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The use of psychiatric drugs has continued to increase in recent years among all age groups, men and women, and members of minority groups. Society is becoming increasingly dependent on prescription drugs to solve psychological and social problems. Drugs like Paxil and Ritalin are advertised directly to the consumer through magazines and newspapers. Other advertisements in mass media urge people to wonder whether they are suffering from the latest popular psychiatric disorder, often encouraging them to ask their doctors about a specific medication and sometimes offering a free sample. TV, news and magazines frequently paint rosy pictures of the latest "miracle drug". Innumerable books continue to be written for the layperson extolling the virtues of psychiatric drugs for myriad psychological or emotional problems in children and adults.
Even psychotherapists who favor "talking therapy" often recommend a visit to a psychiatrist for medication, sometimes in the hope that these drugs will facilitate their clients, progress or help them handle painful and overwhelming emotions. Indeed, many therapists have been led to believe that psychiatric drugs are required as part of the treatment of emotional problems such as "anxiety" or "depression".
Health maintenance organizations (HMOs) and other health care insurers encourage and sometimes insist on the use of psychiatric drugs as a supposedly cheaper alternative to talking therapy. Physicians in almost every specialty - from surgery and obstetrics and gynecology to pediatrics and family practice - are quick to prescribe psychiatric medications for problems such as insomnia, anxiety, depression, obsessions and phobias, and even "stress".
In todays prodrug environment, a doctor often takes only a few minutes to make an evaluation before writing a prescription for an antidepressant, anticonvulsant, antipsychotic, or tranquilizer. But your decision to accept medication may lead to a lifetime of drug use, including exposure to longterm harmful effects. Furthermore, whereas it was easy to find a doctor to start you on psychiatric drugs, it may be very hard to find one who is willing to help you stop.
When you start taking a psychiatric drug, you may not experience any serious negative effects. But what happens when you want to stop taking it? All psychiatric drugs can cause problems during withdrawal. You also need to be aware of those unusual circumstances when the abrupt discontinuation of a psychiatric drug can produce potentially dangerous physical or psychological reactions.
Even if you and your doctor don't realize it, the psychiatric drugs that you are taking could be causing you serious mental, emotional, or physical harm. Your doctor may fail to appreciate that some of your problems are being caused by the prescribed medication and, instead, mistakenly increase your dose or add another drug to your regimen. This prescription cycle - a common occurrence - could expose you to increased risks of adverse drug effects.
When you reduce or skip your medication, you may experience painful emotional or physical reactions as the effects of your drug wear off. This is due to drug withdrawal between the doses. But if you don't realize that you are undergoing interdose withdrawal, you may wrongly assume that you will always feel that uncomfortable if you stop the medication. Similarly your doctor may mistakenly insist that your discomfort is proof that you need to take more of the drug or additional drugs to control your discomfort.
Some of us have relatives who are taking psychiatric drugs. Often we watch with concern and frustration as our husband or wife, or perhaps a parent, takes medications that seem to be doing them more harm than good. Meanwhile, millions of children are being prescribed stimulant drugs such as Ritalin and Adderall, and many other youngsters are being given adult psychiatric drugs that have never been approved for children, such as Paxil, Catapres, Tenex, or Zyprexa. Parents are often told that these drugs are very safe when in fact they can be extremely dangerous to a child.
Perhaps you can see yourself, a relative, or a friend in one of the stories that follow.
"Amanda started taking Zoloft when she became depressed during a period of conflicts at work and in her marriage. After explaining that she had a `biochemical imbalance' in her brain, Amanda's psychiatrist encouraged her to stay on antidepressants `indefinitely'. But after three years on Zoloft, Amanda decided she didn't want to `take pills forever'."
"Amanda skipped two days of Zoloft and `crashed'. It was like falling into a black hole; she wanted to die. Perhaps unaware that withdrawal from antidepressants can cause depression, her doctor responded by writing a prescription that doubled her original dose."
"Amanda wanted to find another psychiatrist who could help her withdraw from the medication, but each new doctor urged her to stay on Zoloft or to start another medication. So she took matters into her own hands and tapered off the Zoloft over a several-week period, fortunately without lapsing into depression."
"As she became drug-free, Amanda realized how stagnant her life had been during the time she was taking the medication. The emotional pain of her conflicts at work and at home had been dulled by the drugs, but her circumstances and the quality of her life had not improved. She found a psychotherapist who would help her to begin the process of taking charge of her life without drugs."
"Robert had been taking one or another psychiatric drug for ten years, including tranquilizers like Xanax and Ativan, antidepressants like Prozac and Paxil, and mood stabilizers like lithium and Depakote. He often found himself saying, `I don't feel like myself anymore'. He was even unsure what he would be like if he weren't on drugs. His daily experience was one of tinkering with his biochemistry. His moods seemed to go up and down depending on how much time had transpired between doses. Although his diagnosis was changed every year or two, his psychiatrist remained certain that Robert had a genetic and biological disorder that made him anxious and depressed. He assured Robert that he would need medications for the rest of his life. But Robert didn't like the idea of being forever dependent on drugs. He wished he had some guidance about how to stop taking them. But he could not seem to make up his mind about what to do."
"Robert's indecisiveness was partly due to the medications themselves. From alcohol to stimulants to antidepressants, all medications that affect the mind tend to impair judgment, making it difficult for people to know whether they are being harmed by the drug they are taking. Most people are well aware that alcohol can impair judgment. They know that friends who are `drunk' cannot judge their ability to competently drive a car or to control their temper in a conflict situation."
"Eventually Robert sought help from a psychiatrist known to be willing to help patients withdraw from drugs. While Robert worked with a psychotherapist who included his family in the treatment, the psychiatrist slowly withdrew Robert from the drugs he was taking. Because Robert had been using psychiatric drugs for many years, it took him more than a year to complete the withdrawal. But with a brain and mind free of drugs, Robert realized that his suspicions had been correct. He was better able to manage his life and to fulfill his potential without mind-altering drugs. Although his life still had its ups and downs, it felt wonderful to know that they were his ups and downs rather than those induced by drugs."
"Pamela began taking an antidepressant, Elavil, thirty years ago when she was in her teens. She had been depressed as far back as she could remember and always lacked confidence in herself. Now she suspected that years of taking the antidepressant had cost her some of her mental sharpness, especially her ability to focus and concentrate. Her psychiatrist, whom she saw every few months to renew her prescriptions, wanted to add Ritalin to her drug regimen for what he deemed to be `adult attention deficit disorder'."
"Pamela suspected that her increasing mental difficulties were due to years of taking Elavil rather than to `adult ADD', so she tried on her own to stop taking the drug. Within twenty-four hours, she underwent the worst attack of `the flu' in her entire life. She was overcome with vomiting and diarrhea, her body ached, her head felt as though it was caught in a vise, and a dreadful sense of impending doom overcame her."
"Pamela experienced immediate relief upon restarting the Elavil. Her stomach and gut settled down, her muscles stopped aching, the headache and feeling of dread went away. What did this mean? Did she have a bad case of the flu? Or did she need Elavil to keep her from going crazy? She called her psychiatrist who said she had probably contracted a viral flu. He urged her to continue on Elavil. The next day Pamela looked up the drug on the Internet and found out that `flu-like' symptoms and depression are commonly associated with withdrawal from Elavil and many other antidepressants."
"With the help of a psychotherapist who did not advocate psychiatric drugs, Pamela was able to plan a withdrawal that ended her dependence on the drugs she had been taking. Because she had been using them for so many years, she spent several months tapering down her doses. To her relief, her mental sharpness gradually returned."
"As she came off the drugs, Pamela began to discover the sources of her lifelong depression. Like many persistently depressed and anxious people, she had endured an extremely abusive childhood. Many dreadful memories and painful feelings surfaced in therapy, but she was glad to be facing her history of abuse with a clear, more focused drug-free mind."
"Pamela also joined an incest survivor group at her church. At first it was an act of faith - believing that a group of survivors could help to encourage and empower her. But she found that sharing her experiences with them gave her new faith in herself and her ability to grow. Over time, Pamela gained great support from the church community and from her rekindled faith in God."
"Marvin became depressed during the beginning of his senior year of high school. He did not think that anything in his life was causing these negative feelings, so he never sought counseling. Hoping for medication, he went to a psychiatrist who diagnosed him as suffering from `clinical' and `biochemical' depression and put him on Prozac. Within a few days, Marvin felt a `lift' in his mood. The drug really seemed to work."
"Within a few more weeks Marvin's somewhat shy personality began to undergo a dramatic transformation. He now felt `super-better than ever' and `very outgoing'. But his parents became concerned about the changes. He was sleeping too little, talking a mile a minute, wearing outlandish clothing, and losing weight. He also stopped studying and, wholly unlike himself, skipped classes on a whim."
"Although the effects of Prozac are described in the package insert that comes with this substance, as well as in the Physicians' Desk Reference, the psychiatrist did not realize that Prozac could be causing Marvin's symptoms of extreme energy and elation. Instead, the doctor changed Marvin's diagnosis from `clinical depression' to `manic depression' or `bipolar disorder' (severe mood swings). He told Marvin and his parents that Marvin was suffering from a `genetic' and `biochemical' disorder. The doctor added lithium to the Prozac and stated that Marvin would have to stay on both drugs for the rest of his life."
"During his first year of college, Marvin began to feel sluggish and lifeless. He also began having trouble focusing his mind on his studies. He phoned his psychiatrist and asked:"
"Could the lithium or Prozac be causing me problems?"
"No." the doctor said, "Since you have a biochemical imbalance, the drugs improve your mental functioning".
"During the summer break, Marvin sought help from another psychiatrist who confirmed his suspicion that the drugs could be suppressing his vitality and his mental processes rather than improving them. The new psychiatrist also informed Marvin that his episode of `mania' during high school was probably caused by the Prozac. Marvin felt betrayed by his previous doctor who had never mentioned this possibility to him or to his parents."
"During the summer, Marvin was weaned off both Prozac and lithium. For the first time since starting Prozac, he felt `like myself' again."
"Marvin also began psychotherapy with his new psychiatrist and quickly began sharing experiences he had been previously ashamed to tell anyone. He recalled that at the time he became depressed in high school, he had repeatedly witnessed severe yelling and screaming matches between his parents that usually left his mother depressed and in tears. Marvin's psychiatrist helped him to understand how these family conflicts had played a prominent role in the initial development of his depression. More recently several family therapy sessions with his mother and father helped Marvin to separate himself emotionally from their problems. They in turn sought help for themselves. Marvin did well emotionally and academically without psychiatric drugs throughout the remainder of college."
"Marjorie was having trouble coping with the isolation and stress of raising two children, as well as with her husband's extreme preoccupation with `making money for the children's future'. She felt so lonely and hopeless about her situation that she tried not to think about it during the day. Instead, she lay awake worrying at night. When she told her family doctor about her `difficulty sleeping' he prescribed the tranquilizer Klonopin before bed each night."
"For the first few nights, Marjorie slept much better. But within a few weeks, she was having more difficulty falling asleep and experienced increased nervousness and tension upon awakening in the mornings. She became short-tempered with her children and nearly violent with her husband. He in turn feared that she needed to go to a mental hospital but knew that he couldn't afford to pay someone to take care of the children in her absence. It never occurred to either Marjorie or her husband that the `sleeping pill' could be causing or contributing to her emotional upsets during the daytime."
"Instead of explaining that Marjorie might be experiencing `rebound anxiety' as the Klonopin wore off each morning, her doctor prescribed yet another tranquilizer, Xanax, for her daytime distress. He instructed Marjorie to take one or two tablets of Xanax three or four times a day for `anxiety', depending on how she felt. Like too many doctors, he may have not fully appreciated the dangers of these drugs, including `rebound anxiety' between doses."
"Marjorie was now in a constantly unstable emotional state. Shortly after taking each Xanax tablet, she would feel calmer. But she would also feel lethargic and apathetic from the sedation. Sometimes she unintentionally fell asleep in the middle of the day while trying to care for her children. Then, as the drug effect wore off later in the afternoon, she would become `hyper' and agitated. Sometimes she had `panic attacks' in between doses. Her memory was also affected, on a `bad day', she would lose track of the number of Xanax tablets she had taken. No matter how many sleeping pills she took, she never had a restful night and never felt refreshed in the morning."
"By the time Marjorie sought help in withdrawing from these drugs, she had lost faith in her ability to handle her life without medication. Her weaning from the drugs over a several-month period was combined with psychotherapy."
"In therapy Marjorie learned more about the balance that she needed in her life between raising children and being with other adults in more intellectually stimulating activities. She volunteered at church and then went to work and to school part-time."
"Marjorie's husband eventually agreed to join her in couples counseling. He learned that he was very much a part of Marjorie's problems in that he had emotionally abandoned his wife and children in his efforts to earn a living."
"Andy's mom and dad didn't want to give him Ritalin. They believed that their child was normal and that with proper discipline and consistent love he would outgrow his problems adjusting to school. But the school psychologist said that Andy suffered from attention deficit-hyperactivity disorder (ADHD). He warned that Andy would need special classes if he didn't go to a physician to get Ritalin."
"After a ten-minute discussion with Andy's mom, the family pediatrician prescribed two doses of Ritalin each day, one before school and one at lunch break to be given by the school nurse. Within a week, Mom noticed that Andy was more `hyperactive' than ever in the evening. Because no one had warned her that Andy's brain might `bounce back' from the medication, resulting in increased hyperactivity later in the day she thought that her son's condition must be getting worse."
"The pediatrician may not have known that Ritalin and other stimulants commonly make children more agitated and excited as they wear off in the evening. In response to a brief phone call from Andy's mother, he added a late-afternoon dose of Ritalin for a total of three per day."
"The third dose of Ritalin seemed to work. According to the afternoon babysitter, when Andy got home from school he took his Ritalin right away and then went upstairs to watch TV or to do his homework. But within a week, the parents discovered that Andy was staying up all night. Now the doctor added Dalmane as a sleeping pill."
"One morning, Andy's mom and dad looked with dismay at their son at the breakfast table. Their hearts sank at the sight of the listless, sad-faced little fellow. They decided to stop all his medications but didn't know how to go about it. After a consultation with a second pediatrician who wanted to put Andy on another stimulant, Adderall, Andy's mom and dad decided to seek help from a doctor who was critical of the practice of giving stimulants to children and who supported the parents efforts to wean Andy from prescription medications."
"The new pediatrician explained the various Ritalin withdrawal effects to both Andy and his parents, encouraged them to stay in close touch, and tapered the boy from Ritalin. As the dose was reduced, Andy no longer needed the Dalmane to sleep. Within a couple weeks, Andy's mom and dad felt that their child had been restored to them."
"Instead of sending Andy back to the public school, his parents enrolled him in a small private school that prided itself in individualizing its programs to the needs of its students. To their joy the child who `needed Ritalin' in the public school did fine in the private school from the very first day of class. In retrospect, they were appalled at how close they had come to subjecting their child to years of drugging in order to make him conform to the local school system."
Nowadays the drug companies are marketing a whole new array of timed-release or long-acting forms of stimulant drugs (See Appendix A). While today Andy would probably have been prescribed one of these, or perhaps Strattera, the outcome for him would have remained unchanged. All stimulant drugs share essentially the same adverse effects. They work by producing short-term suppression of spontaneous behavior, combined with enforcement of obsessive-compulsive behavior, all of which is then mistaken for an improvement. None of the drugs have any proven longterm effectiveness, even in regard to the suppression of behavior. And none of them have been shown to improve a child's learning, scholastic work, social life or psychological outlook (see Chapter 2). In addition, the longer-acting preparations have two disadvantages: First, they make it less bothersome to adults to administer the drugs, thereby further encouraging their use, and second, when an adverse reaction develops, it will last longer because the body cannot as quickly rid itself of the drug. The reader may assume that these negative reactions to psychiatric drugs are rare, but, in reality they are quite common. Moreover, the harm they cause often goes unrecognized or is attributed to something other than the medications. The stories you've just read illustrate several potentially serious problems that you are likely to face when you or a family member are prescribed psychiatric medications;
The above stories also illustrate some important aspects of the drug withdrawal process that your doctor may fail to communicate to you:
if you are considering taking a psychiatric drug but remain unsure about doing so, this book can provide the information you need to make up your mind. For instance, you may be wondering whether the use of mind-altering drugs is the wrong way to go about handling stress, conflict, or psychological problems. You may be concerned about becoming dependent on drugs in a way that undermines your self-confidence. Or you may have read or been told many good things about psychiatric drugs but wonder if the claims are exaggerated or if there is a hidden downside. All of these circumstances, and more, are considered in the chapters that follow.
This book can also be of use if you are concerned about stopping psychiatric drugs. Even if you feel that medications have improved your life, you may eventually want to become drug-free. You may wonder if the improvement you felt after taking a drug was due to your own personal efforts rather than to any drug effect. You may sense that there is a cost to taking drugs - a dulling of your emotions, a slowing of your thinking processes or memory, a lackluster attitude toward life in general.
Perhaps you also want to stop taking psychiatric drugs in order to feel in control of yourself rather than at the mercy of a medication, to properly assess your mental state while free from mind-altering substances, to tap your deeper psychological resources, and to define for yourself the kind of life worth living and to go after it with a clearer brain and mind. You may feel that taking psychoactive drugs isn't consistent with the healthier, less artificial lifestyle that you desire. This book will encourage you to make the changes that you want to make.
Without attributing your problems to your drug intake, you may be suffering from one or more of the many symptoms that are identified in Chapter 4 as commonly caused by psychiatric drugs, including poor memory or concentration, headaches, blurred vision or other difficulties with reading or seeing, insomnia, stomachaches, problems with bladder or bowel function, sexual problems, excessive weight loss or gain, fatigue and lethargy, lack of coordination, tremors or clumsiness, irritability, impatience, anxiety, and depression. Alternatively, you may have developed a facial tic or muscle twitch that could possibly worsen and become permanent.
Perhaps you want to understand why you have been feeling worse in some ways since starting on certain psychiatric drugs. Could the drugs themselves be making you emotionally dull or blunted, hypersensitive, uninterested in sex or other pleasures, withdrawn from loved ones, or stressed? Indeed, many adverse drug effects are difficult to distinguish from emotional problems. This book can help you decide whether the drugs, rather than your psychological difficulties, are responsible for making you feel worse.
Or perhaps your doctor wants you to stay on certain medications while trying higher doses or new combinations, but you suspect that stopping the drugs is the only way to find out if they're doing more harm than good. In fact, stopping is often the only way to discover that psychiatric drugs have been the source of your persistent symptoms. This book can help you and your doctor reach the decision to come off drugs in order to more accurately evaluate their effects.
You may have tried to stop taking psychiatric drugs in the past and failed because of your emotional or physical response in the days, weeks, or even months afterward. You will learn in this book that your reactions might have been caused by drug withdrawal rather than by your psychiatric or psychological problems.
Your doctor may have heard or read that taking psychiatric drugs is supposed to help in psychotherapy by making it easier for patients to handle their feelings and to communicate. The authors' experience is very different. We have found that psychiatric drugs suppress feelings and estrange people from themselves. This makes it more difficult to explore, identify, and channel emotions. Weaning off psychiatric drugs can improve your ability to benefit from any personal or educational relationship, including therapy.
You may have been taking drugs for a long time and can no longer tell if they are doing much good. Very few studies show a positive effect from psychiatric drugs beyond more than four to six weeks of duration. Important recent studies reviewed in David Cohen's introduction reveal that less than a third of people taking drug treatments for depression, schizophrenia, or bipolar disorder experience sustained remissions even after two years of treatment. Furthermore, there is too little information available about drugs' long-term dangers11.
Even if you don't plan to completely stop taking psychiatric drugs, you may want to cut back to the minimum effective dose for you. Psychiatric drugs are often given in doses that exceed recommended or approved levels, thus substantially adding to their dangers. Similarly, you may wish to reduce the number of psychiatric drugs that you are taking. Too often doctors prescribe psychiatric drugs in dangerous combinations. And since very few drugs have been tested or approved for use in combination with others, you essentially become an experimental subject when given two or more psychiatric drugs at the same time. Meanwhile, it is commonplace for patients to get worse and worse, while increasing numbers of drugs are being prescribed, without any question from their doctors as to whether the drugs themselves have become the problem.
Doctors often tell patients not to worry about adverse drug effects because they are being prescribed "small doses" of the drug. But keep in mind that people vary enormously in terms of how sensitive they are to drug effects. Thus you could have a serious, even life-threatening reaction to a relatively small dose of a drug.
Although you may often have wanted to stop taking psychiatric drugs, you may realize that there can be dangers involved in doing so. Evidence suggests that all psychiatric drugs can produce withdrawal reactions. Some of these may be quite distressing or even disabling. In most cases, psychiatric drugs should be withdrawn slowly, preferably under experienced clinical supervision and, especially, with careful attention to how you are feeling and reacting to the change.
During pregnancy and breast-feeding, women should make every possible effort to stop taking psychiatric drugs in order to avoid harming the fetus or baby. All psychiatric drugs have the capacity to cross what is called the blood-brain barrier in order to enter the brain. The same capacity enables these drugs to cross the placenta to circulate in the fetal bloodstream and, from there, to enter the unborn infant's brain. Similarly psychiatric drugs enter the mothers milk and thus also affect the nursing infants brain. Also, antidepressants cause distinct withdrawal and distress reactions in neonates whose mothers were medicated during the last trimester of pregnancy. Accordingly, all psychiatric drugs can impair the brain function of both the fetus and the nursing infant. Although few studies have attempted to measure any potential lasting effects on the brain that may result from this early drug exposure, enough is known in the field of developmental neurotoxicity that parents should be warned to avoid taking psychiatric drugs during pregnancy and while nursing (Vitiello, 1998).
In addition, some psychiatric drugs are known to cause obvious physical abnormalities as a result of fetal exposure. For example, women who take lithium or Depakote during pregnancy expose their infants to an increased rate of heart defects. Information about known birth defects caused by individual psychiatric drugs can be found in many standard sources, including the Physicians' Desk Reference.
This book provides a review of the withdrawal reactions associated with individual psychiatric drugs and describes methods for coming off them as safely as possible.
You may initially have encouraged your husband or wife to take psychiatric drugs to combat a psychological or emotional problem. Perhaps your doctor said that lithium or Depakote would "smooth out" your spouses moods and make him or her easier to live with. Or perhaps you went along with having stimulants prescribed for behavioral control of your child. But, then, after a few weeks or months of apparent improvement, you have begun to notice negative changes in this individuals behavior.
The drugs may seem to be making your loved one less sensitive, less in touch, less interested in enjoying the company of friends and family even less loving. He or she may seem more cranky or distant. In some instances, especially when medical supervision has been inadequate, people have developed toxic psychoses - severe drug-induced states of brain dysfunction with loss of touch with reality and bizarre behavior.
Too often doctors dismiss warning signs, such as communications from the family that the patient "isn't acting right", "seems more irritable and impatient", or is "getting quiet and withdrawn". Failing to stop the offending drug at the earliest signs of an adverse emotional reaction can lead to disastrous consequences such as a severe drug-induced personality change or psychosis. Drugs such Paxil, Prozac, Effexor, Zoloft, Xanax, Strattera, and Ritalin have been implicated in many cases in producing or aggravating depression, suicidal ideation, and aggressive behavior12.
Perhaps you are a school teacher whose students have been taking Ritalin or other stimulant drugs. School policy encourages you to recommend difficult children for referral for evaluation and possible medication. Although some of the children do become quieter and easier to manage on medication, the "sparkle" seems gone from their eyes. They look vacant or dulled. What is being sacrificed for the convenience of the school? You need more facts about what the drugs are really doing to these children.
Alternatively you might be a health professional, such as a pediatrician or psychologist, who has been involved with diagnosing or prescribing drugs for children or adults. You've always taken for granted what you've read or been told about how safe and effective they are, but your own clinical experience is raising doubts. Could you have been misled by the drug companies and the "experts"? You wish you had more information about adverse effects and techniques for helping your patients or clients withdraw from medication. With the possible exception of the more notoriously addictive drugs, such as tranquilizers like Xanax and Valium, even medical doctors are rarely taught much about how to help their patients withdraw from psychiatric drugs.
Sources that advocate the use of psychiatric drugs are readily available in libraries and bookstores, so we shall not take up space here by repeating the standard arguments in favor of them. Rather, we believe that the benefits of psychiatric drugs are vastly exaggerated, that their disadvantages are too often minimized, and that there is far too little information about how to stop taking them. This book is, in fact, the first and only one to focus on the overall problem of why and how to stop taking psychiatric medications. We are not, however, trying to convince anyone not to take prescription drugs. We are simply providing a more critical viewpoint than is readily available. For more thoroughly documented critiques of biological psychiatry and psychiatric drugs, see the following: Breggin (1991 [49], 1997a [55], 1998a [57]); Breggin and Breggin (1994 [53]); Cohen (1990 [107], 1994 [108], 1997a [92]); Fisher and Greenberg (1989 [153], 1997 [156]); Jacobs, 1995 [211]; Mender, 1994 [275]; and Mosher and Burti, 1994 [290].
Choosing whether or not to take psychiatric drugs should be an independent, personal decision. Law and ethics support the right of competent adults to make such a decision.
In recent years, the virtues of psychiatric drugs have been widely extolled, but an informed decision can be made only when people also have access to both a more critical view of drugs and a frank analysis of their hazards. The law also supports the right of people to be fully informed about potential hazards before agreeing to a doctor's recommendation for a drug.
Ideally, withdrawal should be a collaborative effort involving the individual who wishes to stop the medication, a competent consultant or therapist, and family or friends when necessary. Of course, many patients stop taking psychiatric drugs on their own. In fact, whereas many doctors encourage patients to take drugs for seemingly endless periods of time, most patients stop on their own. Often they do so without any difficulty. But sometimes they run into serious withdrawal problems.
It can be difficult to predict who will have an easy time and who may experience profound distress during drug withdrawal. However, clinical experience confirms that the larger the doses and the longer the exposure to the drug, the more distress you can expect during withdrawal.
Stopping the long-term use of "antipsychotic" drugs such as Risperdal and Zyprexa can be emotionally and physically difficult and should be done very slowly with a great deal of social support. Stopping the long-term use of lithium can lead to severe emotional reactions, including mania. Stopping the short-term use of minor tranquilizers, such as Xanax, Klonopin, Valium, and Ativan, can cause anxiety agitation, insomnia, or even seizures. And stopping almost any antidepressant, including the newer ones, can lead to depression and even suicidal feelings.
This book reviews the hazards of psychiatric drugs in general, examines the potential withdrawal reactions from most classes of psychiatric drugs currently in use, and makes specific suggestions on how to withdraw as safely as possible. It concludes with a discussion of how you and your therapist can handle emotional crises without resort to drugs.
Do not let anyone pressure you into starting or continuing psychiatric drugs. As a competent adult, you have the ethical and legal right to make your own decisions about taking psychiatric drugs. You also have the legal right to be completely informed in advance about the dangers of any psychiatric drug, including its withdrawal effects.
No matter how many doctors favor one or another psychiatric drug, you can and should decide for yourself. Your decisions about taking or rejecting drugs need to be made without coercive pressure from doctors and in the absence of exaggeration, misinformation, and deception.
Similarly, don't let anyone push you into stopping psychiatric drugs before you're ready. This decision, too, has to be your own. If you have already begun to withdraw from drugs, don't let anyone hurry you. You are the best judge of how much you can handle during drug withdrawal, and you have the right to go at your own pace.