What I Have Learned in Working With 300+ People in Their Journey of Tapering

I am a psychiatrist in the US who completed residency in 2010. I always felt that there was something “off” with my profession. Yet I didn’t know how to question the specifics of my formal psychiatric training.

I performed as a psychiatrist the way I was expected to, in the way I had been taught.

In 2020, a colleague recommended a number of books to me. All of them were taking a critical look at psychiatry from authors including Peter Breggin, Kelly Brogan, and Robert Whitaker.

One such book was Anatomy of an Epidemic.

This book changed my life.

Why? Because prior to this, I had no idea that all psychiatric medications can be difficult to reduce or stop. Not because of relapse of the original condition, but because of withdrawal symptoms that mimic the original distress.

Reading about the sordid historical past of the practice of psychiatry over more than a century, it became abundantly clear that my already sneaking suspicions were true:

Psychiatry, despite it being adorned in very convincing professional-looking garb, is practiced more akin to sorcery than science.

This clear narration of the history of psychiatry allowed me to see the larger picture as it developed over the course of time, which gave me permission to question it… deeply.

“Had what I been taught in my psychiatric training been true science?”

This questioning led me to countless hours of research through whatever resources I could find. I was in and out of online peer-based support communities, Facebook groups, books, YouTube videos, and podcasts in search of truth.

The more I learned, the clearer it became that it is a very real thing for people to struggle with reducing, stopping, or changing their psychiatric medications. Hundreds of thousands of people taking to the internet to find genuine help when they are suffering are not likely to be lying. And why wouldn’t this make sense scientifically? We understand this for psychoactive drugs in other classes, so why would SSRIs, mood stabilizers, and antipsychotics be any different?

When I started helping people safely taper psychiatric medications, I had the Ashton Manual and Surviving Antidepressants as references. I had the basic guideline of making 10% reductions, of whatever psychiatric medication it was, every month.

This was where I began.

I feel bad for my first patients at that time, as I was just as bewildered as they were. I did not know what I was doing, but felt it was better than the potentially dangerous advice of making 50% medication reductions or stopping cold turkey.

What I have learned over the years of working with 300+ people in their tapering journey is that it’s a lot more complex than 10% per month.

In fact, I don’t think I’ve had anyone finish a taper using that specific percentage the entire time.

I soon realized what medication tapering is. It is stepping into each individual’s complex world of biology, history, psyche, circumstance, and tolerance for discomfort.

Naively, I thought this would be relatively simple work. That we would create a tapering schedule, meet regularly, and follow it. What I learned is that it is anything but that.

What I’ve observed is that coming off psychiatric medications can be daunting, even when the medication is clearly no longer indicated or causing adverse reactions. Many people describe their experience of psychiatric medication withdrawal as “the worst experience of my life” and use words like “horrific” and “torturous.” I have heard those expressions more times than I can count.

It is commonly one of the most intense periods of a person’s life.

What I’ve learned is that medication tapering also includes:

• The transformation of an individual who is dealing with their views of the medical system,
• Feelings of betrayal by authority figures,
• And a fundamental shift in honoring one’s autonomy rather than handing complete control over to anyone.

There is no exact one-size-fits-all approach to tapering.

In the tapering process, we are dealing with a person’s brain chemistry and aspects about their physiology that we do not understand, nor can we quantitatively test for. And we have to use their personal, subjective experience as a primary guide.

Nothing about this is simple.

The process is nuanced, completely unique for every individual, and often painstaking.

So How Did I Change My Approach?

The very first thing I did was start believing my patients. This may sound absurd or like I was a heartless doctor in the past, but what I realized was that I was carefully groomed to disbelieve the people whose health I was trying to take care of.

This is one of the most insidious things about the medical profession. We are subtly (or not-so-subtly) taught that we (doctors) know best, no matter what.

As a psychiatrist, I was not taught to sit and listen to the individual’s experience of the mind-altering medication they were taking without judgement. I was not taught to question or wonder. I was taught to administer. I was taught that only I know best what is right for this individual.

And what would happen if the treatment administered didn’t work?

I was taught to go back to the very limited tool kit I was given and try again. I was not taught to question the medication itself. Or to investigate its potential frailties. Or even consider that we may not know nearly the scope of what we pretend to about these mind-altering chemicals.

First, I had to start believing what people were telling me. That their psychiatric medication was causing major problems for them, especially when they tried to discontinue it.

This wasn’t easy.

Even for someone who has a deeply questioning mind like me. There were moments I struggled to fully accept the reality of what people were telling me.

• That they had tried multiple times to get off an SSRI and failed because of withdrawal symptoms.
• That a tiny decrease in a benzo was causing them to not be able to function in their life.
• That the medication itself was causing the very symptoms it was meant to treat.

Over time, the more I heard, the more I understood that psychiatric medications are not what we are portraying them as. When I started to listen, the patterns became obvious.

I saw firsthand that any psychiatric medication taken on a daily basis (not just benzos) can cause physiological dependence. And that this dependence can produce dangerous withdrawal symptoms when a person tries to reduce or stop a medication abruptly.

So, What Works?

When it comes to tapering, what I have found works is a hyperbolic approach that is patient-led and non-fixed.

What do I mean by “non-fixed”? It means you can’t just hand someone a sheet of paper with all the calculations for their doses and expect that to work for them over the course of time, which can be years. Life changes. A taper has to mirror this reality and be dynamic responding to the individual’s needs in the present moment. This means percentages should be adjusted based on their current state, if needed. I have never seen someone maintain the same exact percent reduction throughout their taper.

For example, when someone has to change jobs, this is a stressful situation. It’s often a time when people choose to hold their dose for a longer duration or lower their reduction percentage to account for their system being sensitized by added mental stress. After that stress has passed, one can typically resume their previous reduction pace.

I’ve also seen people feel better at the end of their taper when the medication burden is low, and consequently, safely increase their reduction pace. It is individual for everyone. I cannot stress this enough.

There is no one-size-fits-all prescription for a person’s taper.

The most common and relatively comfortable rate I have observed is making medication reductions between 2.5-10% every 4-6 weeks.

But there are plenty of people operating outside this range too.

• Some people start at a higher percentage and then reduce it as their medication dose gets smaller as they observe their reaction to the reductions.
• Some who are having an adverse reaction to the medication need to hasten the taper to rapidly reduce their exposure to it.

A reduction pace for the same medication for one person may not be tolerable for another.

The Mindset of Stability

I have learned the hard way, what matters most, is not how quickly a person can taper down to 0 mg, but maintaining the individual’s mental and emotional stability.

Many people that find me are fed up with their medication. They do not want to spend one more moment under its influence. In that mindset, they want to get off the medication as quickly as possible. Tapers work well when we focus on that individual maintaining mental stability. I used to get seduced into the idea that what mattered most was tapering as fast as possible. But then I watched people suffer when the pace was hasty.

Their zest to get off the medication can easily work against them. Helping people understand that tapering is a marathon, not a sprint–that is the tortoise, not the hare who wins this race—is not always easy navigation. But eventually, once the individual realizes the power of tapering slowly, finds relative mental stability, and is able to maintain a comfortable pace, it can be a relatively smooth process.

What became clear is that a taper can be most expeditious when a person feels “relatively stable” throughout. This does not mean feeling perfect. There will be ups and downs, but when we upset the delicate balance of an individual’s psyche, the suffering takes its toll. It often causes periods of stopping or slowing the taper.

What works well is to find a reduction percentage that feels tolerable, even if it’s smaller than you expected, and keep making that reduction regularly. In that way:

• The individual gains confidence in the taper,
• They get to have a reasonable quality of life,
• And they maintain their functionality (going to work, paying the bills, taking care of family).

Exposure to Different Medications

Every medication has a different side effect and tapering profile. It has taken me years to learn the intricacies of each one. I’m still learning every day.

For example, tapering Prozac is not the same as tapering Lexapro. With Prozac a person can get away with larger percentages than with Lexapro. Prozac has a very long half-life, which we can guess is the reason it’s easier. Lexapro, with a shorter half-life, is a very “touchy” medication to taper. It can quickly precipitate intensely uncomfortable withdrawal symptoms with minor dose changes.

Each person also has their own unique journey that has brought them to the point of finding me. Typically, they’ve already tried to taper unsuccessfully and are in various states of distress or destabilization. Many have been exposed to multiple medications in failed attempts by other providers to find an alternate solution for their distress.

Each exposure to a rapid dose reduction, reinstatement, or alternate drug trial acts as an event of “kindling” to the brain. Kindling means any event that causes an assault to the brain from which the brain may struggle to stabilize.

Waiting for the brain to be stable enough to reduce the medication is its own challenge. And being “stable” is a relative term. It’s unique to the person going through the destabilizing event.

It takes subtlety, nuance, and patience to figure out when it is time to start moving doses downward. And the same goes for figuring out what percentage to start with.

Finally, Everyone Is Unique

Every person has their own unique journey. Each person’s biology is unique. What their brain has been exposed to over the years is unique. Each has their own unique tolerance for mental and emotional discomfort.

You have to put all of these things together and try to make coherent sense out of it to help someone stay relatively mentally and emotionally stable while their brain chemistry is being altered. This is not easy to do.

I’ve never listened more to my patients than I do now. I’ve never learned more from my patients than I do now. I am constantly learning, growing, and questioning every single day in discerning what step for someone to take next.

I experience the feeling of being in the boat WITH the patient. We are navigating the stormy seas together. It is a partnership, not a dictatorship, built on a solid foundation of mutual trust and respect.

My patients may not know, but their individual experience has helped many others as I learn from them and apply it.

What I have learned is that this process demands being continuously open-minded, dynamic, and responsive to the ever-changing needs of the individual person.