Although I seem to tolerate my current medication plan quite well, I have been striving to wean off my pills, or at least decrease the dose I am taking. But before I altered anything, I needed information. Despite my recovery from psychosis I have developed a profound mistrust towards psychiatrists and psychotherapists. Out of all the professionals who saw and treated me, maybe 20% actually knew what they were doing. The other 80% either didn’t care to help me, or they wanted to be helpful but didn’t have any idea how, or they were abusive of their authority, or they needed therapy themselves. No joke.
As a result, my first thought was that I needed information to be able to distinguish a competent psychiatrist from a quack, so I could pick the right support for my undertaking. Yet, by continuing to read about mental illness, treatment options and psychoactive drugs, I became more knowledgeable and eventually felt I was able to make informed and more autonomous choices regarding my recovery and withdrawal process. One book in particular stood out as being clearly understandable for any reader and for promoting a holistic approach to the treatment of mental illness and to medication withdrawal: Psychiatric Drug Withdrawal – A Guide for Prescribers, Therapists, Patients, and Their Families. It is one of the more recent publications of Dr. Peter Breggin, who draws on over half a century of medical experience in psychiatry. As a defender of the patient’s freedom of choice, Dr. Breggin promotes what he calls a “person-centered, collaborative approach”. Instead of turning the patient into a depersonalized and passive onlooker of their own treatment, Breggin places the patient at the very center of his therapeutic model. Around the patient, he constructs a support network consisting of a prescriber of psychiatric drugs, a psychotherapist, and significant others (family members, spouses and friends). The prescriber and the therapist can be one and the same person, but do not have to be. What is indispensable, though, is that the patient’s wishes and decisions are taken into account at all times, and that all participants in the collaborative, person-centered approach are communicating efficiently and monitoring the patient’s health development. As the title of the book reveals, Dr. Breggin writes for health care professionals, patients and their significant others alike. None of the information he gives is classified exclusively for one or the other. All people involved have the same right and access to knowledge. The patient and his or her loved ones are empowered rather than patronized. You might be able to guess by now that I highly recommend this book. Further on, I will be reviewing more literature, but for now this is my starting point.
First of all, it is important to understand that there is no standard recipe for withdrawing from psychotropic drugs. Every organism reacts differently to changes. Also, it is impossible to foresee how long it will take to wean off medication or to securely establish a new dose. As a general rule, however, slower is better, and small changes in dose are safer than big ones. This is especially true for those who have been on psychiatric medication for a long period of time. Certainly, you often hear stories about individuals who have successfully gone “cold turkey” or got rid of their pills in the course of a few weeks or months, but they were taking a high risk and were extremely lucky. They were literally playing Russian roulette with their lives. Reducing medication doses is not a sport, and there is no competition going on in who gets there first. The only reasons for withdrawing on the fast lane are life-threatening or disabling side-effects, dangerous drug interactions, pregnancy and medical conditions that turn the use of psychoactive drugs into an additional health risk. Personally, I am not in a hurry. Luckily, nothing in my life forces me to withdraw, and I can take it as slowly and safely as I like. And I like it very safe.
Evidently, withdrawal is easiest to plan being on only one drug. Now, I am on two different medications which counteract one another and are thereby meant to keep me in balance. In the morning, I take 150mg of Sertraline (SSRI antidepressant), which should have a stimulating effect. At night, right before going to sleep, I take 300mg of Quetiapine (atypical antipsychotic), to sedate me. My aim is to reduce doses alternately, maintaining the proportion between both drugs. I will start with the antidepressant. If everything goes well, the antipsychotic is to follow. Again, if the new dose works fine for me, I will keep it up for a period of time and eventually attempt another reduction.
As for the monitoring of my progress, my partner is around me every day and is in the know about my withdrawal plan. He will communicate any observations and concerns to me, is reading the same literature as I and is following my blog. Other friends will also be part of my private watch team. I do have a prescriber, yet I admit I haven’t decided on the involvement of a psychotherapist. Frankly, I feel reluctant to do so. Right up to my psychotic break, I had been seeing a shrink for several years, and she was unable to identify any warning signs or put her finger on the deeper causes of my troubles. I believe I’ve had it for now, as far as psychotherapists go. Also, after the ride I’ve sat through, I am quite confident I know myself better than a therapist who sees me once weekly could. In order to boost my general health and well-being, I will work out regularly, stick to a healthy diet, sleep enough and enjoy relaxation therapies – occasional foot reflexology and back massages.
The following is an illustration of how I ideally wish to proceed. This plan, as for now, has five phases that may be subject to changes, depending on whether I tolerate the dose reductions. If I don’t, I may need to return to the previous dose and postpone further changes for a long enough while to become stable again. You will notice I haven’t planned a complete withdrawal. While I was figuring out the graphics, the thought of actually putting this plan into practice made me feel all wobbly. In the attempt of outlining a sixth and seventh phase I might have fainted and slipped underneath my desk. So, let this be good for now.
I apologize for the miniature format of the graphics. The originals are a good size, but for some reason, they won’t come out bigger once inserted into this post. You can upscale your view of this page on the bottom right of your screen.