Helping Clients Withdraw from Psychiatric Medication

Are you a clinician who wants to help clients withdraw from medication successfully? Maybe you need to go through a withdrawal of your own – a withdrawal from the prescription-oriented mindset. That’s what David Cohen, Ph.D., LCSW, said at CCSME’s Innovative Solutions for Building Recovery with Alternatives to Psychotropic Medication conference last week.

Cohen brought a wealth of experience to the presentation, since he has been studying withdrawal from medications since 1982. He cited many studies showing that if medications are withdrawn gradually, clients experience outcomes that are at least as good – and sometimes better – than they would experience if they remained on medication.

This pattern is consistent across multiple conditions – depression, bipolar disorder and schizophrenia. One study of antipsychotic discontinuation showed that 56 percent of the patients got better while only 12 percent got worse.

“Coming off drugs is a natural outcome in the majority of treatment,” Cohen said. “Many people feel they awaken.” But he also added a caveat. “Drugs are one answer, an answer, and they’re here to stay. We’re a drug culture.”

Drug withdrawal effects can be challenging. Cohen quoted Joanna Moncrieff, one of the other speakers at the conference: “If withdrawal… could be efficiently managed, the success of drug discontinuation might be much greater than usually assumed and might outweigh the disadvantages of continued treatment.”

There is some reluctance in the psychiatric community to acknowledge withdrawal effects, Cohen said, but hundreds of case reports exist. The symptoms may be physical or psychological. The transitional effects persist until the brain reaches a new homeostasis. There are three types of effects that can occur: withdrawal effects, rebound effects, and relapses.

“The only thing that seemed to matter is the half-life,” Cohen said. He showed data demonstrating that drugs with longer half-lives transition out of one’s system gradually, making it easier for brain activity to stabilize.

Cohen said clinicians should try not to work with clients who want to stop taking medication until they have become comfortable with the concept. Otherwise, he said, “We sabotage the effort and use the result as confirmation that we were right all along.”