Most people with depression and/or bipolar think about stopping medications at one point or another. The results can be disastrous or good depending, in part, on the motivation for change and how it is done.
As with any major life decision, it is best not to approach the decision with too much of a sense of urgency. If you’re feeling tremendously frustrated about how you are doing, and if you’re basic idea is that “nothing can be worse than this” so “screw it” you are just going to stop your medications… the odds of this working out well are pretty low.
On the other hand, if you’ve been thinking about it for a while and wondering whether a certain medication is really contributing to your overall well-being, or not, and if you’ve been talking with your prescriber about this question, you may be ready to put together a plan for stopping the medication.
The more gradually you reduce the medication the better will be the results of stopping medications and the more clearly you will be able to see what the effects of the medicine are. Usually we recommend at least two months taper off one medication.
Several things happen as you reduce the dose of a medication. In the first week or two after a dose reduction you may experience “withdrawal symptoms” which are quite different from the therapeutic effects of the medication. For example, many people experience odd physical sensations described as being like “electric shocks” when they abruptly stop certain serotonin antidepressants.
Also, some people experience a transient worsening of mood or anxiety symptoms that lasts a couple of weeks and begins a few days after a dose reduction. After that, their mood may return to its baseline state. Thus, it makes sense to wait at least a couple of weeks before assessing whether reducing the dose was a good idea.
There are four things to consider before stopping medications.
- A Crisis Plan. Have a clear plan in mind for how you would respond to a sudden return of past psychiatric symptoms. We have written about this a number of times before and can’t emphasize how important and helpful it is to have written out such a plan in advance. Doing so improves the odds of success considerably and may prevent catastrophe as well.
- A Supporter. Talk to a friend or family member about your plans and develop way of checking in with that person about their observations of how you are doing as you taper off your medication. Mood can be tricky because our experience of mood changes is often that the world is a different place rather than that something has happened to us, so an outside observer plays an essential role in grounding us.
- Your Prescriber. Make sure that you and your prescriber have carefully worked out a plan and that he or she feels the plan is reasonable, even if they might not personally recommend that you taper off that medication. This is a negotiation and both of you need to feel that the plan you have developed is realistic.
- Self Monitoring. If there is ever a time to pay close attention to your mood, now is it. Get started with the daily mood chart such as one of the ones we discuss elsewhere on this site.
Try to approach stopping medications with a spirit of open curiosity. If you are not willing to see a certain result this is a big red flag.
On the other hand, if you’re genuinely curious about what happens the experience can be useful even if it doesn’t lead to the result you expected.
If you end up resuming the medication you and your prescriber will both have a clearer sense of what that medication does, both in terms of therapeutic effects and side effects and that information can be very helpful when you are thinking about changes in your treatment plan.