It appeared that social support was helpful during discontinuation. Most respondents were engaged in treatment at the time they decided to discontinue. Four respondents who reported having a relationship with a prescriber at the time of deciding to discontinue did not indicate the nature of the decision-making process. This is the first U. Although most respondents possessed certain socioeconomic privileges including race, education, and people to count on , many had considerable experiences in treatment, received public benefits, and were involuntarily hospitalized.
These individuals took psychiatric medications for years before choosing to stop them for reasons already well documented in the literature: adverse effects, potential long-term risks, and the availability of beneficial alternatives 26 — The findings extend and complement those from the few previous surveys, in which fairly similar proportions of participants found medications helpful. The sample in this study reported a longer period of medication use but a similar period without medication since discontinuation and somewhat lower overall rates of withdrawal effects.
The lower rates of effects may be related to how long respondents took to discontinue. The experience of discontinuation itself was reported to be physically and emotionally challenging, with respondents reporting several undesirable withdrawal effects that have been noted in previous research 6 , This study may be the first to report detailed findings on helpfulness of various supports to discontinuation.
Although many respondents described collaboration in the initial decision-making process about discontinuation, most did not indicate that providers were helpful during the ensuing experience of discontinuation. Many who were discontinuing medications did not feel supported by providers, which is problematic, particularly because many respondents reported severe withdrawal effects.
Much work has demonstrated that the therapeutic alliance—the relationship between a provider and a client that enables them to work together—predicts positive treatment outcomes This alliance may be affected by how providers communicate about discontinuation. The limited support respondents reported may be due partly to inadequately validated information to guide prescribers and psychotherapists Communication about discontinuation faces a challenge similar to that faced by research on discontinuation: it can be difficult to define and distinguish between withdrawal effects and psychiatric symptoms Individuals undergoing discontinuation have described experiencing the resurfacing of difficult emotions and withdrawal effects simultaneously In practice, prioritizing patient goals for medication use and well-being may help maintain open communication while the field awaits further research Many individuals must find support through friends, family, peers, and online support groups.
In this study, respondents found these sources of support particularly helpful, along with self-care.
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Resources and interventions employing these supports may be especially promising, along with tapering options that guide providers to reduce the risk of severe withdrawal effects. As with most currently available surveys on discontinuation, this study relied on retrospective self-reports, which are subject to significant recall bias. In addition, individuals may have responded because of especially positive or negative experiences self-selection bias. Individuals were recruited by nonprobability sampling.
Another limitation was marked homogeneity in race-ethnicity and gender. Data on nationwide trends in medication use show that fewer people of color and fewer men are exposed to psychiatric drugs 1. It is not known whether individuals who choose, or are able to choose, to discontinue medications share these demographic characteristics. Finally, a strength of the design was its focus on persons who discontinued more than one medication class, which reflects real life better than focusing on only one medication; however, exclusion of respondents who had attempted to discontinue more than two medications greatly reduced the sample size.
Many potential participants were excluded for this reason, which may indicate that many individuals take—and desire to discontinue—several medications at once, and this may be a neglected research area. Furthermore, our findings describe the experiences of individuals discontinuing various classes of psychiatric medication; thus these experiences cannot be generalized across drug classes. Initial studies have documented the withdrawal effects of various classes of drugs 5 , 6 , 13 , We plan to address this problem in a more complete exploration of withdrawal effects in this sample.
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These preliminary results contribute to the limited research on discontinuation experiences and helpful coping strategies. As the results highlight, discontinuing psychiatric medication is a complicated and often difficult process. Clearly, future research should guide health care systems and providers to better support patient choice and self-determination 35 , 36 , provide information on the risks and benefits of discontinuation, and assist individuals through the process.
In the Netherlands, programs have been implemented to help long-term users discontinue benzodiazepines, and the Norway Ministry of Health has recently instituted a medication-free psychiatric treatment ward in a public facility, which also helps patients taper medications if they wish to do so Opportunities for support from friends, family, and peers, along with improved provider education, would help individuals during discontinuation.
Although the Food and Drug Administration mandates research to establish efficacy and safety of short-term medication use, little federal support exists for research on long-term use or optimal discontinuation strategies. Most medication users report finding psychiatric medication helpful; however, medication appears most effective when combined with other psychosocial supports, and many individuals may require only temporary use 38 , Increasingly, medication management is conceptualized not only as employing strategies to increase adherence but also as supporting patient goals for medication use Research on adherence emphasizes collaboration and engagement, although its main focus is on supporting individuals to voluntarily take medications When they choose to stop taking medication, even after adhering to a regimen for many years, their current option may be to expect little assistance from the health care system, and they may drop out of treatment, which is unfortunate.
Clinicians may point to data indicating that relapse or recurrence of distress is likely to result from medication discontinuation, but the fact that individuals make choices with which clinicians disagree should not preclude clinicians from providing support once these individuals have made a decision. For respondents who are comfortable in treatment, a stronger therapeutic alliance and more options such as holistic health care might improve engagement and lead to less arduous discontinuation experiences. This study recruited more long-term users than some previous studies, but future research would benefit from better representation of underserved populations.
Longitudinal studies would aid treatment planning by better characterizing treatment trajectories, beginning with the experience of medication initiation, and would help identify individuals who could benefit from specific discontinuation strategies. Research should continue to explore ways to support individuals who choose to discontinue medication in order to inform practice and policy efforts to achieve more effective person-centered care. They also thank the Human Services Research Institute for administrative support.
Medicines for Mental Health: The Ultimate Guide to Psychiatric Medication
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Old Password. New Password. Password Changed Successfully Your password has been changed. Returning user. Forget yout Password? If the address matches an existing account you will receive an email with instructions to reset your password Close. Call your doctor right away if you have any of the following symptoms, especially if they are new, worsening, or worry you U. Food and Drug Administration, :. Combining the newer SSRI or SNRI antidepressants with one of the commonly-used "triptan" medications used to treat migraine headaches could cause a life-threatening illness called "serotonin syndrome.
Serotonin syndrome is usually associated with the older antidepressants called MAOIs, but it can happen with the newer antidepressants as well, if they are mixed with the wrong medications.
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Antidepressants may cause other side effects that were not included in this list. To report any serious adverse effects associated with the use of antidepressant medicines, please contact the FDA MedWatch program using the contact information at the bottom of this page. For more information about the risks and side effects for each medication, please see Drugs FDA.
Anti-anxiety medications help reduce the symptoms of anxiety, such as panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Benzodiazepines can treat generalized anxiety disorder. In the case of panic disorder or social phobia social anxiety disorder , benzodiazepines are usually second-line treatments, behind SSRIs or other antidepressants.
Buspirone which is unrelated to the benzodiazepines is sometimes used for the long-term treatment of chronic anxiety. In contrast to the benzodiazepines, buspirone must be taken every day for a few weeks to reach its full effect. Anti-anxiety medications such as benzodiazepines are effective in relieving anxiety and take effect more quickly than the antidepressant medications or buspirone often prescribed for anxiety. However, people can build up a tolerance to benzodiazepines if they are taken over a long period of time and may need higher and higher doses to get the same effect.
Some people may even become dependent on them.
enter To avoid these problems, doctors usually prescribe benzodiazepines for short periods, a practice that is especially helpful for older adults read the NIMH article: Despite Risks, Benzodiazepine Use Highest in Older People , people who have substance abuse problems and people who become dependent on medication easily. If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms or their anxiety may return.
Therefore, benzodiazepines should be tapered off slowly.
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Like other medications, anti-anxiety medications may cause side effects. Some of these side effects and risks are serious. The most common side effects for benzodiazepines are drowsiness and dizziness. Other possible side effects include:. Beta-blockers generally are not recommended for people with asthma or diabetes because they may worsen symptoms related to both. Anti-anxiety medications may cause other side effects that are not included in the lists above. To report any serious adverse effects associated with the use of these medicines, please contact the FDA MedWatch program using the contact information at the bottom of this page.
As the name suggests, stimulants increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration National Institute on Drug Abuse, Stimulant medications are often prescribed to treat children, adolescents, or adults diagnosed with ADHD. Two other non-stimulant antihypertensive medications, clonidine and guanfacine , are also approved for treatment of ADHD in children and adolescents.
One of these non-stimulant medications is often tried first in a young person with ADHD, and if response is insufficient, then a stimulant is prescribed. Stimulants are also prescribed to treat other health conditions, including narcolepsy, and occasionally depression especially in older or chronically medically ill people and in those who have not responded to other treatments.
Stimulant medications are safe when given under a doctor's supervision. Some children taking them may feel slightly different or "funny.
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