My Approach to Medication Tapers

Pharmacotherapy can be life saving

After debilitating symptoms are brought under control and progress is enjoyed, dosing strategies can be revisited. The ability to comfortably lower and even discontinue psychotropic medications when they have served their purpose or are no longer meeting one’s needs can be an integral part of recovery.

Tapering Considerations

However, tapers can be approached too quickly using relatively large dosage reductions (i.e. 25–50%) over short periods of time (i.e. every 1–2 weeks). Symptoms of withdrawal, like sleep disturbances, agitation, and emotional sensitivity, can be confused for symptoms of relapse.

When tapers involve smaller reductions in dose (i.e. 10–15%) over longer periods of time (i.e. every 4–6 weeks), they tend to be better tolerated and are more likely to be successful.

Goals of Tapering

If your goal is to completely eliminate your psychotropic medications and have been unable to do so in the past, we can pursue that goal. However, another goal of tapering medication can be to restore the efficacy of once more useful medications.

Higher doses or daily dosing may be necessary strategies during periods of significant stress, but eventually the body gets used to the same doses every day and efficacy wanes over the years. This is particularly true of controlled substances, such as sedatives and stimulants.

A Dynamic Approach to Pharmacotherapy

That is why, during periods of improvement, returning to lower doses or as-needed dosing strategies can preserve the usefulness of those medications should the need for daily dosing or higher doses arise in the future.

In this way, pharmacotherapy is dynamic over time, responding to your present needs, as opposed to being focused on finding the “right” medication or combination of medications.

Having realistic goals for pharmacotherapy, I believe, can improve the efficacy of that pharmacotherapy and the treatment as a whole.

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FAQs

In general, I have found that you can’t go too slow, you can only go too fast. Most tapers take several months to several years. The longer you have been on medication, the longer it will take to comfortably taper. If you have been on SSRIs for more than 10 years, I will generally start by reducing the dose about 10% and waiting 4-6 weeks before attempting another decrease. The right pace is the pace that feels right. Tapers usually progress a little quicker at first and then more slowly the smaller the dosage gets.
I have found that making one small change at a time and then waiting long enough to ensure that the change was well tolerated is the best tolerated approach. We can, however, move back and forth between medications, spending several months lowering the dose of one before returning to the other.
Occasionally, we may use a compounding pharmacy if smaller doses are not commercially available. Compounding pharmacies are able to make smaller dosages of a medication upon request. I have worked with a number of local, reputable compounding pharmacies in the NJ area.
Even with a very slow taper, some degree of withdrawal may be unavoidable. However, we are frequently in touch and will be able to quickly intervene if symptoms of withdrawal do develop. In general, slow, steady tapers are well tolerated. But life happens, and decisions to pause a taper or resume a higher dose temporarily in response to life stressors are decisions we can make.
The “chemical imbalance” theory of depression is largely an inadequate explanation, has been walked back and refuted over the years, and has likely damaged the social discourse about mental health, furthering stigma in many cases. The truth is, psychotropic medications do not “cure” any chemical imbalance. They help to manage your current symptoms. When our expectations of pharmacotherapy are realistic, the benefits of pharmacotherapy can be more fully realized and enjoyed over a longer period of time.
Yes. Particularly with controlled substances, such as sleeping pills, sedatives, and stimulants, their usefulness can quickly fade with daily use. Tapering from daily use to more “on demand” use can take time but is generally met with restored efficacy of the medication even at lower doses and better overall baseline functioning.