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Antipsychotic Tapering

This entry was posted in Antipsychotic on by .
Medically Reviewed Fact Checked

Last Updated on August 8, 2022 by Carol Gillette

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

Unfortunately, the prescribers of antipsychotics have been given no established guidelines about antipsychotic tapering, weaning, and titration methods that are both efficient and tolerable.8

Even if antipsychotic medications were the best available choice in the middle of a very real crisis, this does not necessarily mean these drugs need to be endured over an entire lifetime.9

Do Your Symptoms
Require Antipsychotics?

successful antipsychotic tapering
Alternative to Meds has delivered antipsychotic tapering, weaning, and titration inpatient style for nearly two decades, accumulating published evidence demonstrating our clients’ success. The difference in our program compared to others can be attributed to thoroughly addressing root causes and often previously ignored underlying medical or other issues. Once these are discovered and mitigated or remedied, a person’s diagnosis often becomes rendered as non-applicable. This is especially true where environmental and dietary changes also accompany antipsychotic tapering to support and even accelerate natural neurochemistry normalization.
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Advantages of Antipsychotic Tapering

antipsychotic tapering treatmentAntipsychotic medications can harm, most notably over long-term use.1,10 And there is evidence to support that not all persons need to be on antipsychotic medications for life.8 The good news is that It is possible to accomplish antipsychotic titration or even completely eliminate the need for these heavy medications in many cases. The road map for achieving the best results is to do so in tandem with efforts to reduce or even eliminate the original symptoms that led to the prescription in the first place. Finding root causes and addressing what is found can make the difference between success and failure in treatment.

This is the foundation of antipsychotic tapering success at Alternative to Meds Center.

While these may seem like broad sweeping statements, studies are showing that both atypical and other forms of antipsychotic drugs can at times be avoided and replaced with much less toxic treatments that do not harm the patient and tend to have better compliance.9 Compromising a patient’s health through unnecessary or over-prescribing harsh, heavy antipsychotic medication has been subjected to much scrutiny and even criticism.10 There is now sufficient evidence to show that other non-drugging methods of help may be more beneficial to recovery in certain cases.11

Researchers have noted that even in cases of schizophrenia, many unmedicated patients do better long-term without antipsychotics.15 Alternative to Meds Center has found this to be true as well, however, this statement we feel would be irresponsible to extend to ALL patients. Careful discernment is truly warranted for good candidates.

Antipsychotic Tapering Guidelines and Schedule

antipsychotic tapering guidelinesIn this section, we lay out some of the fundamentals in bullet points, then offer a discussion to expand upon the principles directly thereafter. Antipsychotic tapering is the most difficult drug class of all, even more so than benzodiazepines or opiates. The below is only given so as to share with your prescriber, not to act on without support.

Methods described below need to be talked about with a prescriber sensitive to your situation prior to attempting. The likelihood of an unsupported antipsychotic taper going off the rails is high, and the consequences can be tragic.

Antipsychotic Tapering Guidelines include:
  • Do not attempt to taper an antipsychotic while unstable.
  • Choose a trusted family member, pastor, friend, etc., to be your contract for safety.43
  • Gather the support of a prescriber to provide the medical observation you will need.
  • Stay away from coffee or other forms of caffeine.18,19
  • Eliminate recreational drug use, especially marijuana. 20,21
  • Eat a solid breakfast, protein-based, and maintain frequent feedings to balance blood sugar. 22,23
  • Regular cardio exercise is physiologically therapeutic.24
  • Have the lowest dose version of your antipsychotic medication available for use during the taper.
  • Get medical advice regarding other medications you are on. (read more below)25,26,44
  • Prepare the taper to last 1 month for every year you have been on the medication.
  • Percent of reduction and the duration between cuts will depend on symptoms and the duration of time you have been on antipsychotics.
  • Become familiar with symptoms that may manifest during the antipsychotic tapering process.45,46
  • Be aware of red flag warning signs of not eating or sleeping.
  • The last cuts may be the most difficult.
  • Optional: Your physician may opt to prescribe Depakote or some other cross-titration medication for use as a bridge medication.5
  • Limit stimulating repetitive music, television, and even stimulating religious material.28
  • Discuss with your doctor conversion from an injectable to an oral form for antipsychotic tapering purposes.
  • Reference our antipsychotic alternatives page, or [your drug name] + alternatives on our website.

Be in a stable place when considering antipsychotic tapering

Some people have a bad reaction to antipsychotics based upon certain genetic polymorphisms,16 and therefore may require an urgent transition from the medication. This can manifest as movement disorders like tardive dyskinesia, akathisia, metabolic disorders including diabetes, or heightened irritability as a result of the medication.17 Other more rapid strategies would be things to discuss with your provider in the event of these scenarios, and we are not in a position to give rapid antipsychotic withdrawal guidance.

For those who have been on the medication for a while and reasonably tolerating the medication, you would want to be in a good place prior to attempting a withdrawal. This includes that you are sleeping well, eating regularly, have implemented an exercise program, have established trustable medical support, have eliminated stimulants, eliminated recreational drugs, have support in the way of family, friends, mentors, etc, and having a stable routine that may include non-overly-demanding work to focus your energy on. Do not attempt this when you are already not sleeping well. If sleep is an issue, consider asking your doctor to potentially increase other non-antipsychotic medication to help with sleep during this process.

Contracting for safety with a trusted person

antipsychotic weaningWhen you are manic, it may be hard for you to take direction from people who love you. You may find them wrong, and your new source of awakening as a result of medication reduction is the path back you yourself. And while this is largely true, if not done in a slow and calculated way, it could be a catastrophe. Find one or more people to be your contract for safety person. If that person says you have to go back on your medications (with the directive from your doctor in hand), then that is what you do whether you agree or not. Write your commitment to this person down on a piece of paper so that they may present it to you if manic, and that you will listen to them. And know that if you “revoke” this mid-process, you will understand if the police or a hospital has to get involved. As hard as it is to see your life ruled by these medications, the only way out is the slow road. Come to terms with this prior to embarking on antipsychotic tapering. Rarely have we seen an abrupt cessation of antipsychotics for psychosis go well, in fact almost never. Some people are prescribed low dose Seroquel as a sleep aid, and those people may be able to quit over a much shorter period of time without experiencing rebound psychosis. Stay in close contact with your medical support person(s) and the persons with whom you have made your safety contract — do not go it alone.

Medical support for your antipsychotic taper

We know this is hard to find. However, it is necessary. Searching around for a holistic psychiatrist in your area would be a starting point before beginning antipsychotic tapering. This is a class of medications that we STRONGLY suggest an inpatient setting with us at Alternative to Meds Center. This can be too much for an outpatient provider to monitor. But we know that many people have to work with what they have. If an outpatient doctor is chosen, please feel free to share the information you find on this page and other pages regarding antipsychotics with the doctor for review.

Eliminate all forms of caffeine or other stimulants

We cannot overestimate this statement. While caffeine might have been a welcome lift while you were sedated while coming off of antipsychotics, it can single-handedly land you in the hospital due to the way it couples with the withdrawal surge of dopamine.18,19 Even other prescribed medications may trigger this reaction and will be discussed below. Discuss any and all of your concerns, reactions, and questions with your prescribing physician/caregivers.

Stop marijuana use

Many people found themselves in a psyche ward and medicated because of drug-induced psychosis.20 Some genetically variant people cannot break down the THC well and it builds up in their system causing psychosis.21 Again, you may have been able to use marijuana or other drugs while on antipsychotics, but this will not be the same experience when engaging in antipsychotic tapering. Speak with your medical support person(s) regularly so they can assist and guide you appropriately.

Eating breakfast and maintaining blood sugar

Discuss with your doctor the fact that blood sugar dips can escalate underlying mental health issues and can tip someone already on the edge into psychosis.22 To prevent this, eat a solid protein-based breakfast. Avoid or sparingly consume sugars and simple carbs like rice, wheat, and other starches. Eat small meals ongoing throughout the day with frequent snacks.23 A bag of green beans is a viable snack. Avocado is also good. Just make sure you are not going into hunger states during this withdrawal period.

Cardio Exercise

Oxygen is one of the cofactors in breaking down excess dopamine.24,41 Running, cycling, anything that gets the heart rate up can be more than just the obvious health benefit. It is actually a therapy for antipsychotic withdrawal. It would be good to implement some cardio before tapering, even if you have to force yourself due to the sedating aspects of the drug. Coordinate with your medical support about an exercise plan that seems doable. A well-established rhythm will give you something to drop into once you are in the antipsychotic tapering phase.

Having the smallest milligram dose available to use for the taper

Ask your doctor to prescribe you the smallest milligram versions of your antipsychotic. This does not mean a drop to the lowest dose. This is about mathematics. You will need smaller pills to help configure the medication total once you are tapering the antipsychotic. For example, perhaps you are on 25mg Zyprexa. You will want to have the 2.5mg version available so that if you were to drop down to 22.5mg, you be able to easily manage the pills to add up to 22.5mg. If you are on 10mg Zyprexa and cutting to 8.75mg, you may have to cut one of the 2.5mg in half. We recommend having your prescribing physician or pharmacist assist you throughout antipsychotic tapering.

Other medications you are on

antipsychotic taperingAntipsychotics can interact with other medications of various kinds.44 If you are on a stimulant, such as Wellbutrin, Effexor, Cymbalta, Provigil, or SNRI type of antidepressants, talk with your doctor about eliminating these first. Stimulants and SNRIs cause psychosis in certain people 25 and their use during the tapering process will likely complicate the withdrawal. Again, they may have given you a lift while on an antipsychotic, but likely will botch your antipsychotic withdrawal. You are likely going to get a flood of dopamine and dopamine receptor supersensitivity hitting your system coming off of antipsychotics 26 and you do not want to couple that with a stimulatory drug.

Discuss with your prescriber whether other drugs like Lithium, Depakote, SSRI antidepressants, benzodiazepines, and mood-stabilizers like Lamictal could likely assist the antipsychotic withdrawal process. If you are already on those medications, have your doctor consider keeping those medications on until after you are stably off of the antipsychotic, or after you have gotten the lowest dose reduction of antipsychotic that you can or want to do. If you find you cannot get off of your antipsychotic, and you level out at a lower antipsychotic dose that gives you the least side effects, then maybe consider and discuss with your prescriber removing the other above-listed drugs, by strategically tapering each one at a time. Always consult your physician during antipsychotic tapering.

At Alternative to Meds, we generally do the hardest drug first. That is after we remove conflicting drugs, in the example case, the stimulants listed above. So let’s say someone is on Wellbutrin, Zyprexa, Ativan, Lamictal, and Lithium. We would likely remove the Wellbutrin first. Then, we would attend the Zyprexa. The remaining would involve more investigation into the individual presentation but might look like Ativan, Lamictal, or Lithium. Removing the stimulants and attending to the antipsychotic first is the most common strategy. Removing the easier drugs first might paint someone into a corner where they have no medication support for the antipsychotic withdrawal. If being off the antipsychotic is not the desired end goal, and you are only looking to reduce the antipsychotic and lessen another medication dependency, then in those cases, stripping away the other medications slowly prior might be feasible although not preferred unless there is an extenuating circumstance such as the person wanting to avert some side-effects of the other medications. These are points for thorough and ongoing discussion with the prescribing physician that is giving you oversight.

How long is antipsychotic tapering going to last?

A guide for us at Alternative to Meds Center is about one month for every year you have been on antipsychotics, but this varies a lot. And tapering duration may be more depending on the amount of support you have in place. Some people are not the best candidates for being medication free. Better candidates are people who experience intermittent psychosis, or voices, or other symptoms. People who are constantly symptomatic, even symptomatic while on drugs, tend to present more difficult challenges.

Percent of reduction and the duration between cuts

Again, steps during antipsychotic tapering are highly dependent on the person. If you have been on antipsychotic medication for 10 years, set the general expectation to be around 10 months. In this case, you may be looking at a 10% reduction every month. You will have to wait until you have been stable for at least two solid weeks or more before enduring the next taper. Stable means that you are not manic, you are sleeping, you are not angry and fighting with everyone, and you are eating and maintaining a good routine. For those who have only been antipsychotics for a month, you may be able to do 10-25% reductions every few weeks over the course of the next 2 to 3 months, but your medical oversight may suggest that each reduction step will have to be extended until you are not symptomatic. You do not want to go to the next cut if you are having symptoms, and you should try for 2 weeks of stability between cuts. There may be times when the cut you are trying to make might be one that you cannot feasibly do with a pill-cutter. Let’s say you are trying to find the spot between 15mg Zyprexa and 13.75mg. Some people opt to alternate days taking 15mg one day and 13.75mg the next and so on. We prefer, and your physician may suggest that you cut the 2.5mg pills smaller to get these sort of fractions, even if it is imperfect, so as to avoid medication rollercoastering. It may be better tolerated to do the alternate days at higher dosing whereas when you get down to the 2.5mg Zyprexa and less, the fractional pill cutting may be more necessary. Choosing the right medical support will ensure that your prescribing physician can assist with these micro-steps.

Symptoms during antipsychotic tapering

It can be difficult to discern what is withdrawal symptoms, and what is the return of underlying mental health issues. The body neuro-adapts to the dopamine being held back by the drug by making the dopamine receptors typically more sensitive.26 This is called upregulation. When the drug is being removed, more available dopamine is going to flood into the nervous system and then hit these hyper-volatile receptors. This we call a dopamine excess. The same can occur with glutamate, another neurochemical often blocked by antipsychotics. It will take time for these receptors to then downregulate and adapt to the increased presence of dopamine and or glutamate. It is in this readaptation period that all of the challenges typically lie. How much stimulation from the withdrawal is okay, and when do you and your medical oversight person conclude that you have to go back up on the medication to avert a crisis? These are difficult answers but well-deserving of adequate discussion with your doctor.

antipsychotic titrationTypically, subjects as “What religion do I believe? Who is God? What sex am I attracted to? What are my life aspirations? Do I trust authorities like the government or my parents? What is my life purpose?” may have become a bit muted while on antipsychotics. The drug is holding back stimulatory neurochemicals associated with reward and so these things may not be highly important under the influence of the drug. But when you pull back the drug, many of these paved-over emotions are likely going to start becoming highly relevant. And to a large degree, that is natural and necessary to establish these concepts in our growth. But these questions when they were not addressed at age-appropriate markers, can start coming at a flurry that needs to integrate in concert with the speed of the antipsychotic tapering. The tapering should only go at the rate at which these life questions can be wrestled with and integrated, and that is different for each person. It is likely you will get angry about things, you have possibly had trauma that is unresolved come to the forefront. But if it is coming too fast and you are not able to come to terms with these things without spinning out, then you have to slow down to a rate where you can. Please remember that a coach or counselor can provide help in devising workable strategies to begin to self-manage these phenomena.42

It is akin to driving a logging truck down a mountain with switchbacks on an icy road. You have to go light on the accelerator and go slow and be prepared to use your brakes. If you are a skillful driver, you get the truck down the mountain. If you try free-wheeling it, you crash and the result is a disaster. Trying the accelerate around the turns because it feels good can turn out the be the wreck that you would expect driving. There are similar laws of gravity involved in an antipsychotic taper. Go slow so you can get down the mountain — that is the over-arching axiom.

Red Flags of Antipsychotic Withdrawal

antipsychotic taperingThere are specific characteristics of antipsychotic withdrawal that make it particularly needful to have guidance and monitoring throughout the process, and why we recommend inpatient treatment with staff on hand who are familiar with these challenges. Not eating, not sleeping, and perseverating over a certain topic that will not leave your mind are sure clues that you are going into the danger zone. If you are on your second day of not sleeping, this is a signal to discuss with your prescriber about going back up on your medications. If you are really slipping, your doctor may advise a substantially increased dosage, and then help you to work your way back to the last higher tapering dose. For instance, if you are going from 150mg Seroquel to 125mg Seroquel, and you go completely manic, your physician may have to induct 200mg Seroquel or higher and potentially even a benzodiazepine like Ativan to shut you down. After you have slept it off, you can discuss with your physician potentially getting back down to 150mg Seroquel without the benzo over the next week. Please talk to your prescriber about what type of intervention would be needed for you in these crisis moments prior to antipsychotic tapering so that you are not trying to figure it out during the crisis. This is like hitting the brakes to a full stop when the logging truck is sliding off the road in the above analogy. It’s okay to do this. It is like punting in football. It is better to keep yourself on the road than to end up in the hospital and truly having to start over. People lose faith in themselves when their efforts turn into rehospitalization. And, it is not uncommon for people who are ultimately successful to have landed back in the hospital while trying antipsychotic tapering. Let those around you know if you get into a place where you feel you are a danger to yourself or others. Please play it safe and go to the hospital. It is far better than ending up dead or in jail. Hospitalization does not mean you are failing or forever doomed. It just means that maybe a lower dose but not medication free is best for you, or that there are more supports you would need to have in place before you could be medication free, or that you need to extend your withdrawal period longer than you expected. Inpatient treatment in a facility where these phenomena are well-understood is often the overall best for these reasons. This is not an easy path for most. Be understanding of yourself and the time it takes to readapt to lowered medication and what life integration really involves. You probably feel as if you have missed a lot of life and that can be depressing. Be patient. You’ll only be able to grow as fast as you can integrate life’s lessons. You can’t get 20 years’ worth of missed life back in a weekend.

Last antipsychotic medication cuts are likely the most difficult

At the center, we have seen this is true for all medications, but particularly so for antipsychotic tapering. As your doctor guides you through each cut, starting with the first, the symptoms you go through and the time it takes to restabilize are generally a guide for each cut that is to follow. However, restabilizing when you get down to the lower dose cuts may be prolonged, and your prescribing physician would likely want to do the last cuts slower (lower percentage of medication per cut), and likely increase the amount of time between each cut.

Depakote as a bridge for antipsychotic tapering

For a person targeting being antipsychotic medication-free, during the last few medication cuts, you may want to discuss with your doctor using Depakote as a bridge medication to soften the impact of the dopamine-glutamate surge 27 associated with antipsychotic withdrawal. For instance, a person is coming off of 30mg Abilify and is now at 7.5mg. As they drop to 5mg Abilify, inducting 750-1000mg Depakote at nighttime could be the bridge. Your doctor may advise you to continue the Depakote until completely off the medication. After going off the antipsychotic and stable, the person could taper off the Depakote, usually no more than 250mg at a time, and ensure enough time between each cut so as to be stable between the cuts. Speak to your physician about this type of strategy and how it may be helpful. We have used this method a lot at Alternative to Meds Center and found it to be highly successful especially when the last part of the withdrawal is presenting challenges.

Limiting stimulating media

antipsychotic weaningRepetitive music can lift dopamine, a good thing for most, but not great for someone tapering antipsychotics.28 This also includes spending too much time watching TV, phone texting, and social media. Each of these things can be like drips of dopamine building up in a person’s system. And if religious ideation is part of your manic features, limiting reading religious texts may be something for you to consider. Wrestling with notions about God during antipsychotic tapering can be overwhelming. We are not in any way discouraging or denouncing religious pursuit, just during an antipsychotic withdrawal, as it can cause problems. Getting outside, walking, observing your surroundings, and physical activity are the types of grounding that support this withdrawal process.

Injectable antipsychotics and tapering

If you are on an injectable antipsychotic, your physician will have to convert you over to an oral equivalent for antipsychotic tapering. Generally, at Alternative to Meds Center, we start the oral at a lower dose prior to when the injectable will expire. For instance, a person is taking an Invega shot that lasts a month. On week three, we may start 1mg Risperdal, and then on week 4, go up to the full about of oral, possibly 3mg depending on the situation. It may also look like starting week three with Zyprexa at 5mg, and then when the Invega shot expires, going up to possibly 15mg Zyprexa depending again on the situation. The oral type of medication choice and the dosing level are truly going to be on a case-by-case basis and your doctor needs to help you decide and choose these variables. But to taper, your physician will almost certainly need you to be converted to an oral form.

Antipsychotic Alternatives

We have pages on our site that address antipsychotic alternatives that you can discuss with your doctor for use during the tapering process. Of particular interest might be our orthomolecular treatments, lab testing, equine-assisted therapy, and many other therapies. We strongly recommend you and your physician review these pages. Quick links are Antipsychotic Alternatives, Zyprexa alternatives, Risperdal alternatives, and Abilify alternatives. You can also go to the top of any page on the Alternative to Meds website desktop version and type [your drug] plus the word “alternative” in the search bar and find our page covering the medication. As shown below:

atmc website search

Understanding the History of Antipsychotic Medications

To help better understand antipsychotic medication, one can look back at the development of this class of drugs. As early as the 1930s, antihistamine drugs were being developed, some of which were found to have a sedative effect.29 These were considered useful to calm a patient before surgery. In 1952, chlorpromazine came to be used as one of these “major tranquilizers.” 30 The term “antipsychotic” did not come about until later in the 1960s when such drugs became more widely used for calming patients suffering from psychotic or aggressive symptoms.2

Drugs have become substituted for other potential methods of help, and sadly, the psychiatric profession for many has become a willing proponent of “the quick fix” rather than seeking to diligently scout for and correct actual reasons for unwanted symptoms and conditions.31 And while antipsychotics do have an impressive short-term reduction in symptoms, there is substantial evidence to support that people can be injured by these medications and that those who treated symptoms without antipsychotics did better in long-term studies.12.13 We are not extending that to say ALL persons, which we feel would be irresponsible to state. However, it is clear that some candidates, according to studies including our own, fare better by avoiding a lifetime of antipsychotic drugging 32 especially with adequate support during antipsychotic tapering such as cognitive counseling and correct nutrition.

Finding Better Methods of Help

Other methods of preventing patients from exhibiting aggressive behavior, psychosis, mania, etc. have also arisen over the centuries. Many of these have degraded the patient by inflicting violence, restraints, and isolation, in a sort of desperate or even punitive fashion. One is reminded of the way horse trainers of the past sought to control wild behavior with restraints, or just beating their charges into submission.

Instead, one can seek to understand the reasons for aberrant or unwanted conditions so that these can be addressed. For example, a horse with an injured back will throw a rider not from spite, but from a protective self-preservation instinct. One could beat the horse into an apathetic resignation to obey, or one could do a medical check and would find the injury so it could be treated.

In a similar way, a person who exhibits schizophrenic, aggressive, manic, or other symptoms and who is eating a diet devoid of fruits and vegetables, but full of stimulants, sugar, caffeine, etc., may feel completely different with changes and improvements to the diet. Their symptoms may improve or disappear altogether, without needing any medication whatsoever. Testing can help to determine if such correctable factors are present.

A study out of the UK found that out of 102 subjects suffering from symptoms of schizophrenia, not a single one had a diet that met even the minimum standards of proper nutrition.6 And, another UK study showed the dramatic impact that changes to the diet had in eliminating symptoms of schizophrenia.7

Diet and nutrition are some of the foundations of effective treatment useful for mitigating and eliminating unwanted symptoms, and lessening the need for medication.

Most Common Reasons for Prescribing Antipsychotics

A disturbing study published in the British Medical Journal in 2015 tracking over 33,000 patients showed that about 71% of antipsychotic prescriptions were written without any evidence of severe mental illness, but for behavior management issues, as in elderly patients with dementia or young people with learning disabilities.33

Like so many other drugs, the list of off-label uses for antipsychotics has continued to expand and includes such conditions as:34

  • Eating disorders
  • Depression
  • Insomnia
  • Bipolar disorder
  • Learning disabilities
  • OCD
  • Aggression in dementia patients (despite black box warnings)
  • PTSD
  • Personality disorder
  • Addiction treatment
  • Tourette’s syndrome
  • Anxiety
  • In children with autism, ADHD, depression, or other “mental health” reasons
  • and many other conditions.

The Case For Antipsychotic Weaning

The sobering truth is that despite the rising number of prescriptions for these heavy medications, proof of long-term efficacy ranges from sparse to non-existent.12 Many physicians have expressed legitimate concerns, especially in light of the fact that clinical drug trials typically last only a few weeks. Additionally, other studies show poor long-term efficacy with much-documented evidence of substantial harm from long-term use of antipsychotics.3

These are some of the reasons many caregivers consider antipsychotic tapering to be a wise health choice.4

Managing Antipsychotic Titration

Harmful effects such as cardiac adverse events, movement disorders that can be irreversible, and other undesirable outcomes 17 make a substantial case for antipsychotic titration in order to prevent such deteriorating health effects. But it is recommended that antipsychotic weaning be done under close observation and monitoring by specialists in this field.5

For various reasons, nutrition, a strategic diet, and providing a safe and comfortable environment all play substantial roles in helping a person to extricate themselves from antipsychotic medication comfortably and safely. The importance of each one of these subjects cannot be overstated. Please read our alternatives pages for more information relating to why such elements are so crucial to a successful antipsychotic tapering outcome.

Downregulation and Upregulation While Tapering Antipsychotics

downregulation dopamineReceptor upregulation is one aspect of stopping an antipsychotic medication that needs to be understood well to manage correctly. In the case of antipsychotic or mood-stabilizing medication, these drugs are designed to hold back dopamine or glutamate.36 One consequence is to dampen the ability of dopamine receptors to transmit the dopamine-driven perception of “reward” 37 or glutamate to produce stimulation.35

As a response to drug-induced diminished availability of stimulatory neurochemicals, the body upregulates the receptors for those neurochemicals. This means building up new dopamine (D2) or glutamate (NMDA) receptors or making the ones that are there more sensitive, in an attempt to counter the muting effects of the drug.26,38 This is in part why antipsychotics become less effective over time. As the body begins to upregulate, seeking balance, the effects of a small amount of dopamine or glutamate are greatly augmented at the receptors. This change needs to be carefully managed to prevent the shockwave as the levels of available dopamine and/or glutamate begin to substantially increase when the dosage is lessened. This reaction, if left unchecked, can result in a “relapse” of mania/psychosis 39 and can land a person back in the hospital. But if understood, and managed well, and given enough time,40 down-regulation and normalization of these receptors can potentially occur. The center uses holistic methods during antipsychotic tapering, including neurotransmitter rehabilitation, supplementation, IV treatments, and many other therapeutics to manage these challenges when needed.

Contact Alternative to Meds Center

If you or a loved one is considering antipsychotic titration, Alternative to Meds Center can help. The center specializes in prescription medication tapering within the context of an overall health improvement plan.

Please contact the center directly for more detailed information on how the antipsychotic tapering programs and antipsychotic titration methods used can make the journey a safe and comfortable one for you or your loved one’s success.

1. Moore TJ, Furberg CD. The Harms of Antipsychotic Drugs: Evidence from Key Studies. Drug Saf. 2017 Jan;40(1):3-14. doi: 10.1007/s40264-016-0475-0. PMID: 27864791. [cited 2022 July 21]

2. Haddad P, Kirk R, Green R, “Chlorpromazine, the first antipsychotic medication: history, controversy, legacy.” BAP (British Association for Pharmacology) 2016 Oct 31 [cited 2022 July 21]

3. Maglione M, Maher AR, Hu J, et al., “Results – Off-Label Use of Atypical Antipsychotics: An Update.” Book published by the Agency for Health Research and Quality [INTERNET] 2011 Sep [cited 2022 July 21]

4. Ruben E, “Long-Term Effects of Antipsychotics,” Psychology Today [INTERNET] 2017 Nov 15 [cited 2022 July 21]

5. Keks N, Schwartz D, Hope J, “Stopping and switching antipsychotic drugs.” The Australian Prescriber [INTERNET] 2019 Oct 1 [cited 2022 July 21]

6. Kraft B, Westman E, “Schizophrenia, gluten, and low-carbohydrate diets – a case report and review of the literature.” Nutrition and Metabolism [INTERNET] 2009 Feb 26 [cited 2022 July 21]

7. Strassnig M, Brar JS, Ganguli R, “Dietary Intake of patients with Schizophrenia.” Psychiatry Journal [INTERNET] 2005 Feb 2 [cited 2022 July 21]

8. Horowitz MA, Murray RM, Taylor D. Tapering Antipsychotic Treatment. JAMA Psychiatry. Published online August 05, 2020. doi:10.1001/jamapsychiatry.2020.2166 [cited 2022 July 21]

9. The Guardian At last, a promising alternative to antipsychotics for schizophrenia by Daniel Freeman and Jason Freeman Fri 7 Mar 2014 [cited 2022 July 21]

10. The Case Against Antipsychotics A Review of Their Long-term Effects Robert Whitaker July 2016 [cited 2022 July 21]

11. Wunderink, L. Recovery in remitted first-episode psychosis at 7 years of follow-up of anearly dose reduction/discontinuation of maintenance treatment strategy. JAMA Psychiatry, 70 (2013): 913–20 [cited 2022 July 21]

12. Stip, E. “Happy birthday neuroleptics!” Eur Psychiatry 17 (2002):115-9. [cited 2022 July 21]

13. Harrow, M. “Factors involved in outcome and recovery in schizophrenia patients not onantipsychotic medications.” J Nerv Ment Dis 195 (2007):406-414. [cited 2022 July 21]

14. Gleeson, J. “A randomized controlled trial of relapse prevention therapy for first-episodepsychosis patients.” Schizophrenia Bulletin 39 (2013):436-48. [cited 2022 July 21]

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Originally Published Feb 8, 2021 by Diane Ridaeus

This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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