How to come off psychiatric medication safely?

Who can be affected by mental health conditions? 

Our mental well-being depends on our ability to manage our thoughts, emotions, behavior and interactions with others, but also on social, cultural, occupational, economic, political and environmental factors. Stress, genetics, nutrition, perinatal infections, and exposure to environmental hazards can also contribute to the development of mental health conditions. 

There are different mental disorders including depression, bipolar disorder, schizophrenia, psychosis, personality disorders, and eating disorders. These are serious conditions despite the fact that they are too often considered a taboo subject and that their symptoms are mostly "invisible".

When it is no longer possible to carry out everyday tasks, to maintain relationships with people, to work, or to enjoy your everyday life, it may be necessary to see a doctor to discuss a possible mental illness. 

It is estimated that 400 million people worldwide are living with a mental health condition, and no one is immune. In the US, nearly 1 in 5 adults live with a mental illness, which accounts for around 52.9 million people.

How are mental disorders treated? 

There are two types of treatment for mental health disorders Somatic treatment includes medication, electroconvulsive therapy (or seismotherapy) and other types of brain stimulation. Psychological therapy includes different techniques, such as cognitive behavioral therapy (CBT) and hypnotherapy, among others. A combination of medication and psychotherapy is usually more effective.

Different healthcare professionals specialize in the treatment of mental illnesses: psychiatrists, clinical psychologists, advanced practice nurses and social workers. However, only psychiatrists and general practitioners can prescribe medication. 

Drug therapy is widely used; psychotropic drugs are considered effective in treating mental disorders. Their aim is to reduce symptoms, so that the patient can lead normal life. They act on the central nervous system, modifying certain biochemical and physiological processes in the brain. These drugs, like many other treatments, can cause side effects and addiction.

What types of drugs are used to treat mental illnesses?

Antidepressants 

They can cause side effects, although most are not very troublesome and usually disappear within a few weeks. Serious side effects can occur but they remain rare. 

• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine and paroxetine,
  
• Serotonin and noradrenaline reuptake inhibitors (SNRIs), such as venlafaxine and duloxetine, 
  
• Norepinephrine and dopamine reuptake inhibitors (NDRIs) such as Zyban®,
  
• Tricyclic antidepressants (TCAs), which are used less frequently because of their side effects, drowsiness and weight gain in particular, although they can help relieve certain types of pain; example: amitriptyline,
  
• Monoamine oxidase inhibitors (MAOIs), mostly used when other antidepressants have not been effective, these drugs induce numerous dietary restrictions; example: Marplan®.
  

Antipsychotics, or neuroleptics 

They are useful in treating such disorders as schizophrenia, as well as certain behavioral disorders (delusions, hallucinations and disorganized thinking). There are, for example, chlorpromazine and Haldol®. Neuroleptics can expose people to motor and metabolic disorders. There are two generations of neuroleptics: first-generation, the older ones, and second-generation, also called atypical antipsychotics. The latter cause fewer side effects. 

Anxiolytics 

To treat anxiety disorders, such as panic attacks or phobias, SSRIs (fluoxetine or paroxetine) or benzodiazepines, such as clonazepam and lorazepam may be prescribed. Benzodiazepines are only effective for short periods of time. After that, their effectiveness decreases, while their side effects persist, among which there are drowsiness, confusion and balance problems.

Mood stabilizers 

They are used to treat bipolar disorders: lithium, Tegretol®, or Topamax®. The quantity of lithium in the blood must be regularly monitored to avoid overdose.

Prolonged use of psychotropic drugs alters the regulation of the brain by neurotransmitters, which is the therapeutic effect of these treatments. However, some diseases do not really need life-long treatment.

When can you stop taking your treatment? How to do it right?  

When a treatment taken over a period of time has proved to be effective and the symptoms have disappeared, it is quite normal to wonder whether the treatment is still necessary and when it can be stopped. Discontinuation of treatment should be done with the help and support of your doctor.

Certain medications need to be taken throughout life despite the discomforts they can cause; in this case, the benefits they bring justify the continuity of treatment.

Discontinuation of a treatment that has been taken for several months must be done gradually, especially in the case of certain psychotropic drugs which can lead to dependence if they are stopped abruptly, such as anxiolytics, MAOIs and antipsychotics. Stopping medication abruptly has a withdrawal effect. The brain does not have time to gradually return to its previous regulation.

Drug dependence can be both physical (withdrawal symptoms) and psychological, when the patient fears that he or she will not be able to manage without the drugs. The symptoms of withdrawal from a psychotropic drug appear according to the lifespan of the drug, i.e. the time during which it is effective on the psyche with each intake, but also according to the regularity of the intakes, the length of time the drug has been taken and the dosage of each intake.

The physical symptoms of a too rapid withdrawal are: 

• Anxiety, irritability, agitation, but also aggressiveness or sadness,
  
• Sleep disorders, insomnia, nightmares
  
• Deja-vu, hallucinations, delusions, mental confusion
  
• Tremors, dizziness, motor incoordination, ataxia (a disturbance of balance and motor coordination)
  
• Headaches, muscle pain
  
• Sensory disorders (impaired sense of smell, strange taste, hypersensitivity, photophobia, etc.)
  
• Intestinal disorders (nausea, vomiting, diarrhea, stomach ache)

A gradual reduction in the daily dosage enables an effective dosage to be rapidly re-established in the event of a relapse, and allows to limit the manifestations linked to physical dependence that may have set in. Particular attention should be paid to the slightest physical sign suggesting a withdrawal reaction. 

Because of the risks associated with withdrawal from certain types of medication, it is recommended that, in order to successfully stop them, you should never stop without talking to your doctor, and that you should never stop a psychotropic treatment abruptly. 

Before stopping your medication, you should ask yourself if it is the right time, if you feel well, if you are not stressed, if you have family or friends who can support you, and above all, you should not hesitate to ask for a second medical opinion if you disagree with your doctor. 

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