Dr Horowitz also experienced panic and insomnia when withdrawing from antidepressants. It took him years to come off his medication, using a system that informed his subsequent research. He says the continued prescription of psychotropic drugs without good guidance on how to stop them carefully is the equivalent of \u201cselling cars without brakes\u201d.<\/p>\n
\u201cThere have been a thousand studies on starting antidepressants, and only a couple of dozen on coming off them,\u201d says Dr Horowitz. \u201cWithdrawal from these drugs has historically been downplayed, but there is now too much evidence to deny the risks outright.\u201d<\/p>\n
Not everyone has problems coming off their medication. \u201cBut studies have shown that more than half of antidepressant users do, and for a quarter of patients, withdrawal may be severe,\u201d says Dr Horowitz. \u201cI\u2019ve seen people so dizzy they\u2019re unable to stand, barely able to sleep and suffering panic attacks. Others experience tinnitus and visual disturbances, or have been bed-bound for months. People can end up trapped on tablets for life because the withdrawal effects are so severe. In the most serious cases, some people are driven to suicide by the withdrawal symptoms, not their original condition, as doctors often used to argue.\u201d<\/p>\n
My battles with withdrawal<\/p>\n
I remember little about the years from 2011 to 2018, so fuzzy-headed from the chemical soup sloshing around my brain that I couldn\u2019t work, was unable to look after my children, and temporarily moved in with my father.<\/p>\n
My main problems were caused by coming off a Valium-type benzodiazepine. I was only supposed to be on it for a short while, but the psychiatrist kept upping and repeating my prescription until I started to tolerate the dose. By the time my pack of pills ran out, I was feeling anxious and \u201cwired\u201d. On Monday mornings, I would hop from foot to foot in front of the chemist, waiting for it to open so I could collect my next weekly prescription.<\/p>\n
It\u2019s fair to say that doctors are mostly aware of the dangers of benzos (as they are colloquially known), but that didn\u2019t stop them later putting me on pregabalin, an anti-seizure drug prescribed for anxiety that doctors now describe as \u201cValium on steroids\u201d.<\/p>\n
I eventually admitted myself to an ill-equipped rehab clinic, where I was withdrawn from the benzos too quickly. I became so agitated that I was admitted to a psychiatric ward.<\/p>\n
By the time 2019 dawned, I was starting to recover and saw no reason to stay on medication. Gradually, I came off the \u201ceasier\u201d (for me) drug, olanzapine, an antipsychotic that was supposed to \u201caugment\u201d the antidepressants but only made my weight balloon. I found I had no problems cutting it in half, then in half again, over a period of weeks until I stopped without incident.<\/p>\n
As I write, I still take the sleeping pill zopiclone, a tiny dose of trazodone and a few molecules of pregabalin. These are not so easy to stop. The latter I dilute with water because I am well below the smallest capsule dose. If I reduce the pregabalin too much, it makes me sick and sleepless. Reinstate that tiny amount, and I feel better within the hour.<\/p>\n
\u201cWhen you take a psychotropic drug, your body and brain become used to it,\u201d says Dr Horowitz. \u201cAnd when you stop, your brain and body cry out for the drug. This is physical dependence: it is not the same as addiction, which is where a person is abusing a drug, experiencing euphoria or seeking it out.\u201d<\/p>\n
For many people, the best way to come off their medication is to \u201ctaper\u201d it, reducing the dose in tiny increments, slowly enough for the body to readjust without too much suffering. Dr Horowitz is a proponent of \u201chyperbolic tapering\u201d, gradually discontinuing psychiatric medications in progressively smaller increments as the dose decreases (for example, by 10 per cent a month of the remaining dose). This means the reductions are much smaller and take place over a longer period than with traditional \u201clinear\u201d tapering, which cuts a fixed milligram amount each time.<\/p>\n
\u201cStopping a drug gradually over months or years reduces withdrawal effects and makes it easier to stop completely,\u201d says Dr Horowitz. \u201cThis is especially the case after long-term use.<\/p>\n
\u201cBecause of the pharmacology of the drugs, small doses can still have big effects on the brain,\u201d he adds. \u201cThis means people need to go down to very low doses before stopping \u2013 much lower than the smallest available tablet or capsule \u2013 to avoid severe withdrawal effects. The last few milligrams are the steepest part.\u201d<\/p>\n
Most doctors have historically not understood the need for hyperbolic tapering. But as awareness has grown, this is finally, albeit slowly, starting to change.<\/p>\n
The rise of deprescribing psychiatrists<\/p>\n
Until a couple of months ago, I was tapering my medication on my own. It was very much trial and error \u2013 at times my kitchen resembled a chemistry lab. But then my desperate Googling for expert support threw up a couple of UK private psychiatrists who list \u201cdeprescribing\u201d among their specialties. One of these is Dr Anna Crozier, whom I have started to consult.<\/p>\n
Dr Crozier is a consultant psychiatrist and medical psychotherapist with more than 25 years\u2019 experience, who works both privately and for the NHS in the East of England. During her training, she found herself questioning the role of drugs in treating her patients.<\/p>\n
\u201cDrugs such as antidepressants have an important place at the more severe end of emotional disturbance,\u201d says Dr Crozier. \u201cBut they don\u2019t treat the cause. Medications might work as an \u2018emotional painkiller\u2019, but they don\u2019t help to make sense of bad things that might have happened in a person\u2019s life.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"Dr Horowitz also experienced panic and insomnia when withdrawing from antidepressants. It took him years to come off…\n","protected":false},"author":2,"featured_media":814407,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[520,64,63,4830,4046,137,13069,500,514,353961,156,14059,7594],"class_list":["post-814406","post","type-post","status-publish","format-standard","has-post-thumbnail","category-healthcare","tag-anxiety","tag-au","tag-australia","tag-depression","tag-doctors","tag-health","tag-health-and-fitness","tag-healthcare","tag-mental-health","tag-nhs-national-health-service","tag-standard","tag-top-story","tag-wellbeing"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts\/814406","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/comments?post=814406"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts\/814406\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/media\/814407"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/media?parent=814406"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/categories?post=814406"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/tags?post=814406"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}