Although my last post argued against viewing psychiatric drugs as scientific miracle pills, it remains true that some patients experience decisive improvement on medication. I believe such individuals are fortunate. As my writings have made clear, I did not enjoy much success with drug treatment.
Lack of efficacy combined with dreadful side effects led me to taper off the medications, slowly and over several years. If the pills had worked for me over the long haul, I’d probably still be taking them.
Pragmatics, not ethics, determine my opinion here. I see little reason to argue against pharmaceuticals in those cases where life feels enhanced and neither adverse effects nor expense have proven troublesome.
Even so, as a physician I can affirm that limiting the number and dosage of medications to the minimum necessary for the desired effect is always a good policy. As a human, I can endorse occasional reevaluation of life strategies as a wise practice.
The pharmaceutical industry promotes the misconception that psychiatric drugs are, essentially, vitamins: permanently necessary for mental health. This is simply untrue. Some patients may need medications for life, but clinicians do us a huge disservice when they assume this without proof. The only way to know for sure is to occasionally try the alternative: professionally guided drug reduction.
Lacking helpful clinical advice, and often out of frustration, many patients stop taking pills in hope of living drug-free. Unfortunately, abrupt cessation of pharmaceuticals almost always leads to decompensation. Although the desire to discontinue medications is natural, quitting too quickly can cause profound deterioration if not hospitalization. Unthinking clinicians view the downward spiral that follows sudden drug cessation as evidence that the patient has an illness that requires chemical treatment, but it’s more likely a sign that the brain has become habituated to the drug and that the withdrawal was too rapid. Only by slow, careful tapering can a person’s condition on less or no medication be fairly assessed.
Pharmaceuticals too often get prescribed for years and decades despite a striking lack of controlled evidence for benefit with such prolonged treatment. At the same time, it’s all too easy to substantiate the harm drugs can cause when used for extended periods. Unfortunately, it is easier for psychiatrists to keep writing scrips than it is for them to undertake the difficult work of assisting with medication reduction. They also fear malpractice liability should a patient harm self or others (though this risk is probably minimal when tapering is done properly and with good communication). So countless patients end up on potentially toxic pills for life without ever getting a legitimate try at doing without.
Drugs can be helpful, especially early in one’s recovery. But after a time on medication, as one gains familiarity with calmer, more balanced mental states, one often feels ready to cut back on pharmaceutical support. It may make sense at that point to try measured reductions to see if the recovery remains stable with less intensive treatment. One might find that hypomanic energy (for instance) that once felt intolerable can now be managed or even used to advantage. Such a trial would be a personal choice that should made in consultation with clinicians.
Getting completely off medications once seemed impossible to me, but it turned out to be achievable. Most important to my success was learning to tolerate uncomfortable feelings without acting them out. Acceptance and Commitment Therapy (ACT) was instructive in this regard. Cognitive Behavioral Therapy also helped, as it taught me to avoid exacerbating psychic distress with distorted thoughts. In addition, mindfulness meditation practice helped me observe my feelings and thoughts without buying into them. Regular exercise, helping others, and like-minded social contacts were also vital in supporting this work.
For me, successful drug tapering hinged on my going slowly and remaining in touch with mental health professionals who supported my goal of drug reduction. Since I knew they shared my long-term agenda, I trusted them when they suggested I should increase the dose of a medication temporarily. I did this several times in the four years I spent tapering. I’d go up on the dose until some transient stress resolved, or the winter days got longer, or I simply felt stronger. I tried to avoid rigid refusal to take pharmaceuticals, but I never let go of my long-term hope of reducing the medication load as much as possible. In the end, I was able to completely stop, but if it had been necessary to continue on a low dose, I would have done so without feeling bad about it.
What matters is balance and contentment, not some misplaced philosophical purity. If medications bring a person to a better state, feel like the right choice at the time, and don’t cause harm, I see no reason not to use them. But it still makes sense to take a second look from time to time.