Exploring the ‘art’ of coming off psychiatric drugs

At 14 years old, Laura Delano was diagnosed with bipolar disorder. She was told that her condition was “incurable” and that she would be on psychiatric drugs for the rest of her life.

Delano ignored her diagnosis and instead threw herself into academic pursuits. Born into an upper-class family, she dutifully followed the pathway to reach the beacon of Ivy League success. But at Harvard, she felt trapped in an “inauthentic life,” unfulfilled by collegiate expectations.  

Delano fell back into the arms of the mental health system. “I followed the textbook of the medical model and stepped into the role of a good compliant patient,” she said. The decade that followed was a waking nightmare: psychiatrists gave Delano multiple diagnoses and cycled her through 19 powerful psychiatric medications before she finally decided the only way out was suicide, which she attempted. But then Delano read a book called “Anatomy of an Epidemic,” that led her to a different choice, one that felt almost as extreme: she decided to taper off her meds.

Delano was transformed into a crusader of sorts as a result of her journey, campaigning to assist other patients who want to stop taking antidepressants and other psychiatric medications. Delano refers to her experience as learning the “art” of coming off psychiatric drugs. She started an advocacy group and has a forthcoming book entitled “Unshrunk: My Life as an Ex-Mental Patient.” 

It is a delicate, difficult subject — 1 in 6 Americans are taking psychiatric drugs, and mental health research has shown that medications like Lexapro and Xanax have improved the lives of millions. But judging from a recent event in Manhattan, Delano’s message of patient empowerment and choice has a receptive audience. 

Speaking to a small but rapt crowd in a dimly lit movie theatre in SoHo, Delano described the “art” of  safely coming off the psychiatric drugs that had addled her for so long. As she spoke bluntly about her odyssey through the American mental health system, audience members murmured their agreement and a few even shared their own withdrawal journeys and experiences. They laughed at her blunt jokes — “During my formative years, my greatest achievement was taking a shower when I could, and not bingeing on a box of stale Dunkin’ Donuts,” she said — and fell into stark silence when she talked about her past suicidal thoughts. 

The process of coming off the five psychiatric drugs she was taking at the end of her treatment — Lithium, Effexor, Abilify, Lamictal and Ativan — was like an explosion, she said, illustrating the point with a slideshow image of a bomb going off.  

Antidepressants are especially difficult to quit because of how they act in the brain and nervous system. SSRIs — selective serotonin reuptake inhibitors — are a class of antidepressants that work by rebalancing levels of serotonin, a neurotransmitter compound that carries messages between nerve cells in the brain and elsewhere. Everything in our bodies, including the brain, seeks a state of homeostasis, or equilibrium. When we take SSRIs, our serotonin levels increase and the brain adjusts and establishes a new balance.

 Hence, effective withdrawal from these drugs needs to be gradual, explained Dr. Anders Sørensen, who specializes in psychiatric drug withdrawal and appeared at the event with Delano. 

Withdrawal symptoms — which range from restlessness and anxiety to psychosis and intrusive thoughts — can be very disturbing for patients. Sørensen urges patients to be aware of their withdrawal symptoms but to avoid focusing on them. The Danish psychologist likened this to a form of personal mindfulness, analogous to focusing on the content of his talk without being distracted by the feeling of the rough velvet seat, the low hum of the projector and the musty smell of dust in the theater. 

 Laura Delano came off her medications in just six months, but the current literature recommends a longer withdrawal period, with a more gradual dose reduction to minimize serotonin imbalance in the brain. Sørenson agreed, urging patients to gradually reduce their dose by 5-10% over a long period of time. He compared the tapering process to a speed paradox — patients will get off, and more importantly, stay off the drug by tapering slowly.

However, it was not as easy as simply stopping the medication; Delano’s tapering journey was a bumpy one. She describes how she felt like a newborn in life, rediscovering everyday experiences such as grocery shopping. Although adjusting to life without the medications is tough, Delano urged the crowd not to “be afraid” of themselves, and to embrace their physicality.

Sørenson thinks his fellow clinicians should exercise more restraint in prescribing antidepressants, especially while upping doses when they are ineffective. When a patient notices their drug dosage going up, but feels no positive benefits from the increase, it might be time to consider whether the drug is working for you, Sørensen said. In a recent review, Sørensen identified that increasing the dose of a drug does not always increase its effectiveness. The research showed that the desired effect of SSRIs often tapers off at very low doses — in some cases there was no difference in increasing the drug from 150mg to 225mg  of the drug venlafaxine. “It’s a short-term solution to a long-term problem. These higher doses often increase the side effects without treating the issue itself,” he explained. 

Delano hopes that her own life experience will give patients the confidence and courage to educate themselves and take an active role in their own treatment — and to not simply say “yes” every time a psychiatrist pulls out a prescription pad. “Expertise does not always come from the amount of letters after your name,” she said. “Sometimes the most helpful knowledge lies with the lay person’s wisdom.”