Reducing or Eliminating Psychiatric Medications

By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth

Psychiatric medications are one of the most commonly prescribed classes of medication. Every year, up to 1 out of 5 adults will be prescribed medications for mood and often end up taking them for the long-term. Medications can be helpful when symptoms of anxiety or depression – the most common mental health issues – are acute and severe. However, long-term use is often not required, needed or even recommended. If we are taking medications for mood, and as symptoms improve, it’s wise to consider whether ongoing use is needed – particularly given the unpleasant side effects. Any changes to medications should always be discussed with your physician, but it can be helpful to go into these conversations armed with information.

What causes anxiety and depression?

For most people, the emergence of anxiety or depression symptoms is the result of a complex interplay of multiple factors, which include:

• Genetic predisposition
• Early childhood experiences
• Life events
• Personality
• Current stressors
• Existing social supports

The way we think about the world (our thoughts) and the way we cope with stress (our actions and behaviours) also play an important role in whether – and to what degree – we will manifest the emotional state of depression.

Although there is little empirical support that anxiety or depression are exclusively caused by a biochemical imbalance, biochemistry does play a role. The efficacy data on the use of antidepressants and anti-anxiety medications are also very clear: they are most effective and recommended when symptoms are moderate to severe – primarily to assist with improving what is called the vegetative (or physiological) symptoms that accompany anxiety and depression – such as sleep or changes in appetite. When symptoms are less intense, non-pharmacological interventions such as cognitive behavioural therapy (CBT) are recommended. Contrary to popular belief, long-term, permanent use of psychiatric medications is not recommended or even needed – and can lead to other side effects and problems.

In fact, an extended duration of time during which mood is consistently stable, combined with significant changes in psychosocial circumstances and external stressors is often an indication that psychiatric medication use can be reduced, if not eliminated altogether.

Safely reducing or eliminating medications

If you feel that you are ready to reduce or eliminate the psychiatric medications that you are taking, here are three things to keep in mind before making any decisions on your own.

Enlist the support of a mental health professional who can offer insights into the psychosocial factors that played a contributing or exacerbating role for you. They can also help build a relapse prevention plan – with a heavy focus on preventative strategies that can help you manage symptoms from a non-pharmacological perspective.
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Any reduction of medications should be done in close consultation with a physician so that the side effects of both the reduction in medication, as well as close monitoring of symptoms can be conducted.

Then, if you decide that reducing the medication is the right next step for you, make sure to involve your partner or get the support of a close friend or family member. Having the support of another can help you to identify and manage any symptoms that emerge as a result of the tapering off process.

Remember that not everyone is reliant on medications for their lifetime, but there is no shame if they are required.
 
Editor’s Note: This post was originally published as part of a Globe and Mail “Ask the Psychologist” column authored by Dr. Samra, and has been edited and updated.