Today, unfortunately, many psychiatrists who also practice as psychopharmacologists often engage in something called "polypharmacy." In many, if not all, cases, there is no evidence that polypharmacy is helpful; in fact, professional ethical practice guidelines do not support this method.

Despite this, most likely due to the influence of the pharmaceutical industry, many psychiatrists prescribe multiple types of medication to control their patients' symptoms, without really understanding or treating the root cause of the illness or disharmony of their patients.

Some are put on two or even three antidepressants at once, or several different classes of psychiatric medication to treat set of symptoms. Most of this prescribing is "off-label," meaning that these drugs are not approved by the Medicines and Healthcare Products Regulatory Agency (MHRA) in the UK or FDA in the US or indicated for what they are being prescribed.

Many times this leads to an unnecessary dependence on toxic drugs that cause sometimes serious side effects or even addiction in the case of controlled substances such as Adderall, Xanax, Klonopin (Clonazepam), Ambien (Zolpidem), etc.

Since entering clinical practice, I have seen many adults and adolescents who are unnecessarily overmedicated by their conventional psychiatrists. Successful detoxification with marked improvement in functioning and well-being is a difficult task for both the holistic psychiatrist and the patient.

As a holistic integral transpersonal transcultural psychiatrist, one does not meet with pharmaceutical or sales representatives, neither accepts consultation fees nor gifts from pharmaceutical companies. One's decisions regarding medication are always based on objective, scientific evidence and are unbiased.

Many people have a dark view of a prescribed drug withdrawal. One may have read or heard the scare stories about uncomfortable side effects or come across alarming headlines related to the risks of reducing or stopping various psychiatric medications. The reality is that it is possible to safely reduce or suspend any medication, including psychiatric ones. However, it is a very complex, labour-intensive and demanding job for both holistic psychiatrist and a patient.

Here are some general guidelines:

1. Stop your medication for the right reasons

Timing is everything.

Just because someone wants to stop taking their psychiatric medication doesn't mean they're really ready. There are many reasons why people decide to stop taking psychiatric medications. For example, they may feel better and think they no longer need treatment. Their family or social environment may be pressuring them to stop. They read something about a psychiatric medication that scares them, or they fear the medication will affect their personality. Sometimes people want to come off psychiatric medications after making major changes in their lives, such as getting divorced, moving, changing jobs, etc. But, in reality, this could be the worst time to stop, because at this time people are not stable or properly balanced mentally and emotionally.

In addition, according to established orthodox psychiatry, some mental-emotional health conditions require taking psychiatric medications indefinitely, which in some cases may be justified.

Ultimately, the length of time a person is taking a psychotropic drug depends on one's internal and external personal characteristics, one's individual illness, how one relates oneself to that illness, and one's responses to treatment, among others.

For example, in established orthodox psychiatry, some patients diagnosed with depression may take an antidepressant for nine months to a year and experience a decrease in symptoms and signs; others may need two to five years; and still others can be so called genetically loaded for depression that they may need medication indefinitely.

Do not stop your medication abruptly. Stopping abruptly can be especially precarious in some cases.

Depending on the drug, stopping abruptly or "cold turkey" can cause a variety of distressing reactions, ranging from mild to moderate symptoms of early discontinuation with antidepressants, rapid return of the disease being treated, or even life-threatening seizures at a high dose such as with benzodiazepines (Diazepam, Bromazepan, Midazolam, Alprazolam, etc).

One should consult one's psychiatrist before stopping any psychiatric medication and never try to do it on one's own.

Consider whether you have received a thorough or extensive evaluation.

A comprehensive evaluation is required before reducing or stopping the drug.

Among other indicators, one's psychiatrist should consider patient's current clinical condition and life circumstances, previous clinical history up to the present time, reasons for considering reducing, suspending or continuing treatment, side and adverse effects, and the presence of stressors and tensors, help and support, as well as the dosage and duration of the medication one is taking.

One should discuss these indicators with one's psychiatrist and thoroughly plan how the medication will be reduced or discontinued.

There are no firm and established rules to reduce or stop psychiatric medications, because each person is unique and special due to his/her past and present environment and life history. However, there is an important rule of thumb: reduce the dose gradually whenever possible. How long is enough time to safely reduce is not yet definitely known. Still, the slower the dose reduction, the better the chance of preventing the return of symptoms of the disease for which treatment was started.

Very slow discontinuation is especially important when a person has been taking high doses of a drug for a long time.

Reducing or stopping multiple medications is like peeling an onion. Generally, one should leave the most essential psychiatric medicine for last. Then reduce the doses of one or more optional or supplemental psychiatric medications slowly and gradually. Stopping all psychiatric medications at once is not healthy and safe.

Dealing with small final doses is tricky when going from a low dose to nothing. Holistic psychiatrists sometimes reduce the dose to one pill a day or one every other day or divide it in half. Splitting pills is very useful.

2. Don't expect stopping psychiatric medication to be a quick process

Gradual and safe reduction or discontinuation of a drug does not happen in a few days. Some psychiatric medications, including antidepressants, show no benefit for several weeks after starting; it seems better to avoid discontinuing faster than over several weeks.

If one has been taking a psychiatric medication for years, it is recommended that the dose be reduced gradually, stepwise, over at least six to seven weeks. While this may be a conservative practice, sometimes one may not notice a change for a few weeks, but then difficulties may arise. Discontinuation symptoms usually occur within days of stopping a psychiatric medication, but relapse of symptoms of the condition being treated can be delayed for weeks after initially feeling well.

For example, in bipolar disorder, the rate of discontinuation of ongoing treatment determines the risk and timing of relapse. Initially, the risk of relapse after stopping lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others), and Lamotrigine (Lamictal)) was reduced to the half or more when slow dose reduction over several weeks was compared to abrupt discontinuation. In other cases, gradual discontinuation of antipsychotic drugs also resulted in a lower risk of relapse in schizophrenia.

In a recent study, it was found that stopping an antidepressant abruptly or only for several days was found to result in a much higher risk of depression or panic than gradual discontinuation over two weeks or longer.

If one is switching from one psychiatric drug to another, one may be become more aggressive than when one stops completely. Psychiatric medication is usually switched due to ineffectiveness or side and adverse effects, and a new psychiatric medication is commonly introduced as the old one is gradually phased out. In this way, there is little or less concern about withdrawal symptoms or relapse, assuming that both psychiatric drugs have similar effects or belong to the same class. If one is changing classes, it's common to “cross-taper” psychiatric medications: one takes both medications for a while, and then the psychiatrist lowers the dose of one and increases the dose of the other.

3. Your psychiatrist may prescribe another psychiatric medication

If a patient is taking a relatively short-acting antidepressant medication, such as Paroxetine (Paxil) or Venlafaxine (Effexor), and experiences bothersome symptoms, the attending psychiatrist may prescribe a long-acting antidepressant such as Prozac for a time and then gradually discontinue the long-acting drug to limit the risk of withdrawal symptoms.

The main byproduct of Fluoxetine's metabolism has an extraordinarily long half-life or duration of action, and can take weeks to leave the patient's system.

This approach is not well established for discontinuing other classes of psychotropic medications, including antipsychotics and mood stabilizers, so discontinuing such medications gradually, with close clinical monitoring by the attending psychiatrist, is often the best option.

4. Consult a qualified mental-emotional health professional

Discontinuation of psychotropic medications is an ongoing process that requires a comprehensive evaluation and collaboration between the patient and the attending psychiatrist.

How to know if the psychiatrist in charge is qualified?

First, one must ensure that the attending psychiatrist has a solid experience or specialized training and certification to treat psychiatric illnesses.

It is reasonable for one to ask the psychiatrist the following questions:

Do you know several options to treat, reduce and/or stop treatment?

Do you have enough affirmed experience during the reduction or discontinuation of psychiatric medications?

How often have you treated this disorder or condition and reduced or stopped the medications I am taking?

If one tells one's attending psychiatrist that one would like to stop taking psychiatric medication and he/she agrees without a question and without extensive or thorough evaluation, that is not acceptable. Again, the decision to reduce or stop taking psychiatric medication should not be taken lightly.

If one has not yet started taking a psychiatric medication, one should be encouraged to ask the attending psychiatrist about the following:

Can you give me an idea of how long I will be taking the psychiatric medication?

What are the common side or adverse effects?

How many?

When and how do I reduce or stop the medication?

What is the prognosis?

A great difficulty in taking, reducing and suspending a psychotropic medication is that many patients are excessively passive when it comes to following the advice of psychiatrists. Many tend to view psychiatrists as "all-knowing." But psychiatrists cannot do their job properly if patients do not ask questions and do not participate actively responsible in the treatment process.

5. The patient should be closely monitored

Because one may not experience symptoms and signs for weeks or even months after reducing or stopping a psychiatric medication, patients should be closely clinically monitored during and after drug discontinuation for several months.

In addition to the above, the following may also help when it comes to reduce or discontinue a psychiatric medication:

• One should lead a healthy and sound lifestyle: The importance of adopting healthy and sound habits, including a regular schedule of sleep and activity, and a nutritious healthy diet, should always be stressed. Attempts to reduce or discontinue a psychotropic medication are likely to be unsuccessful if one is under stress and tension, overworked, and deprived of rest and sleep.
• The patient should participate in regular physical activity: Several research studies indicate that exercise can provide a significant antidepressant and anxiolytic effect, mild to moderate depression and anxiety may do about as well with exercise or talking as with medication. Exercise also has other benefits, like helping one deal with stress and tension. One should just be sure to choose physical activities one truly enjoys.
• One should seek psychotherapy: It is important to emphasize the importance of participating in psychotherapy, regardless of the type of mental-emotional illness suffered. Many research studies have shown the value of such approaches, alone or in combination with psychiatric medications, depending on the nature and severity of one's condition.
• One needs to learn to be flexible and open: One can try to go through the process of reducing, suspending or discontinuing the psychiatric medication with the attending psychiatrist, but still one may not be able to do so, because each and every patient is unique and special. One may not be ready or flexible and open enough for this process on time. This does not mean that the patient should feel ashamed or desperate, but it is a crucial moment to understand that the goal is not to be with reduced or discontinued prescribed medications as soon as possible, but to go through a necessary, and adequate process in order be truly ready.

Unfortunately, concerns about the potential stigma of taking psychiatric medications, or the fear of becoming dependent on them, leads many to avoid or want to discontinue them. There may also be pressure from family or friends or even psychiatrists or other health professionals.

One should view psychiatric medication as just one among many possible treatments for psychiatric illnesses, and that its use needs to be tailored to the objective clinical needs of each and every patient.