Psychiatric Drug Withdrawal

Overview

This series of seven webinars will feature presentations by people with “expertise by lived experience,” psychiatrists, and other professionals. The educational purpose of the series is to present information and insights that arise:

• from users’ experiences and their efforts to support others who want to taper from their psychiatric medications; research on drug withdrawal
• the clinical experience of psychiatrists and other professionals who have supported patients tapering from psychiatric medications
• research on drug tapering programs and efforts

This course is not designed to provide advice to individuals who are seeking to taper from their medications. It is, instead, designed to explore the risks and rewards of doing so, and methods for doing so successfully. It is also designed to identify the many shortcomings in our medical and societal knowledge about withdrawing from psychiatric drugs.

Note: This series does not currently provide continuing education credit.

Who should view this series

Webinars

October 24, 2017: Experts by experience

5:30 pm Eastern 4:30 pm Central 3:30 pm Mountain 2:30 Pacific

Emily Cutler will moderate and participate in a panel of individuals who have successfully withdrawn from psychiatric medications. They will tell of their experiences doing so, and also describe their ongoing efforts to provide support to others seeking to taper from the drugs. Panel members in addition to Emily Cutler are Jocelyn Pedersen, and Dina Tyler. Below, hear Jocelyn Pedersen speak about the course:

Learning Objectives:

1) To describe psychiatric medications commonly prescribed for common psychiatric diagnoses

2) To discuss observations on the process and timing of withdrawal from psychiatric medications

3) To list resources available for supporting safe withdrawal from psychiatric medications

4) To describe lessons learned in supporting others in their choices to taper and withdraw from psychiatric medications

5) To explain the concept of “harm reduction” in withdrawing from psychiatric medications

November 14, 2017: Antipsychotic withdrawal/reduction in a public mental health setting

2:30 pm Eastern 1:30 pm Central 12:30 pm Mountain 11:30 am Pacific

Psychiatrist Sandy Steingard presents on research that provides an evidence-based rationale for supporting patients to taper from antipsychotics. She will discuss some of the challenges psychiatrists face when they are open to tapering and discuss her 5-years of experience of using a collaborative decision model that supports public mental health clients in deciding whether to reduce their dose of neuroleptic drugs. Below, listen to Sandy Steingard talk about her presentation:

Learning Objectives:

PART 1: Overview of the problem and framework for resolution

1) To describe the 2 core principles of clinical care--informed consent and standard of care

2) To demonstrate Accepted Community Practice (ACP) for antipsychotic drugs and schizophrenia:

3) To describe major challenges to accepted practice based on data and clinical experience

4) To describe a different model of tolerating psychosis for longer, working to establish a minimally effective dose and consider stopping drugs when a person is stable

5) To compare studies on the association between duration of untreated psychosis and short- and long-term outcome in schizophrenia

6) To assess relapse studies conducted by Leucht et al, Cochrane Database 2012

7) To assess well-constructed studies on risks of drug exposure and functional outcome

8) To identify studies on using optimal dosing

9) To describe supersensitivity psychosis--how antipsychotic drugs can increase risk for psychosis and clinical implications

10) To describe "shared decision making" and "dialogic practice" as a way forward

PART 2: Applying principles in practice

1) To describe the drug tapering protocol used in Dr. Steingard's clinic

2) To analyze the 5 years of outcome data from this clinical experience using the drug tapering protocol including work status per drug use status and antipsychotic drug discontinuation data

3) To describe the clinical conclusions from this research

4) To identify cognitive bias and tapering from antipsychotic drugs

5) To compare 3 client vignettes

December 12, 2017: Medication reduction and wellness

2:30 pm Eastern 1:30 pm Central 12:30 pm Mountain 11:30 am Pacific

Psychiatrist Kelly Brogan presents on her clinical experience working with patients withdrawing from psychiatric drugs, especially antidepressants. She addresses the physiological reasons for some who experience depression, lab tests that can help guide the withdrawal process and provides tips for making withdrawal more successful. These include environmental, nutritional and several web-based sites for support. She bases her information on research and her clinical experience helping patients withdraw.

Learning Objectives:

1) To identify general effectiveness, ineffectiveness and risks of taking and withdrawing from antidepressants

2) To describe reasons for prescription of antidepressants in spite of risks

3) To identify common physiological triggers for depression

4) To assess Kirsch and Columbia University studies on the ineffectiveness of antidepressants

5) To list grassroots and web-based resources for withdrawal from antidepressants

6) To describe lifestyle supports for withdrawal

7) To list recommended nutritional supplements to support withdrawal

8) To identify lab tests to monitor health status during withdrawal

9) To describe tips for tapering of psychiatric drugs

January 16, 2018: A review of the research literature on psychiatric drug withdrawal

2:30 pm Eastern 1:30 pm Central 12:30 pm Mountain 11:30 am Pacific

Robert Whitaker, journalist and founder of Mad in America, will present both on what has been studied, and identify “research that needs to be done.” Robert Whitaker has written in-depth on the efficacy of psychiatric drugs and is a co-founder of the International Institute for Psychiatric Drug Withdrawal.

Learning Objectives:

1) To describe the “addictions model” of the effects of psychiatric drugs on neurotransmitter systems

2) To demonstrate how exposure to antipsychotics affect dopamine function

3) To describe the concept of dopamine supersensitivity

4) To compare "adverse events" with "withdrawal effects"

5) To explain how receptors respond to gradual vs abrupt withdrawal

6) To identify what relapse rates look like upon withdrawal from anitpsychotics and antidepressants

7) To demonstrate protracted withdrawal syndromes for antidepressants and benzodiazepines

8) To describe flaws with the addiction model in understand withdrawal dynamics

9) To demonstrate a model for distinguishing relapse from withdrawal syndromes

10) To discuss the studies on why and how people decide to stop taking psychiatric drugs

11) To describe the most common specific withdrawal symptoms reported by people who withdraw

12) To list activities and people that were helpful to those who withdrew

13) To review the most current and comprehensive survey on long-term users of psychiatric medications (Ostrow, 2017)

14) To propose a research agenda using the addiction model and the “user-oriented” model

February 20, 2018: The evidence base for psychiatric drug withdrawal and risks of withdrawal syndromes

1 pm Eastern 12 Noon Central 11 am Mountain 10 am Pacific

Psychiatrist Peter Breggin will present on the hazards of long-term use of psychiatric drugs, which provides a compelling “evidence base” for psychiatric drug tapering protocols; drug-withdrawal syndromes that patients experience when tapering from psychiatric drugs; the biological explanations for such syndromes; and for patient-centered and controlled approaches to successful drug tapering and withdrawal.

Learning Objectives:

1) To demonstrate the way in which neuroleptic drugs marked the beginning of the pharmaceutical era in psychiatry

2) To describe how the neurotoxicity of psychiatric drugs was discovered

3) To discuss how experience in a state hospital led to the work to demonstrate the dangers of ECT, lobotomies and the neuroleptic drugs

4) To explain the brain-disabling principle of psychiatric drugs

5) To describe the concepts of “medication spellbinding” or “intoxication anosognsia”

6) To demonstrate how the 2 concepts above apply to antipsychotics, stimulants, benzodiazepines and other sedatives, and mood stabilizers

7) To describe the final common pathway of persistent drug effects which are apathy, indifference, declining engagement and declining quality of life.

8) To discuss the development of “chronic brain impairment”

9) To describe how to prepare a patient for drug withdrawal in an outpatient setting

10) To describe the process for succeeding with drug withdrawal in an outpatient setting

11) To demonstrate the importance of developing residential facilities for drug withdrawal

March 20, 2018: A harm-reduction approach to psychiatric drug withdrawal

1 pm Eastern 12 Noon Central 11 am Mountain 10 am Pacific

Therapist Will Hall, PhD candidate and author of the Harm Reduction Guide to Coming Off Psychiatric Drugs (translated into 15 languages and used world-wide), discusses how he works with individuals, families, and clinicians using a person-centered and flexible approach to drug withdrawal as a life change and learning process, including drug response diversity, crisis risk, and alternative responses to experiences seen as psychotic.

Learning Objectives:

1) To identify what “harm reduction” in coming off psychiatric drugs means

2) To describe a critical analysis of mental disorders and psychiatry

3) To list some of the difficulties in coming off psychiatric drugs

4) To demonstrate the way psychiatric drugs affect the mind and body

5) To list the health risks of psychiatric drugs

6) To describe reasons why people want to stop taking psychiatric drugs

7) To list steps in reducing and withdrawing from psychiatric drugs

8) To analyze reasons why people may want to stay on psychiatric drugs

9) To describe ways to deal with a doctor who does not want a patient to withdraw from drugs

10) To identify things to consider before coming off drugs

11) To discuss ways to work with the fears that can be associated with coming off drugs

12) To describe ways to use drugs on an intermittent basis

13) To list alternatives to using psychiatric drugs

April 17, 2018: Developing a drug-withdrawal agenda for the future

1 pm Eastern 12 Noon Central 11 am Mountain 10 am Pacific

A panel of people with lived experience review this first MIA withdrawal course, its strengths and shortcomings, and discuss an agenda for developing drug-tapering knowledge and support programs. What do we, as a society, know about this subject, and what do we need to learn?

Commonwealth Educational Seminars (CES) seeks to ensure equitable treatment of every person and to make every attempt to resolve grievances in a fair manner. Please submit a written grievance to: Bob Nikkel, [email protected], Phone: (503) 929-9346. Grievances would receive, to the best of our ability, corrective action in order to prevent further problems.