Stopping psychiatric medication without medical supervision and review is a dangerous proposition.Sometimes when medication is working the way it is supposed to, the patient may mistakenly assume s/he does not need it any longer and stop taking it with unhappy results.
The risks associated with suddenly stopping medicines that may be helping cannot be overstated.
Working as a therapist in a medical center I see many patients who have been prescribed medicines to help with certain specific psychiatric disorders such as depression, anxiety or bipolar conditions. I have become increasingly aware of and concerned about some of the reasons for and consequences of people stopping their medication without medical supervision or clinical review by a professional.
The reasons people think it is OK to just stop taking their medicines tend to fall into one of two general categories. Either 1) They do not like something about the effects of the medication so just stop taking it, or 2) They feel better and so believe they don’t need the medicine any longer. In the first case, the situation can be quite complex running a gamut from unpleasant side-effects to people actually ‘missing’ some of the symptoms the medicine was ameliorating. In the second category, the medicine is working so the person feels better.
Stopping it often simply opens the door for the former problems to resurface.
Not everyone who is prescribed and takes psychotropic (medicines targeted to help what manifest as psychological problems) will need to take them for the rest of their lives. Good medical follow-up would include regular review, usually including blood work-ups to assure that the correct therapeutic dosage is being maintained in the person’s system. If/when a person feels that they might no longer need the medicine, they are well advised to be working with the doctor to ‘titrate’ the medicine (gradually lower the dose) to see what difference a reduction might make before arriving at a conclusion that the medicine can be safely stopped. Timing is everything.
I recently saw a 25 year-old woman who had been diagnosed with a rather severe bipolar condition a couple of years ago. She was prescribed medicine for it which she took and, over a period of weeks, her symptoms (great, uncontrolled mood swings and attacks of acute anxiety and panic) ceased. After being pretty much symptom-free for about a year, she decided she no longer needed the medicine. She felt she was doing well and simply did not need it any longer.
Within a month, the symptoms she had first presented with began to return. She was overwhelmed with anxiety, racing thoughts, sleeplessness and dark and foreboding thoughts. A physician on staff evaluated her then refilled her medication. She was restored to her higher functioning abilities in a matter of weeks.
It is not always that quick or straight forward. Many psychotropic medicines cause weight gain. This is an unacceptable side-effect for many people who would rather be ill and thin than well and a bit heavier. Sometimes medicine intended to stabilize a person’s moods, takes the depth out of the depressive side and for that most patients are please. However it also may take the edge off the ultra-high “manic” or “euphoric” periods and these are sometimes desperately missed.
There is still much to be learned about psychotropic medications but we are certain that abrupt stopping them can cause severe regression and a return to the full-blown illness as it once was.
Ultimately, none of us really knows best what the ‘right’ thing is for someone else. With that in mind, a thoughtful medical professional considers as many of the variables as possible and prescribes what they believe will benefit the patient the most. Whether or not there are trade-offs and whether or not those trade-offs are acceptable to the patient is, ultimately, the patient’s call. Psychiatrists and psychotherapists know and understand that. In most instances.
The control is in the hands of the patient and the professionals can only advise, try to understand, offer support, new tools and an opportunity to talk out difficult things. Whether or not to take or, once started, to continue to take medicine is always the patient’s call.
It is an important call; One with possible consequences that might be avoided if the impulse to stop was interrupted by a visit with the prescribing physician to discuss the situation first.