Medication Tapering - Brisbane ACT Centre

Antidepressant Tapering

Antidepressant adverse effects? Physical dependence? Withdrawal issues? We can help!

Many people believe depression to be a life-long condition caused by a chemical imbalance in the brain requiring lifelong treatment — which is now known to be incorrect. Long-term use is not recommended for most people. Many people experience initial helpful numbing of difficult feelings, but within weeks or months this becomes troublesome emotional blunting, sexual numbing with consequent relationship issues, also tiredness, inner restlessness and many more adverse effects.

Why might someone taper off Antidepressant Medication ?

There are many reasons people decide to stop including:

• The life issues that led to starting medication have resolved or improved
• Recent awareness that antidepressants do not “fix a chemical imbalance.”
• Experiencing unwanted medication adverse effects.
• No longer feeling that their medication is helping them.
• Being pregnant or trying to conceive - also for males
• Concerns around the risks associated with long-term medication use.

Withdrawal symptoms are very common and are not a sign that a patient needs the drug, but rather that they need to reduce the dosage more slowly.

Antidepressant Withdrawal Symptoms

Withdrawal symptoms are very common, from 50 to 75% depending on the drug, and can be severe with strong negative emotions, including low mood, irritability, anxiety – if these happen within a few days it's withdrawal and not the "illness coming back". Other common withdrawal symptoms include also feeling spaced out, head zaps, and a range of odd and often very distressing neurological symptoms.

Here at Brisbane ACT Centre our director, psychiatrist Dr Rob Purssey has over a decade of expertise in helping people with just these issues to successfully taper. He is continuously learning more effective strategies by directly communicating with the world's foremost experts including psychiatrists, importantly those with lived experience and decades of supporting others in online forums such as Surviving Antidepressants.

Hyperbolic Tapering to Minimise Antidepressant Withdrawal Symptoms

A hyperbolic curve describes the relationship between the dose of drug and the effect on the brain. It is very steep at small doses, with the curve flattening out at doses commonly employed clinically.

The Law Of Mass Action means that when few molecules of a drug are present, every additional milligram of drug will have large additional effects, because of the large number of unoccupied receptors to act upon, while when larger amounts of the drug are present, receptors are increasingly saturated and so each additional milligram of drug will have smaller and smaller incremental effects.

See this video which graphically demonstrates the importance of this pharmacological fact:

Minimising Antidepressant Withdrawal Symptoms

This image illustrates why initially every small increase in the drug in your system has large effects, swamping receptors at very low doses then flattening out very quickly. This is the original SSRI fluoxetine (Prozac) and ALL psychiatric drugs have the same kind of receptor occupancy profile.

This image illustrates the MUCH larger changes at lower dosages, which directly correlates with what people experience in terms of withdrawal:

Hyperbolic Tapering to Minimise Antidepressant Withdrawal Symptoms

First, tapering must be done gradually: sometimes tapering over months, or even years, especially if the drug has been taken for long periods — and certainly not weeks. This allows the brain to adapt to the changes. Stopping too quickly is a bit like jumping off the tenth floor of a building. Coming down step by step over a longer period of time causes much less disruption to the system.

Second, the rate must be adjusted to the individual. Everyone is different so it is hard to determine ahead of time. The best way to work this out is through a test reduction to see how someone responds to determine further steps.

Lastly, extra care must be taken on reaching the last few milligrams of the drug. This is because very small doses have much larger effects than one would expect, because when there is little drug about every extra milligram has a large effect, but when it is more crowded with drug every extra milligram has less and less additive effect.

We’ll be using the best possible information to structure your tapering program, specifically the Maudsley Deprescribing Guidelines, and sharing detailed knowledge about what to expect, and how we will handle the process.

Building Psychological skills to help during and after tapering

Deprescribing is more than just chemistry. It is helped enormously by learning ACT psychological flexibility skills to handle symptoms of withdrawal as may arise, and also to deal with the difficult thoughts and feelings that have been numbed / tranquilized by the antidepressants.

Dr Rob Purssey is also an ACT therapist, expert in helping with training these skills, alongside the tapering process. Or he can work collaboratively with your Brisbane ACT Centre psychologist, managing the medication side whilst your therapist helps you build flexibility skills and grow your life.

Tapering off Psychiatric Medication with Us

At Brisbane ACT Centre in Milton our psychologists have regular interaction with Dr Purssey. In this way they can directly access his expertise in helping navigate your medication journey, helping ease adverse antidepressant effects, while building a richer emotional life.

SO – please call our reception to arrange an appointment if this is relevant for you. The fastest way is to initially see a Brisbane ACT Centre psychologist who can assess your issues, and outline your situation with Dr Purssey. We will then have a basic gameplan laid out, prior to seeing Dr Purssey directly for your own specific tapering program.

We'd Love to Hear From You!

Get in touch with one of our friendly staff to ask any questions you have or to book your appointment today.