- Don’t Stop Bipolar Drugs on Your Own
- Discontinuing Medications: When, Why, and How-to
- How Is Lithium Withdrawal Treated?
- Lithium Withdrawal and Its History
- Lithium Withdrawal Symptoms
- Do I Need Immediate Help for Lithium Withdrawal?
- Seeking Treatment for Drug Abuse
- On This Page:
- Don’t Stop Your Medication…Yet
- Tapering Off Medication for Mental Health Conditions
- We Can Help
Don’t Stop Bipolar Drugs on Your Own
Bipolar Disorder: Sound Reasons to Stop Medications
This is not to say that wanting to stop one or more of your bipolar disorder medications is unwarranted.
In fact, there are many justifiable reasons to stop a bipolar medication, including dangerous side effects. Sometimes several drugs have to be tried before the right combination of drugs is found. After a period of treatment, the efficacy of a drug sometimes seems to wear off, although researchers aren’t sure whether it’s actually the drug in question or something unrelated that’s going on in the patient’s environment that is bringing an escalation of bipolar symptoms.
It’s also the plain and simple fact, Dr. Simon says, that drugs for bipolar treatment are not always that effective to begin with.
“Although the drugs make them better, people may still experience some degree of depression and some periods of feeling speeded-up or racy. It’s understandable that a patient would want to quit, more so than would the patient who is taking blood pressure medication or medicine for high cholesterol,” Simon says.
Bipolar Disorder: Going for Gradual, Monitored Change
If you feel as if your medications aren’t working, your doctor will most likely prefer that you work with him on a series of steps that may include:
- Keeping a diary of symptoms, if possible, for a week or two.
- Being honest with your doctor about those symptoms and your frustrations and concerns.
- Working with your doctor on options, including increasing your dosage, decreasing your dosage, and changing medications.
- Making a gradual, monitored change from one drug to another.
- Bringing your family and loved ones into the conversation.
Family members can be particularly valuable at this time, providing your doctor with additional insights about your response to particular medications.
“The management of bipolar disorder is a collaboration between the treatment provider, the patient, and the family,” says Dr. McInnis. “The individual bears the burden of the illness. His responsibility is to adhere to the treatment regimen and report back to the doctor with a degree of fidelity on the symptoms and the severity of life stressors. The family is the sounding board for observations and perspective. With that trio in place, one can really effectively manage the treatment through all kinds of storms.”
Discontinuing Medications: When, Why, and How-to
CME credit for this article is now expired. It appears here for informational purposes only.
Most often, psychiatric medications are discontinued unilaterally by the patient, without the psychiatrist’s input or consent. This creates a burden on the mental health system when discontinuation of medication results in decompensation into a psychotic, manic, or severely depressed state that leads to an emergency psychiatry visit or hospitalization.
As clinicians, our best preventive strategy is educating patients and their caregivers about why the medication is being prescribed, what the adverse effects are, how to manage the adverse effects, and the risk of relapse with abrupt medication discontinuation. Setting the stage early with a discussion about medication discontinuation is time well spent. Pregnancy, medical comorbidities, extended travel abroad, relocating geographically, change in insurance/financial status, and converting to a medication-aversive religion are just a few of the occurrences that create an immediate need to discuss the risks and benefits of medication adherence.
If discontinuation of a medication is inevitable, a planned discontinuation will optimize outcomes. Table 1 lists many common scenarios in which a planned discontinuation occurs. The psychiatrist’s role is to act as a consultant to maximize the likelihood of a successful taper and discontinuation, and minimize collateral morbidities or withdrawal complications. With some disorders, including MDD, obsessive-compulsive disorder (OCD), and panic disorder, guidelines exist with a clear recommendation of a time frame for symptom remission before a taper and discontinuation are considered.
In disorders such as bipolar I and II disorders and schizophrenia, a strong case can be made for lifelong pharmacotherapy. However, even with these serious disorders, a patient or his or her guardian may request a drug holiday or medication-free trial to see if the patient can do well without continued use of the medication, with an accompanying relief of sometimes significant adverse effects. There is evidence that a minority of patients with bipolar disorder or schizophrenia remain relapse-free indefinitely after medication discontinuation.1
Once a patient has made a clear decision for a medication-free trial, it is important to collaborate with him during this process. Ideally, this includes regular follow-up visits to monitor the patient for early signs of relapse and withdrawal or discontinuation symptoms. Assure the patient that you will remain active in his treatment, despite your disagreement with the decision to stop the medication, and that you will restart the medication at any time as needed.
In rare cases, when medication discontinuation creates a risk of danger to the patient or others, legal intervention may be required, including the possibility of requesting a court-appointed guardian to make the final decision. One example of this is a patient with recurrent MDD, currently symptom-free and receiving medication, who has a history of high suicide lethality when depressed. Another example is a patient with schizophrenia, currently with remission of positive symptoms, who experiences auditory hallucinations and delusions when decompensated and places others in serious danger.
Current evidence-based guidelines
The American Psychiatric Association has developed guidelines to aid in the treatment of many major mental illnesses. For cases in which these guidelines are outdated, an updated “Guideline Watch” is often provided as a bridge to the next published practice guideline, although these are not considered comprehensive or complete.
Major depressive disorder. The practice guideline for the treatment of MDD was most recently updated in October 2010.2 The guidelines recommend that patients who have had 3 or more episodes of major depression should remain on a regimen of maintenance pharmacotherapy. Considerations that support maintenance therapy for patients with fewer than 3 episodes include severe episodes, the presence of psychosis or suicidality, family history of affective disorders, and ongoing psychosocial stressors. A higher degree of confidence for discontinuing pharmacotherapy for MDD occurs when the patient completes a course of adequate cognitive-behavioral therapy or interpersonal psychotherapy. The antidepressant medication should be slowly tapered over several weeks at a minimum.
Bipolar disorder. The practice guideline for the treatment of bipolar disorder was published in November 2005.3 The more comprehensive guideline was published in April 2002.4 An updated comprehensive guideline is pending. There is general agreement that bipolar disorder is a lifelong illness that presents with mood episodes of all types and with significant heterogeneity from person to person. The guidelines are outdated and in dire need of an update. It is common practice to treat bipolar I disorder with lifelong maintenance pharmacotherapy, but the published literature is limited on this topic. There is consensus that maintenance pharmacotherapy should follow a single manic episode.
Bipolar depression, also known as bipolar affective disorder or manic depression, results in a person experiencing periods of elation or mania, alternating with periods of depression.
A characteristic of people in the elation state is that they are talkative, full of energy and may be involved in many plans and events. As a result, they are are often unaware of the problem because they feel energetic and full of life.
The treatment for this condition is complex, but a combination of drugs are needed to stabilise mood.
However according to CNS, Sinead Boland, who co-ordinates the bipolar education programme at St Patrick’s Mental Health Services in Dublin, over the course of a year, ‘more than half of patients with prescribed medication will stop treatment’.
“Additionally, seven out of 10 patients will stop taking their medications at some time in their lives and nine out of 10 will think very seriously of abandoning it,” Ms Boland explained.
She emphasised that interrupting medication, particularly mood stabilisers, ‘is associated with a worsening of the course of the disease and increased hospitalisations’.
“More than half of those who stop treatment will experience a relapse within five months and nine out of 10 will have a relapse within a year,” she explained.
She also pointed out that the risk of suicide increases significantly and there is an additional risk that the medication will not work as effectively as before.
Non-adherence can include taking too little or too much of a drug and can be intentional or unintentional.
Ms Boland added that a there are many factors that can influence adherence to medication, including age, gender and symptom severity, but a patient’s understanding of their condition ‘is positively related to adherence’.
“Attitudes towards bipolar affective disorder and the patients’ health beliefs play a significant role in the emergence of poor adherence.”
Ms Boland made her comments in WIN (World of Irish Nursing & Midwifery), the Journal of the Irish Nurses and Midwives Organisation.
For more information on depression, see our Depression Clinic here
Discussions on this topic are now closed.
Lithium is the gold standard therapy for bipolar disorder, treating acute mania and depression, preventing episode recurrence, and reducing suicide risk (Cipriani et al. 2005; Geddes et al. 2004). Because of its side effect burden, narrow therapeutic window, and an increasing pharmacopeia, there are clinical situations in which lithium is no longer a first line treatment and/or when toxicity necessitates drug discontinuation (Malhi et al. 2012; McKnight et al. 2012).
Lithium has an acute (nephrogenic diabetes insipidus) and chronic (interstitial fibrosis, segmental glomerulosclerosis, and/or tubulointerstitial changes associated with renal insufficiency) effect on the kidney (Baig et al. 2011; Bassilios et al. 2008; Grunfeld and Rossier 2009). Lithium interferes with thyroid metabolism and increases the incidence of overt and subclinical hypothyroidism and may cause hyperparathyroidism with a high incidence of multiglandular disease (Hundley et al. 2005; Kleiner et al. 1999). Renal, thyroid, and parathyroid toxicity related to long-term treatment often contribute to drug discontinuation (Hundley et al. 2005; Kleiner et al. 1999; McKnight et al. 2012). We report a case of lithium-responsive bipolar disorder and the risk/benefit ratio of ongoing mood stability vs. end organ toxicity.
Ms. D is a 60-year-old woman with bipolar I disorder. Her early course of illness was characterized by two hospitalizations in 1982 for major depression. Her only hospitalization for euphoric mania was in 1983, at which time lithium was started. After mood stability was achieved, the medication was discontinued, with recurrence of major depression several months later. Restarting lithium, she noted mood improvement, maintained lithium 1,200 mg for another 3 years (1985 to 1988) before discontinuing the drug. For a 1996 postpartum depression unresponsive to divalproex sodium, she returned to lithium and again achieved mood stability (1997 to 2001). There was no family history of bipolar disorder or previous use of lithium.
In August 2001, she was diagnosed with a retroperitoneal myxofibrosarcoma with kidney involvement and underwent a right nephrectomy. Adjustment to her lithium dose was done to maintain levels at 0.6 to 0.8 mmol/L. Her serum creatinine nonetheless slowly began to increase, with a 1.5 mg/dL peak 10 years later in 2011. The diagnostic work-up included a creatinine clearance (42 mL/min) and a computerized tomography scan that identified small cysts. Stage 3 chronic renal insufficiency and chronic interstitial nephritis of her left solitary kidney was diagnosed and after nearly 15 years of non-continuous lithium treatment (three trial periods) the drug was discontinued.
Within 1 week of starting carbamazepine, she developed a severe vaginal and perineal rash. The drug was discontinued, and treatment was switched to maintenance risperidone 1 mg. After 5 months of treatment, symptoms of major depression emerged. She was titrated to a quetiapine dose of 100 mg but complained of excessive sedation and worsening depression. In 2011, lithium was reintroduced and remains today, dosed at 300 to 450 mg maintaining levels between 0.4 and 0.6 mmol/L. There was consideration of a lamotrigine trial, but she declined due to the previous adverse reaction of other anticonvulsants and her insistence upon returning to lithium, which she found helpful.
Over time, her creatinine/estimated glomerular filtration rate has progressed from 1.5/36 in 2009 to 1.8/29 in 2014. Since 2011, her thyroid-stimulating hormone has fluctuated between subclinical hypothyroidism (thyroid-stimulating hormone 6.8 mIU/L) and transient subclinical hyperthyroidism (0.01) status postparathyroidectomy; she has never been on long-term levothyroxine replacement. In 2012, she was hospitalized for a sudden abdominal pain secondary to a cecal volvulus that was resolved by ileocecectomy. During the hospitalization, she developed asymptomatic hypernatremia probably secondary to nephrogenic diabetes insipidus related to lithium therapy. In 2013, mild hypercalcemia was identified with further testing revealing primary hyperparathyroidism; calcium supplement was discontinued and a partial parathyroidectomy was performed. Subsequent calcium levels have remained slightly elevated, without evidence for metabolic or surgically active urolithiasis.
There remains a group of lithium-treated patients who have maintained decades of mood stability and who, when the drug is discontinued for side effect toxicity, develop significant mood destabilization. The risk/benefit of end organ toxicity/mood stability must be evaluated in each individual case. Up to 40% of the patients who received long-term lithium experienced nephrogenic diabetes insipidus; whereas the risk of end-stage renal failure is greater than in healthy controls, the absolute risk is low approximately 0.5% (Baig et al. 2011; McKnight et al. 2012). The benefit of discontinuing lithium once the kidney begins to fail is a controversial decision. There are no clear guidelines about when and how to stop the prescription. While not in this case, the beneficial renal effect of discontinuing lithium is observed mainly in patients with moderate chronic kidney disease (creatinine clearance >40 mL/min) (Baig et al. 2011; McKnight et al. 2012). Moreover, recent research from a Swedish renal registry suggests that more modern treatment principles of lithium maintenance (i.e., serum levels 0.5 to 0.8 mmol/L vs. 0.8 to 1.2 mmol/L, regular and frequent renal function monitoring) may have reduced this lithium-associated renal event (Aiff et al. 2014). The rate of hypothyroidism and primary hyperparathyroidism is increased sixfold and tenfold, respectively, related to lithium treatment (McKnight et al. 2012). There are no clear recommendations about the threshold for initiation of thyroid supplementation in lithium-treated patients with subclinical hypothyroidism. However, it is increasingly recognized that subtle change in thyroid-stimulating hormone and free thyroxine are associated with rapid cycling and bipolar depression recurrence (Frye et al. 1999; Frye et al. 2009). Lithium can be associated with hypercalcemia more commonly than hyperparathyroidism (Lally et al. 2013) and can exacerbate preexisting hyperparathyroidism, increasing the rate of multiglandular disease; subtotal parathyroidectomy, intraoperative parathyroid hormone determination-guided excision, or the use of calcimimetics are the proposed treatment options (Szalat et al. 2009). In this case, after subtotal parathyroidectomy, the serum calcium levels remained elevated (parathyroid hormone normal), which is not the usual response in the lithium-related cases. In the final overview of lithium-related toxicity, it is important to differentiate between side effects due to inappropriate use of the drug (from the standpoint of both overdose or dehydration) and practice evolution of lithium maintenance treatment monitoring (Aiff et al. 2014). Clinical assessment for appropriateness of lithium treatment selection (i.e., response predictors) and close clinical monitoring may decrease the risk/benefit ratio.
The patient’s decision to always return to lithium was based on the recognition of superior mood stabilization over other treatments, support and validation from her family regarding treatment benefit of lithium, and access to close medical follow-up. Her lithium course of illness response was remarkable for several reasons. First, she had clear response predictors (i.e., euphoric mood, absence of substance abuse, non-rapid cycling) with evidence of drug discontinuation three times with depressive episode recurrence, and, more notably, re-responsive illness with lithium reintroduction. Second, the patient had either poor tolerability (quetiapine), adverse allergic reaction (carbamazepine), or non-response (risperidone, divalproex sodium) to other treatment options. Her multidisciplinary treatment including psychiatry and nephrology teams tried to use other mood stabilizers that could help her to stabilize her mood and not deteriorate her physical health, but every other treatment failed for lack of efficacy or poor tolerability. In spite of her medical illness burden (status postnephrectomy, stage 3 renal failure, nephrogenic diabetes insipidus, status posthyperparathyroid resection with persistent hypercalcemia, history of subclinical hypothyroidism, and hyperthyroidism), lithium continued to be her maintenance mood stabilizer. The patient had every reason to discontinue lithium, but in her opinion, guided by her medical providers, lithium provided the best mood stabilization for management of bipolar disorder.
As a longtime psychotherapist, I have observed several disturbing trends that can wreak havoc among patients on psych meds. Some want their meds to serve as a “magic pill” that will allow them to live happily ever after without doing any emotional work. Others take their meds in an on again/off again fashion, rather than as prescribed. A subset refuses to take drugs even temporarily, no matter how much they need the chemical aid to help them emotionally stabilize.
Then there are those that are the subject of this article: people who take psych meds for months, perhaps years and suddenly stop without consulting their doctor. A survey conducted 2007 into 20081 shows approximately 60% of patients with schizophrenia do not adhere to a prescribed regimen, go off their meds, or take them sporadically. According to a survey conducted by Mental Illness Policy Org,2 a major reason for this nonadherence in those with schizophrenia is “anosognosia”— a belief they do not have mental illness.
Other reasons for non-compliance posited by this survey include substance abuse, the expense of the meds, a poor relationship with their psychiatrist and fear of the drug’s side effects. Tragically, in the severely mentally ill, not taking antipsychotics or lithium as prescribed can lead to a multitude of woes—relapse of symptoms, hospitalization, homelessness, episodes of violence…
Of course, a person needn’t be psychotic to stop following their meds protocol. But as Kimberly Garruto-Morgan, a psychiatric nurse practitioner at New York’s Mt. Sinai Hospital, sadly observes, “I see many patients go off their meds and end up coming to see me on the inpatient unit as a result.”
For six years *Warren faithfully took anti-depressants as prescribed for his major depression and OCD. Eventually, tired of feeling emotionally flat (“Even when I think of my mother’s death six months ago, I can’t cry”) and having no sex drive, Warren became intrigued when a friend suggested psychedelic mushrooms as an alternative to Prozac. Determined not to be dissuaded of his plan, Warren kept silent about the decision to wean himself from the meds. On the positive side, Warren was aware that the safest way to go off a drug is to “titrate” or slowly reduce the daily dosage rather than flush the meds down the toilet. (Warning: titration should not be attempted without a doctor’s guidance.)
Warren’s aim was to be chemical-free within one month from the start of his withdrawal. The closer Warren got to this goal, the more overwhelming his depression. The mushrooms provided a very-temporary boost. Experiencing severe suicidal ideation, Warren returned to his psychiatrist to restart the Prozac. Anti-depressants typically take weeks to start being effective. Since the drugs were now completely out of Warren’s system, rather than start at the dosage level that had been effective, he needed to be placed on a very low dosage and titrate up. He spent two of the five weeks it took him to emotionally stabilize inpatient at a psych ward.
Then there’s *Rebecca. Each time she told her psychiatrist how upset she was that lithium made her gain weight, or that she felt “stigmatized” for having to rely on meds for the rest of her life to control her bipolar disorder he would say something like, “Just be grateful that it works.” Fearing disapproval from her doctor, Rebecca decided to keep quiet about her decision to try taking the meds only when she felt herself cycling. Her reasoning: “I’ve been doing really well for quite a while.” Alas, the result of her irregular dosing was a mania episode during which, convinced she was Jesus Christ, she nearly jumped off a roof.
Empowerment, Education, and Reframing
I am not advocating that once you are prescribed a psych med for a mental illness—this includes 1 in 6 Americans!—you need to stay on it for life. Indeed, a 2017 study of 250 adults who strove to discontinue use of at least one psych med showed that 54 % were successfully able to titrate and stay off the drug for at least one year with little incidence of relapse or hospitalization.3 Approximately 70% of those respondents had been on their meds for at least 10 years! The reasons people gave for discontinuing their meds included fear of health risks and side effects of long-term use.
I am also aware that often psychiatrists offer drugs too quickly, and without also strongly advising the patient concurrently do therapy to help deal with emotional issues. This is at best, short-sighted. The use of meds alone can increase the duration and sometimes the intensity of issues like depression and acute anxiety. It’s like slapping a band-aid on a cut without cleansing the wound.
It is essential to have a mental health care team who will respect your feelings and apprehensions and will work with you in a collaborative, rather than controlling or condescending manner.
It is equally essential to be educated about your mental health disease and the best ways to deal with it. This includes knowledge of the meds you take. What are the side effects and potential long-term risks? Are you on the correct med or is there an alternative that might work better for you? Is it feasible to titrate and end your chemical reliance? Warning: this is not the time to also end psychotherapy.
Tayla Miron-Schatz, PhD, CEO of CureMyWay, a science-based consultancy firm aimed at driving behavior change in patients, consumers and caregivers, notes that many people view their psych meds as a “reminder that they are sick.” She suggests they “reframe” this thought pattern and change the mantra from, “I take Abilify and Effexor because I am damaged” to something like, “I take Abilify and Effexor because I am a person who takes care of what needs to be done.”
If you have a chronic physical illness, it’s doubtful you are joyful about taking meds every day but it likely doesn’t impact your self-image and you take them as prescribed. Hopefully, someone on psych meds can come to view that situation exactly the same way.
*Names and identifying details are changed
Article Sources Last Updated: Sep 25, 2019
How Is Lithium Withdrawal Treated?
Lithium, like many other prescription drugs, can cause a withdrawal syndrome, which is why it is very important to take the drug exactly as prescribed at all times. However, some people abuse lithium and experience withdrawal while others may encounter the issue after taking the drug as prescribed for a long period of time and suddenly stopping their treatment regimen. Call 800-768-8728(Who Answers?) now to seek help for lithium withdrawal and addiction.
Lithium Withdrawal and Its History
According to a study from the medical journal Encephale, for a long time, lithium was considered to be a medication that could be stopped abruptly “because it was guessed that lithium salts did not induce withdrawal symptoms.” Unfortunately, this was untrue.
Thanks to several studies, we now know that lithium can cause withdrawal and that those who both use it as prescribed and those who abuse it can be affected by this issue.
However, because the withdrawal symptoms are so similar to the symptoms of manic-depression (or bipolar disorder, which is the medical issue lithium is usually prescribed to treat), it can be difficult to determine one from the other––and to provide the proper treatment.
Lithium Withdrawal Symptoms
The common symptoms associated with lithium withdrawal are as follows:
Depression and suicidal thoughts are common lithium withdrawal symptoms.
- Mood swings
- Suicidal thoughts
Most of the symptoms associated with this syndrome are psychological in nature; however, it is possible for a person to experience physical withdrawal effects as well. For example, some individuals experience aches and pains, similar to those caused by opioids. In addition, a person might feel feverish and fluish. This is rare, but with the combination of aches and pains, headaches, and nausea (which also occurs on occasion), withdrawal from this particular drug can sometimes feel similar to the flu.
According to the National Library of Medicine, patients are urged not to “stop taking lithium without talking to doctor.” The reason for this is because ending one’s use of any drug suddenly can be problematic, but lithium itself does seem to cause withdrawal symptoms that, in certain situations, can be rather intense Therefore, this particular withdrawal syndrome can sometimes be treated by weaning the patient slowly off their medication.
This is not always an ideal concept, especially if the drug itself is causing a person other side effects, but depending on the situation, it can be a helpful option. In addition, some individuals experiencing withdrawal have been abusing lithium, and in this case, they will often need to attend a detox program of some kind and/or a rehab program if their situation calls for it. In general, the drug itself is not believed to be addictive, but someone who was abusing lithium with other, habit-forming drugs will often need to attend a rehab program.
Other medications may be given to treat the patient’s symptoms as necessary. There are a number of drugs used to treat bipolar disorder that could be appropriate for an individual’s safe recovery from lithium withdrawal.
In addition, therapy has been proven to be one of the most helpful options for bipolar disorder (and other mental illnesses), and in combination with certain medications, it could be helpful in treating the psychological issues associated with withdrawal from lithium as well as the reasons why the person began taking the drug in the first place.
Do I Need Immediate Help for Lithium Withdrawal?
If you have been abusing lithium, it is very important to seek treatment. It is usually likely that someone who has been abusing this drug was also using another substance, and this can be extremely dangerous. In order to make sure that you are able to get through withdrawal as safely as possible, though, whether you were abusing the drug or not, seek help from your doctor and make sure you follow their instructions exactly so that you can avoid any dangerous side effects and/or symptoms.
Seeking Treatment for Drug Abuse
Have you been misusing your lithium prescription as well as other drugs? Do you believe you won’t be able to stop on your own? If so, it is time to seek help. Call 800-768-8728(Who Answers?) now to find a reliable rehab center that will cater to your needs and help you put an end to your substance abuse.
On This Page:
- Reasons Not to Abruptly Stop
- Tapering Off Medication
- We Can Help
- Continue Reading
The human body is always attempting to maintain homeostasis or balance, and for this reason, many medications that are taken for a long period of time cause the body to adapt and change. Therefore, stopping a medication, like clonazepam, abruptly can sometimes unbalance the system and can lead to uncomfortable and possibly dangerous withdrawal symptoms.
Some medications are more likely to be problematic when stopped abruptly than others are. Among those likely to cause problems are antidepressants, antipsychotics, mood stabilizers and anti-anxiety medication.
Don’t Stop Your Medication…Yet
Although it is tempting to think it’s no big deal to quit a medication at any time, it can lead to complications and even dangerous situations. They include the following:
1. Withdrawal Symptoms
When the body adjusts to the presence of a medication, it develops a dependence on the drug in which the body needs the drugs in order to feel normal. When the medication is stopped, the body recognizes that it is missing what has become normal.1
Withdrawal symptoms are common in this situation and generally are opposite in nature from the drug’s actions and similar in nature to the original condition for which the drug was taken. Flu-like symptoms are also common withdrawal effects from many substances.
Common withdrawal symptoms for different classes include the following:
- Antidepressants – Withdrawal from antidepressants can cause insomnia, confusion, anxiety, panic, agitation, nightmares and worsened depression. People may also experience fatigue, nausea, vomiting, dizziness, muscle spasms, headaches and loss of coordination.
- Antipsychotics – Abrupt discontinuation of antipsychotic medication can lead to anxiety, involuntary muscle movements, neuroleptic malignant syndrome, parkinsonian symptoms and a severe relapse of psychotic symptoms.
- Lithium – When abruptly discontinued, people who have been taking lithium to stabilize moods may experience mood instability and a relapse of mania.
- Benzodiazepines – Benzodiazepine drugs, often prescribed for anxiety disorders, can cause serious withdrawal symptoms including seizures, tremors, hallucinations, heart palpitations, insomnia, nausea and increased anxiety.
2. Difficulty Determining True Health Status
It may be difficult to determine the nature and extent of the condition for which the drug was originally prescribed. As noted, abrupt discontinuation of many medications leads to withdrawal symptoms that mimic the underlying condition for which the drug was taken. This can make it very difficult for both patients and their healthcare providers to determine the patient’s true health status. This, in turn, makes the best course of treatment difficult to know.
3. Lost Treatment Time
If the medication must be re-started, time can be lost. Many mental health medications work by balancing neurotransmitters, which can take time to build. It can take four weeks or more for antidepressants to change brain chemistry to the extent that symptom improvement is noted. If drugs are stopped abruptly and then need to be resumed, there may be a gap of weeks to months where symptoms are not being effectively treated.
4. Risk of Worsening Other Conditions
The body is an interconnected system, and imbalance in one area can lead to problems in others. Some health conditions are more difficult to address in patients with untreated depression, and when patients are taking multiple medications, abruptly stopping one can lead to an imbalance and improper dosing of others. Mental health conditions and addiction often co-exist, and when mental health symptoms rebound, the substance abuse and addiction risk may rise.
Tapering Off Medication for Mental Health Conditions
Generally, when discontinuing medication for mental health conditions, the best course to follow is to taper off the drug slowly under a doctor’s supervision. Harvard Medical School suggests that when patients wish to wean off antidepressants that they allow two to six weeks, or even longer, between dose reductions. Dose reductions can be managed with pill cutters in some cases or with liquid formulations.2
The best tapering schedule for any given individual will vary based on the drug, current dosage, length of time on the medication and personal health history. This is why it is extremely important to always be under the care of a supervising physician when adjusting any medication.
Symptoms should be continually monitored. If an increase in symptoms is seen after a dosage reduction, it may be wise to add back half of the dose that was decreased. Other options may include switching medications within the same class to better manage withdrawal.
We Can Help
If you need treatment for addiction to drugs like clonazeapm, or for co-occurring addiction and mental health conditions, we can help you find the assistance you need. Our helpline is toll-free and available 24 hours a day at 706-914-2327. Our knowledgeable and compassionate admissions coordinators understand the issues and can answer your questions.
They can help you understand your treatment options and can even check your insurance coverage for you if you wish at no cost or obligation. There is never a wrong time to call, so why not call now?
1 “Tolerance, Dependence, Addiction: What’s the Difference?” NIDA for Teens. 12 January 2017.
2 “How to taper off your antidepressant.” Harvard Health Publishing. 2 April 2018.
Articles posted here are primarily educational and may not directly reflect the offerings at Black Bear Lodge. For more specific information on programs at Black Bear Lodge, contact us today.
Date: November 11, 2018 3:21 pm
Tags: Cold Turkey, Prescription Drug Use, recovery, Treatment
Categorized in: Prescription Drugs