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Psychiatric Drug Withdrawal
A Guide for Prescribers, Therapists,
Patients and their Families
 
By Peter Breggin, M.D.
  

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Springer Publishing Co. 2013

 

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Nothing in the field of mental health will do more good and reduce more harm than encouraging withdrawal from psychiatric drugs. The time is past when the focus in mental health was on what drugs to take for what disorders. Now we need to focus on how to stop taking psychiatric drugs and to replace them with more person-centered, empathic approaches. The goal is no longer drug maintenance and stagnation; the goal is recovery and achieving well-being.

 

My new book, Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and Families, responds to a citizen rebellion that demands, “Help us get off these drugs!” It also encourages a professional revolution among concerned therapists who want to reject the idea of enforcing “patient compliance.”

 

It’s time for therapists—psychologists, nurses, social workers, family therapists, and counselors—to stop pushing their clients and patients to take psychiatric drugs that cause brain damage, harm the body, and shorten their patients’ lives. In Psychiatric Drug Withdrawal, therapists will learn about psychiatric drugs to actively participate with patients and families in the medication decision-making process.

 

The book provides a new roadmap for prescribers, therapists, patients and their families that will enable patients to taper off their drugs and achieve emotional and physical recovery and well-being. At the same time, it provides an improved treatment approach for all patients regardless of whether they are taking psychiatric drugs.

 

Prescribers of psychiatric drugs should welcome much greater participation of therapists, patients, and their families in decision-making about psychiatric drugs. This new emphasis on patient partnership and well-being will greatly increase awareness of adverse psychiatric drug effects and facilitate patients withdrawing before the harm becomes irreparable. It will improve the prescriber’s overall satisfaction and effectiveness as a service provider.

 

Some therapists have told me they are afraid of being sued if they offer opinions or participate in psychiatric-drug decision making. In my extensive forensic experience, this almost never happens, and I know of no such successful suit against a therapist. Instead, the highest level of professional ethics requires the therapist to confront the risks and dangers associated with their patients’ psychiatric drugs.

 

There is now so much scientific evidence proving that psychiatric drugs damage the brain and overall health and lifespan, that the major concern should be “How to stop taking psychiatric drugs.”  It can be dangerous and even agonizing to stop, and people need to take charge of the process and no longer let prescribers like psychiatrists, general practitioners, and pediatricians dictate to them how long they or their children need to stay on drugs. 

 

Up to now, professionals—when agreeing to withdraw patients from drugs—have withdrawn them at their own predetermined rate and often much too abruptly. This book explains and illustrates a Person-Centered Collaborative Partnership that focuses on the patient’s feelings and needs throughout the withdrawal process.

 

Therapists are often the first to realize that their patients are overly or unnecessarily medicated but they have been discouraged from voicing their opinions or discussing them with their clients or patients. They have also been discouraged from participating in medication decision-making and have been urged or mandated to enforce medication compliance. This book offers a new pathway for therapists to participate in an active patient and family partnership, along with the prescriber. It begins with a review of the dangers associated with psychiatric drugs and then describes and illustrates the process of person-centered withdrawal and mental health recovery, often with the collaboration of the therapist and family.

 

Patients often come to me wishing to withdraw from psychiatric drugs but are terrified because their previous prescribers, if agreeing to drug withdrawal, have withdrawn them much too rapidly and without regard for their suffering in the process. Nothing is more important than the patient’s sense of control over the process and the timing of withdrawal.

 

At a time when scientific research is demonstrating the harm from long-term drug exposure, the proposed new Diagnostic and Statistical Manual of Mental Disorders (DSM-V) will be pushing for increasingly widespread drug prescription. The mental health field needs to reverse itself by vastly increasing emphasis on psychiatric drug withdrawal and drug-free recovery.

 

This model for a patient-centered collaborative team approach not only transforms drug withdrawal but mental health treatment in general with its greater emphasis on the patient partnership and well-being. Its approach transforms treatment for all mental health clients and patients. The book is especially vital for the treatment of dependent children and adults, individuals struggling from emotional crises and serious mental turmoil, the elderly, and anyone with compromised judgment and cognitive ability.

 

The Person-Centered Collaborative Partnership approach ushers in a new era of patient- and family-centered treatment. It offers a whole new level of drug-free recovery and enhanced well-being. The goal is no longer a drug-induced holding pattern, but genuine physical and psychological recovery and growth.

 

 

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Prescribers, therapists and other health professionals-as well as patients and their families-are provided with the theoretical framework underlying this approach along with extensive scientific information, practical advice, and illustrative case studies that will enable them to:

 

  • Establish a collaborate, trusting and empathic team approach to psychiatric drug withdrawal
  • Recognize common, serious and sometimes overlooked adverse drug effects that may require drug withdrawal
  • Treat emergencies during drug therapy and during withdrawal
  • Identify common withdrawal reactions for every type of psychiatric drug
  • Determine the first drugs to withdraw during multi-drug therapy
  • Distinguish between withdrawal reactions, newly occurring emotional problems, and the recurrence of pre-medication problems
  • Estimate the length of withdrawal
  • Prescribe very small doses of medication when necessary
  • Understand how "medication spellbinding" (intoxication anosognosia) makes patients unaware of the adverse mental and emotional effects of their drugs during treatment and withdrawal
  • Identify and handle Medication-induced Chronic Brain Impairment (CBI)-a common but easily missed need for psychiatric drug withdrawal
  • Modify the withdrawal program for children, the elderly, and severely emotionally disturbed patients
  • Decide when and how to provide individual, couples or family therapy appropriate to the specific stages of medication withdrawal

 

 

Pre-Publication Endorsements for Psychiatric Drug Withdrawal

 

 



Dr. Peter Breggin has written an invaluable reference for mental health professionals and lay-persons alike who are seeking a way out of dependency on psychiatric drugs. He describes the many dangers of psychiatric medication in straightforward research-based and contextually nuanced terms. Most helpfully, he articulates a method of empathic, person-centered psychotherapy as an alternative to the prevailing emotionally and system disengaged drug-centered approach. In this book, Dr. Breggin systematically outlines how to safely withdraw a patient from psychiatric medication with rich case examples drawn with the detail and sensitivity to individual and situational differences that reveal not only his extensive clinical experience, but his clear, knowledgeable, and compassionate vision of a more humane form of treatment. In this volume, Dr. Peter Breggin has again demonstrated that he is a model of what psychiatry can and should be. This is an indispensable text for both mental health trainees and experienced practitioners seeking a practical alternative to the dominant drug-centric paradigm.

 

Gerald Porter, Ph.D.

Vice President for Academic Affairs
School of Professional Psychology
Forest Institute Springfield, MO

 


 

Today many psychologists, nurses, social workers, and counselors are struggling with how to help adults and the parents of children who are over-medicated or who wish to reduce or stop taking their psychiatric drugs. Dr. Breggin’s book shows non-prescribing professionals, as well as prescribers, how to respond to their patient’s needs in an informed, ethical, and empowering fashion.

 

Sarton Weinraub, PhD

Clinical Psychologist and Director at the
New York Person-Centered Resource Center, NYC

 



I don't know anywhere else to get this information, at least not compiled in this easy-to understand way. This book is the culmination of Dr. Breggin's lifetime of work, and it is chock-full of facts, practical recommendations and wisdom from experience working with children and adults. His person-centered approach is a breath of springtime air for those tens of millions of people who have tried “treatment as usual” and not been helped, and wonder what to do now. Daily, people come to my office after having tried pills, more pills, newer pills, different pills, and pill combinations, with no real relief, or things have gotten worse. Now they are on medicines and they can't get off, or they are afraid to try. Those people need answers. Breggin has answers.

 

Douglas C. Smith, MD, psychiatrist

Former clinic director, Juneau, Alaska

 



Peter Breggin has written a unique, brilliant, and comprehensive book that every mental health professional should read and “prescribe” to their patients and families! Dr. Breggin is a true pioneer in identifying the dangers of psychiatric drugs, being the first to warn us decades ago that treatment of the mentally ill would devolve to the shameful status it reveals today. Professional and lay populations everywhere have come to recognize that we are a dangerously over-medicated society, urgently in need of a fix, and Dr. Breggin’s new book provides an intelligent way out of this quagmire.

 

Fred Ernst, Ph.D.

Professor of Psychology

University of Texas - Pan American

 



In this exceptional, easy-to-read, highly informative and thought provoking book, Dr. Breggin continues to be the conscious of psychiatry and leading expert in the field of psychiatric drug withdrawal. This groundbreaking work will empower patients, their family members and mental health professionals. It is a must have for all those wanting the most accurate, up to date information regarding collaborative, empathetic, effective and safe psychiatric drug withdrawal.
 

Wendy West Pidkaminy, LCSW-R

Adjunct Professor of Social Work, Syracuse University

 



Our culture has increasing need of a new language to counteract and clarify the ascendant role of psychotropic medication in our society. Peter Breggin has provided us with that language. In Psychiatric Drug Withdrawal he has created a truly concise and eminently practical guide for evaluating the effects of psychotropic medications and finding ways to withdraw from them. It is a superb summary of the knowledge he has collected over a lifetime. This is invaluable knowledge for those clients of all ages who have ended up addicted to these medications. The guidelines in this book can lead to the recovery of their lives.

 

Tony Stanton, MD

Adult and Child Psychiatrist

Private Practice, Poulsbo, WA

 



This much needed book and guide to psychiatric medication withdrawal is clearly written and easy to understand. As people become more empowered and able to inform themselves about the effects of pharmaceuticals, practitioners will be called upon to wean their patients off of damaging medications. This book will provide that guidance. Thank you Dr. Breggin for having the courage to oppose conventional psychiatric thinking and the caring to improve the quality of life for individuals who are ready to experience their own innate healing instead of reaching for a pill to mask the symptoms.

 

Melanie Sears, RN, MBA

Author, Humanizing Health Care and Choose Your Words

 



Dr. Peter Breggin has written an invaluable reference for mental health professionals and lay-persons alike who are seeking a way out of dependency on psychiatric drugs. He describes the many dangers of psychiatric medication in straightforward research-based and contextually nuanced terms. Most helpfully, he articulates a method of empathic, person-centered psychotherapy as an alternative to the prevailing emotionally and system disengaged drug-centered approach. In this book, Dr. Breggin systematically outlines how to safely withdraw a patient from psychiatric medication with rich case examples drawn with the detail and sensitivity to individual and situational differences that reveal not only his extensive clinical experience, but his clear, knowledgeable, and compassionate vision of a more humane form of treatment. In this volume, Dr. Peter Breggin has again demonstrated that he is a model of what psychiatry can and should be. This is an indispensable text for both mental health trainees and experienced practitioners seeking a practical alternative to the dominant drug-centric paradigm.

 

Gerald Porter, PhD

Vice President for Academic Affairs

School of Professional Psychology at Forest Institute

Springfield, MO

 



The field of mental health counseling is rooted in principles and practices informed by empathy and client empowerment. Using these core elements of counselor education as guiding principles, Dr. Breggin challenges the status quo of psychiatric practice and provides practitioners with an alternative vision that raises both controversy and consciousness. This book underscores the counselor’s ethical imperative to be informed, critical professionals in regard to psychiatric “evidence-based” treatments. Amidst the swell of public resistance to the growing use of psychotropics, Dr. Breggin’s bold work bolsters the ability of counselors to contribute to the professional discourse that surrounds the complex decisions clients make concerning their journey toward healing and wellness.

 

Kathryn Douthit, PhD, LMHC

Chair & Associate Professor, Counseling & Human Development

Warner Graduate School of Education & Human Development

University of Rochester, Rochester, NY

 



Dr. Breggin has again created an invaluable resource for both treatment providers and treatment recipients. His authoritative knowledge of these issues creates a position of confidence for clinicians, while empowering those individuals and families receiving care. The writing style is great. It offers 'chunks' of information –clear, concise, and you don't need to read the whole chapter to get valuable information, making it a handy reference. This important contribution to the field will create a powerful ripple-effect, aimed at ultimately improving the treatment outcomes for those in need of compassionate and effective treatment.

Robert Foltz, PsyD

Assistant Professor, Department of Clinical Psychology

Chicago School of Professional Psychology

Chicago, IL





A pill is a poor substitute for human connectivity and compassion, and Dr. Breggin’s new book is the first step toward understanding the insidious nature of foregoing the call to comfort one another during times of hardship. Some sufferings cannot be fixed with a magic wand, or magic mantra, or magic pill.  I urge everyone to read this book, slowly and mindfully. There is, perhaps, no more important message for those who wish to help heal and those who desperately seek such healing.

 

Because a pill is a poor substitute for human connectivity and compassion, this book provides insight and guidance to empower therapists who are willing to play a much greater role in helping their patients make decisions about taking, and not taking, psychiatric drugs, without fear they have to enforce "medication compliance." 

 

Joanne Cacciatore, PhD, LMSW, FT

Bereavement Trauma Specialist

Assistant Professor, Arizona State University

Clinical Director and Founder, MISS Foundation

 



This is a warning. Your psychiatric medicines are dangerous. Further, withdrawal from the medications can trigger horrendous consequences, additional psychiatric symptoms, and even death. In Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients & their Families, Dr. Peter Breggin addresses very important issues regarding the use of psychiatric medicines, and the termination of these medications. Counselors, social workers, psychologists, and psychotherapists will find Dr. Breggin’s material helpful for understanding the adverse drug effects, feeling empowered in helping adult patients and the parents of child patients make decisions about medications, for monitoring their patient’s drug experience, and in assisting families concerning the issues of patient withdrawal from medications.

 

Douglas W. Bower, RN, LPC, PhD

Athens, Georgia

 



The psychodynamic and medical issues critical to stopping psychiatric medications are explained.  Dr. Breggin provides a novel and comprehensive blueprint for prescribing doctors, therapists and patients to join in a collaborative effort to stop taking psychiatric medications.  It is a book that patients, therapists and physicians will all want to read.

 

Stuart Shipko, MD. Psychiatrist in Private Practice

Pasadena, California

 



This is such an important book. Describing the problem of withdrawal from psychiatric drugs in detail, and providing clear advice regarding how to deal with this problem as Peter has done so well in this book, is long overdue. For decades, the belief system that is mainstream psychiatry has denied the existence of withdrawal problems from the substances they prescribe so widely. In reality, withdrawal problems with psychiatric drugs is a common occurrence. Because of psychiatry's reckless denial of this real and common problem, millions of people worldwide have not had the support and care they desperately need when attempting to come off psychiatric drugs, often been erroneously advised that these problems are confirmation of the existence of their supposed original so-called 'psychiatric illness.' Dr. Breggin's book is therefore both timely and necessary.

 

Terry Lynch, MD, physician and psychotherapist, Limerick, Ireland; author of Beyond Prozac: Healing Mental Suffering Without Drugs and Selfhood: A Key to the Recovering of Emotional Well Being, Mental Health and the Prevention of Mental Health Problems

 


 

As a physician who specializes in addiction medicine and drug withdrawal and written widely on them, I recommend Dr. Breggin's book to every health professional who deals with anyone taking psychiatric drugs. He gives highly useful information and reasons for stopping or avoiding them. It’s an excellent one-stop source of information about psychiatric drug effects and withdrawal. Prescribers, therapists, patients and families will benefit from this guidebook.

 

Charles L. Whitfield MD

Atlanta, Georgia

Best-selling author of Healing the Child Within, and recently Not Crazy and Wisdom to the Know the Difference

 



This is a needed book. Thoughtful clinicians, including psychiatrists, other prescribing physicians, clinical psychologists, social workers, and other therapists, frequently think their patients should be withdrawn from psychiatric medication, but they are not sure. In addition, they do not know the best way to help the patient to safely withdraw from psychiatric medication.

 

They are often afraid of the disapproval of their professional colleagues. Nonmedical therapists may feel they have no right to question the judgment of their medical colleagues about medication. Non-psychiatrist physicians may feel they should not discontinue the medication unless it is requested by the original prescriber, usually a psychiatrist. Psychiatrists may feel that if they withdraw their patients from psychiatric medication they will be resented by colleagues who almost never withdraw their own patients.

 

Psychiatric medication is often helpful in the short run, but if continued becomes a problem, and eventually a disaster. For a few patients it becomes a disaster right away.

 

The first part of the book is a careful and relatively complete description of the reasons why one should consider psychiatric drug withdrawal or dose reduction and when. Included are detailed discussions of antipsychotics (neuroleptics), antidepressants, stimulants, benzodiazepines and other sedatives and opiates, and lithium and other mood stabilizers.

 

The second part of the book is a detailed description of the best way to withdraw from psychiatric drugs, taking into account the specific drug or multiple drugs, the length of usage, and the characteristics of the individual patient. Case histories are presented of simple and of complex cases of withdrawal. This is information not previously available anywhere.

 

Withdrawal is best handled by the prescriber, therapist, patient, and one or more family members, working together as a team. Prescribers rarely see patients often enough and long enough to have a detailed knowledge of withdrawal effects without information from the others. Therapists are more likely to know about adverse drug effects, including withdrawal effects, especially if they are looking for them. Patients are likely to report symptoms if they think their therapist and their prescriber want to know. However, one common side effect and withdrawal effect of psychiatric medication is a lack of awareness of symptoms ("medication spellbinding" or intoxication anosognosia). That is why a family member can be useful in pointing out and describing obvious symptoms of which the patient seems unaware.

 

The most heartening chapter is on children and teenagers. Most children and teenagers can be withdrawn with relative ease and safety, if their parents are cooperative. Withdrawal from stimulants is easily accomplished with children and teens diagnosed with ADHD if sensible family therapy and possible consultation with the child's teachers are provided. Not only will they be off the medication, their troubling symptoms will also be gone. Of course, it would have been better to provide family therapy without medication from the beginning.

 

Children and teens diagnosed with bipolar disorders also readily respond to family therapy and withdrawal of medication. "Manic" symptoms in children and teens are almost always a side effect of antidepressants or of stimulants. Children diagnosed with autism need help in relating and medication impairs their learning to relate. They are able to respond to efforts by parents and others to relate to them once they are off medication. Children and teens, whatever their diagnosis, even after prolonged exposure to multiple drugs, respond to family therapy and a team approach and usually can be withdrawn easily if they have a stable family.

 

Peter Breggin has more experience in safely withdrawing psychiatric patients from medication than any other psychiatrist. In this book he shares his lifetime of experience. All of our patients deserve the benefit of our obtaining that knowledge.

 

Bertram Karon, PhD

Professor of Psychology, Michigan State University

Author, The Psychotherapy of Schizophrenia

Former President of the Division of Psychoanalysis of the American Psychological Association


 

In his new book, Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and their Families, Dr. Breggin takes on a subject and practice that draws both anxiety and hope from all parties: withdrawing from psychiatric medication with the goal of avoid medication-induced chronic brain impairment. His person-centered principles of respect, concern, empowerment of individual choice, providing as much comfort as possible during withdrawal, encouraging a supportive environment, and careful attunement to clinical monitoring, provide the necessary conditions for the journey of withdrawal to be an experience of personal transformation. At the same time, Dr. Breggin’s lifelong career in this field mitigates against a naïve and Pollyannaish romanticism of this process. He explicitly, and regularly, addresses the dangerousness of sudden and unsupervised withdrawal, and instead, encourages a collaborative approach centered on the utmost respect for a patient’s choice and pace in this journey, while very sensitively discerning and weighting the damage that could be done without withdrawal in relation to the discomfort of the withdrawal. Dr. Breggin equalizes the authority of all parties in this process, thus dethroning the dictatorship of the prescriber, but not excluding him or her.

 

I have been waiting for a text like this one to recommend to numerous families that come to me distressed and vulnerable to authoritative voices that box them into the false dilemma of either taking medications that have severe side-effects for themselves or for their children, or being tagged as medically noncompliant and/or neglectful. Dr. Breggin should wear a large “B” on his chest and a cape as this text is a crime fighting text that will certainly contribute to expanding options for countless individuals seeking liberation from chemically induced violence.

 

What is also very important here is that Dr. Breggin’s person-centered approach is not a militant enforcer of withdraw, which would merely adjust chairs on the same sinking ship. On the contrary, he emphasizes that attunement to the patient means encouraging autonomy, responsibility, decision-making, and pacing are vital to a successful experiences of withdrawal, a stance quite different than what has typically been the case to date. Again, this isn’t an argument of polarization of patients against prescribers, but an invitation to a collaboration of shared power in mutual dialogue about how to handle suffering in life.

 

Most importantly, Dr. Breggin notes that “The best way to avoid psychiatric drugs is to forge ahead with creating a wonderful life.” We do this through the power of intimacy and love, which can alter more than brain chemistry; it can alter how we are with each other in the world in more communal ways, thus nullifying the need for medications to orchestrate our lives. In Dr. Breggin’s book, the possibility of liberation has come.

 

Todd DuBose, PhD

Associate Professor, Chicago School of Professional Psychology, Chicago, IL

 



Peter Breggin shows us the wave of the future. The polluting of our mind and souls goes beyond the gulf oil spill. Dr. Breggin gives us the vision to see the damage and the tools to start the cleanup.

 

Timothy D. Evans, PhD,
Private Practice Tampa, Florida, and Executive Director, Florida Adlerian Society

 

 

 

 

 

 

 

 

 

  

 

 

WARNING!

Most psychiatric drugs can cause withdrawal reactions, sometimes including life-threatening emotional and physical withdrawal problems. In short, it is not only dangerous to start taking psychiatric drugs, it can also be dangerous to stop them. Withdrawal from psychiatric drugs should be done carefully under experienced clinical supervision. Methods for safely withdrawing from psychiatric drugs are discussed in Dr. Breggin's new book, Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients, and Their Families.