Tapering Antipsychotics, or Antidepressants

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Originally published Oct 1, 2022
Updated periodically 

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Use the tips in the main tip list (for schizophrenia, or depression, or bipolar, or anxiety respectively) to get yourself in a place where it may be possible to consider attempting reducing your medication dose. You must be in what you believe is a good mental space before considering reducing a psychotropic medication, if you can successfully reduce your dose your mental health should improve even further.
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Antipsychotic

Slow, gradual taper (hyperbolic or less than 10% increments best (but much smaller increments towards the end of the taper)(hyperbolic best))
lack of sleep bad sign that you should raise your meds again
expect side effects (tardive dyskinesia) from withdrawal (see main article for tips to prevent this)
Gets harder to withdrawn towards the end of your withdrawal (more likely to relapse then)
avoid coffee, cannabis, alcohol, stimulating movies/books, blood sugar spiked
exercise, eat well
consider talk therapy
consider having a safety monitor from a friend or family member that can take control if you start acting out of sorts
do it with medical supervision
1 month withdraw period for every year on antipsychotics
Riskier for some people to discontinue completely, may be good to stay on very small dose (if you try to reduce to zero and get issues a few times, consider staying on a low dose forever).
Reductions may need to be halted occasionally and your previous dose or an even higher dose may be needed to be consumed temporally before trying to reduce again (alternativetomeds.com)


Hyperbolic dose discontinuation examples 















Gradual taper is better
However, 4 weeks is a brief period and a more recent meta-analysis finds an inverse dose response between the duration of discontinuation and the rate of relapse over the next year: abrupt stopping led to relapse in 77% of patients; stopping over 1–2 weeks to relapse in 57%; 3–10 weeks to 47%; and stopping over longer than 10 weeks led to a relapse rate of 31%.4
(Drive meta analysis drug discontinuation)
Also has info on TD and withdrawal 

Physical activity / yoga may help, social support (friends, family, church) potentially important.
Staying busy helps
TrueHope EMPowerPlus (multivitamin) REALLY helps with withdrawal along with their AminoAcid product. 
More internal sense of control helps
AVOID food and environmental allergens (that you react to mentally)
More NAC
More Acetyl l Carnitine

Good to have a extra medication (PRN) available in case you start getting symptoms or you can use CBD (from marijuana)
Full spectrum CBD better than CBD isolate potentially (according to a follower)
Smoked M 31hr halflife
Oral drops 1.5 to 12hr halflife
Hits system within 15 min
50-60% bioavailability smoked vaped
Versus 15% oral (~4x difference)
31hr halflife smoked
5 hr halflife oral
800mg CBD oral (studied to be extremely effective in reducing schizophrenia symptoms)
200mg CBD vape
Maybe 100mg oral full spectrum or 25mg smoked (??) (if full spectrum is better)
Inositol (for panic, agitation)
Phyphosdylcholine (for rushing thoughts)

Withdrawing from antipsychotics often leads to tardive dyskinesia and movement disorders, see my blog entry on TD for potential solutions:




Antidepressants

The problem
12% of people in America take antidepressants
Women 2X
Europeans 3X
Asians lowest risk (4.8X lower than Europeans)

Tapering strips had 70% success rate for antidepressants
https://www.taperingstrip.com/ (LOOK UP your antidepressant here and click on it, they show you exactly how fast to reduce your dose (hyperbolicly (for a constant reduction in effectiveness not mg of drug (faster at the start, slower at the end of the taper), though pauses are sometimes needed and 21% of people had to restart taking their medication in one of their studies (see drive)))
56 days average tapering time (two strips used), I would recommend tapering over a longer period than two months. (You can always split pills, or dilute the medication in water to more easily measure fractional doses). 

10% (red) or 15% (green) reduction in antidepressant per week (example: 10mg (week 1) to 9mg (week 2) to 8.1mg (week 3) to 7.29mg (week 4)) 


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10% experience withdrawal symptoms from a placebo



James greenblatt functional medicine for antidepressant withdrawal book: https://www.psychiatryredefined.org/functional-medicine-for-antidepressant-withdrawal-book/


People who struggle with antidepressant withdrawal often lack amino acids from protein (that make seratonin)
Problems 
need protein
stomach acid
stress
Free form amino acids (protein) are readily absorbed (amino acids from TrueHope or amino replete from pure encapsulations) (recommend to help reduce withdrawal symptoms)
Digestive enzymes help (make sure has betaine HCL HCL is key) digestive enzymes ultra (pure encapsulations)
Tryptophan is key in amino acid supplements, amino replete (pure encapsulations) or TrueHope (serotonin precursor)
Seroplus another possible supplement (pure encapsulations) (used at end of taper to avoid crash at end)(has 5HTP)  (serotonin precursor)
Co-factors for serotonin like folate, magnesium, vitamin D, B6, zinc, that are needed to build serotonin (EMPowerplus from TrueHope or Seroplus has some of these)
Lithium orotate 1mg to 2mg helps with irritability mood problems (may help with withdrawal symptoms) (reduces dopamine and glutamine, increases serotonin and GABA) (helps aggressive kids a lot)
Agmatine sulfate (may help with depression and withdrawal symptoms)
One women could withdrawn after HCL
One men needed 5HTP and lithium
One women needed vitamin D
Omega 3's 
Overgrowth of gut bacteria (another factor)

If you still have withdrawal symptoms going back on a very small dose of your antidepressant may resolve the issue.
(see below link)

Paroxetine can be hard to taper off of, and switching to a longer half life medication can be difficult too.
Many members are having difficulty going off fluoxetine, citalopram, aripiprazole, diazepam, and clonazepam. (Halflife has an association)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970174/ (What I Have Learnt Tapering Thousands Of People)

This article also has some links at the bottom to how to taper better:

“In total, n = 69 individual reports of those who had protracted withdrawal issues were selected for analysis. At time of the subjects’ most recent reports, duration of PWS (protracted withdrawal syndrome) ranged from 5 to 166 months, mean = 37 months, median = 26 months. Length of time on the antidepressant causing protracted withdrawal ranged from 6 to 278 months, mean = 96 months, and median = 79 months. Throughout the withdrawal experience, affective symptoms, mostly anxiety, depression, emerging suicidality and agitation, were reported by 81%. Somatic symptoms, mostly headache, fatigue, dizziness, brain zaps, visual changes, muscle aches, tremor, diarrhea, and nausea were reported by 75%. Sleep problems (44%) and cognitive impairments (32%) were mentioned less frequently. These broad symptom domains were largely uncorrelated.”

“it is not difficult to distinguish withdrawal symptoms from relapse. Generally, a readily recognizable constellation of unusual neurophysiological symptoms appears, such as electrical sensations (zaps) or sudden onset of dizziness, pain, nausea, or insomnia. If these are present with no other accountable medical factors, the condition is likely withdrawal syndrome, even if emotional symptoms are also present.27,35,78 Patients often will describe physiological or emotional symptoms as new or exceptionally severe: “I’ve never felt this before”,27 but withdrawal symptoms tend to surge irregularly as “waves and windows”,28,84–86 while relapse of the original condition will be more consistent in pattern and takes longer to gradually develop.3”




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