long time and feel “stuck”? Have you been feeling more stable and capable of facing dif cult emotions? These might be good times to prepare to reduce and come off.

• Make a list of the stressors that led to crisis in the past. How many are present today? Do you anticipate any in the future? Give yourself time to address these before starting a reduction.

24 29 How Withdrawal Affects Your Brain and Body

In addition to placebo, all psychiatric drugs work shows you need to drink alcohol. It just means your I Want to Come Off My Psychiatric Drugs, by causing organic brain changes. This is why going brain has become dependent on the drug, and has off leads to withdrawal: your brain gets used to dif culty adjusting to a lower dosage off it. Psychiat- But My Doctor Won’t Let Me. What Should I Do? having the drug, and has a hard time adjusting ric drugs are not like insulin for a diabetic: they are when the drug is removed. It takes time to bring a tool or coping mechanism. Somee prescribers have a contn roollining atttiituuded andd will not susupport a decision to explp ore the activity of receptors and chemicals back to gog ing off psychiatric druggs.They may hoh ld the feae r of hospip talizaz tit on andd suicidee over the original state before the drug was introduced. However, when you have been on psych drugs for patit ents as a daanger. SoS mem seee themsm ele ves as custodians, and feel like whatever happens While doctors sometimes use confusing terms like years, it can sometimes take years to reduce or go is theeirr ressponsibility. Otherrs never meet people who’vee sucu cec sssfully recoveredd, or they “dependence,” “rebound,” and “discontinuation off them, or you may have long term physical or encoounu ter soo much crisis aftter abrupt withdrawa al they assume no one can coome off. syndrome” (and there may not be dosage psychological dependency. Sometimes people on tolerance), the psychiatric drug action that causes these drugs develop ongoing withdrawal symptoms, Iff your prescribber doeo sn’t suppport your gooals,s askk them to expplal in theirir reasosons in withdrawal symptoms is basically the same as chemical brain injury, and damage. This may not detail. CoC nssidere what tht ey say carrefully – if thhey are makking sense, youu mayy want to addiction. Tapering off slowly is usually best: it allows be permanent, but sometimes people live the rest reevala uate youo r plana . You mayy also want to geg t a frriei ndd or ally to help yoou expxpressss your brain and mind time to get accustomed to of their lives with these brain changes. Scientists yoourself, especiallyy someone in a position of authority like a fammiilly memberr, therappisst, or being without the drugs. Going off fast does not used to believe that the brain couldn’t grow new heeala thh practtiti ioner. Preseentt your reassons clearlly.y Expplal in that you undersr tand the risks, usually allow enough time to adjust, and you may cells or heal itself, but today this is known to be annd desccrir be how you arer preeparir ng to maakek changn es careffuullyy witth a good plaan. Give experience worse withdrawal symptoms. them a copo y of thiis Guide, and educate theem about the resseearchh behhind yourr dece ision and the maany people who succeed in reduccing and goinng off tht eiir drd uggs.s Remind the presscribere their job is too hellp you help youurself, not runn your life forr you, annd tht at the Important: the signs of psychiatric drug risks are youru s to takke. withdrawal can sometimes look exactly like the “mental illness” symptoms that Inn alll areas of medicic nen todayy patiients are beb cooming emppowwered consumers, so don’tt medications were prescribed for in the givev up!You may need too inforo m your docctor you are going aheaad with your plaann rst place. annywy ay: sometimem s they will coopo erate evenn if thhey dono ’t appror ve. If your presccriber is still unsupporttivee, consider swiw tct hiing to a new ono e.You can also rely on a heheallth carre practitioner succh as a nurse, naturor path, or acuupup ncturir st. Someetimes peeople eveen When someone goes off a psychiatric drug they begin a medid cation reduction witi hoout infn orrming their dooctotor or counseloro . Thiss isnn’tt might have anxiety, mania, panic, depression and best, buut may be undeerstandable in many circumstances, such asa if you have benets other painful effects. They can become “psychotic” that might be in jeopardy if you are considered “noncompliant.” Weigh the risks of such or have other symptoms from the psychiatric drug an approach carefullly.y withdrawal itself, not because of a “disorder” or condition. This may be the same, or even worse, The leading UK charity MINND, in their study on coming off psychih atric drugs, found than what got called psychosis or mental disorder that “Peoopple who caame off theeirr drugs against their doco tor’r s advice were asa before the drug was taken. Typically people are then likely to succeed as thosee whhosse doctors agrg eee d they should comem off.” AsA a told this shows their illness has come back, and rer suult of this nding, MIND realizzed doctors are soommetimes tooo controolll ing, and so that they therefore need the drug. However, it may they changged theh ir of cial pop liicy: MINDN no loonger recommeends thhata peoe plle attempt be the withdrawal effect from the drug that is causing to go ooff psychiatrir c drugs only with their doctor’ss approval.l Supppop rt is usuallly best these symptoms. hhowew ver, so try to collaboratee with prrescribers when possible. These withdrawal symptoms do not necessarily prove you need a psychiatric drug any more than headaches after you stop drinking coffee prove you need caffeine, or delirium after stopping alcohol 28 25 untrue. Everyone can heal: new research into Staying on Psychiatric Drugs and Harm Reduction “neurogenesis” and “neuroplasticity” means You may decide that, given the degree of crisis you are facing and the obstacles to workable alternatives, the brain is always growing and changing. you want to continue psychiatric medication. Don’t feel judged for making the best decision you can. Friendships and love, along with good You have the right to do what works best for you, and other people don’t know what it’s like to live lifestyle, nutrition, and positive outlook, will your life. It may still be a good idea to take a harm reduction approach. Make changes to improve the help nurture your brain and body to recover. quality of your life and minimize the risks associated with the medications you are taking: You may nd that the goal of going off • Don’t leave it all to the drug. Take an active interest in your overall health, alternative completely is not right for you at this treatments, and wellness tools. Finding new sources of self-care can ease adverse effects, time. You may feel better staying on your and may eventually reduce your need for medication. medication, and decide instead to just reduce or continue at the same dosage, and focus • Get regular healthcare, and stay in communication about your medications. Get support on new ways to improve your life. Follow from trusted friends and family. your own needs without judgment or blame: get support for your decisions in the face of • Make sure you have the prescriptions and re lls you need, because missing doses can any feelings of shame or powerlessness. add stress to your body and brain. If you do miss a dose, don’t double up. • If you take other medications, watch out for drug interactions. Beware mixing with recreational drugs or alcohol, which can worsen adverse effects and be dangerous. Why Do People Want to Stop Using Psychiatric Drugs? • Don’t rely just on your doctor for guidance. Learn for yourself, and connect with others who’ve taken the same medications as you. People are often told that no matter what are key in helping many people, many others have the side effects, psychiatric drugs are always found ways to recover without psychiatric drugs. • Discover what you can from a variety of sources about your medications. Use nutrition, better than suffering from “untreated” mental Many report their lives are better without them. herbs and supplements to reduce adverse effects. disorders. Some doctors claim mental disorders Everyone is different, but sometimes people do • Consider exploring lowering drug dosage, even if you don’t intend to go off completely. have a “kindling” effect, that early medication is deal with “psychotic” states successfully without Remember that even small dosage reduction can cause withdrawal effects. best, or that madness is toxic and medications medication. Diverse, non-western cultures often are “neuroprotective.” These theories remain respond to and understand these experiences • If you are starting a medication for the rst time, some people report that an extremely unproven -- though ongoing crisis and a life out differently, even seeing them as positive and small dose, much lower than recommended, can sometimes be effective, with fewer risks. of control can certainly be cumulative stresses. spiritual. It remains a personal decision how to Doctors spread fears unfairly: while medications relate to madness. • Try to reduce the number of different drugs you take to just the essentials, understanding which ones carry the greatest risks. Stick to temporary use if you can. • Test regularly to monitor drug reactions, and have baselines done for new medication. It’s not an either-or choice Tests may include: thyroid, electrolytes, glucose, lithium level, bone density, blood pressure, between taking psychiatric drugs liver, ECG, kidney, cognition, prolactin, and screening for other adverse effects. Use the or doing nothing. There are many best, most sensitive tests available to reveal problems early. alternatives you can try. In fact, • Anti-psychotics remain in the body, and some research suggests “drug holidays” of a day or two off can ease toxicity. Remember that some problems that are called everyone is different. symptoms of “mental disorders” • Explore the emotional relationship with your might turn out to be caused by medications. Draw a picture, create a role play, give the the drugs people are taking. medications a voice and message and have a dialogue. Do you know the energy or state the drug gives you? Can you nd other ways to achieve this energy state? 26 27