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Lybalvi Tapering Guidelines, Timeline and Natural Mental Health

Last Updated on October 20, 2022 by Diane Ridaeus

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

Lybalvi tapering methods are not well known by a majority of medical practitioners and case studies are few as Lybalvi is a relatively new product. Even with much older drugs, relatively little time is spent on learning about medication tapering in medical school. Done incorrectly, which is common, the default reaction is to mistake tapering failure as a ‘relapse’ — a bit like blaming the oven for a failed souffle.

Alternative to Meds has spent almost 2 decades refining the mechanics of successful antipsychotic tapering and how to best assure success. Perhaps more importantly, our staff have a profound knowledge of what strategies and raw materials are available to support natural healing and wellness throughout the process, and well after, along one’s journey to natural mental health.

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Alternative to Meds is a leading inpatient facility specializing in medication tapering and restoring natural mental health, which we believe is especially crucial after imperfect drug-based therapy. Our published evidence clearly shows our consistent success with patients from all over the world deeply struggling with a wide variety of personal circumstances. A roster of over 40 professionals comprising physicians, holistic psychiatrists, and licensed caregivers is here to help you with your Lybalvi tapering program. We take pride in our excellent patient care and are deeply devoted to helping others as we ourselves were helped.

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Guidelines and Timeline for Lybalvi Tapering

There can be no cookie-cutter timeline for Lybalvi tapering. Each person has a unique profile, history, and set of circumstances requiring an individual tapering program to be designed for success. And, Lybalvi has some characteristics that require some pharma-expertise for a smooth taper.

There are helpful tapering guidelines to follow that apply to antipsychotics. These are the broad brush strokes that should be incorporated into the plan. We urge you to discuss these guidelines with your prescriber so that there is a shared understanding of what to do, when to do it, and what to expect. We realize that inpatient care may not be accessible to everyone, but at the very least please seek out a physician to help you who is familiar with the difficulties of medication tapering, especially for Lybalvi tapering, and can help you navigate safely through the process.

Guidelines for Lybalvi Tapering can include:
  • lybalvi tapering guidelinesPerhaps more than other classes of drugs, recognize that antipsychotic tapering done incorrectly is bound to go off the rails. Relax. Aim to go slowly. Realize this is not a sprint. Antipsychotic medication tapering is a SLOW and GRADUAL process.1
  • A prerequisite for reducing the dosage, even by a small increment, is that you must first be sleeping well, eating well, and not in emotional distress, or experiencing erratic behavior at the outset. This is profoundly important. At Alternative to Meds, the pre-tapering program is the first preliminary focus. These safeguards are a major determinant of success.2,3
  • The same principles apply after a step-down, to let any changes settle out before making new adjustments.
  • Begin with lab testing to discover and begin to correct nutritional deficiencies as well as the presence of toxins and other anomalies that may interfere with the taper. This is the specialty of Alternative to Meds and is done at the beginning and continues with a corrected diet and needed supplementation throughout, even after the tapering process is complete. More details are given below on what should be included in the overall plan.
  • If inpatient Lybalvi tapering is not accessible to you, at the very least we urge you to find a practitioner who is licensed to prescribe who you trust, and who is sympathetic to your desired goal. This is especially important when outpatient treatment is being considered, as the complexities of tapering off a drug like Lybalvi may exceed what can be provided to you in an outpatient setting.
  • Put in place what is called a Ulysses contract for safety. This is a voluntary pact that you put in writing and sign, agreeing that if you become unable to follow directions and medical guidance, you agree to hospitalization or the police may have to become involved. This empowers you over your own safety in the event of such a crisis and helps your caregivers to act in your best interests. You and your care professionals or a trusted family member can make a strong team with such an agreement in place.4
  • A number of things should be avoided as they may contribute to excessive surges of dopamine that need to be managed very well while tapering Lybalvi. Such things to avoid may include the recreational use of drugs including marijuana and alcohol, stimulants of any kind including caffeine, excess sugar intake, repetitive or loud music, overstimulating media, television, or reading material, activities involving religious or political fervor, and situations or people that are sources of irritation, stress, or pressures.5,6
  • Taking time off work to navigate Lybalvi tapering may be a helpful strategy, especially if doing so sequesters you from environmental stressors. You will need adequate time for physical rest.
  • Consider arranging therapeutic options to help including physical exercise, CBT, relaxation techniques, and other strategies that can be researched more fully on our treatment and services pages.9
  • A modified diet can provide much support during your Lybalvi taper, as well as supplementation to help the CNS and gut transition comfortably throughout the process. More details on diet recommendations and microbiome support follow below.10
  • Enlist the help of people you trust for support. Let these individuals know your plans, and if they are willing to help, ask for assistance with preparing meals, shopping, errands, chores, and responsibilities that you may desire help with.
  • Work as a team with your prescriber to work out a tapering plan tailored to your needs and tolerance level.
  • Keeping a daily log of what you experience can be helpful to the design and evolution of the taper. If reactions are harsh or intolerable, tolerably mild, or non-existent, these pieces of information can inform accurate dosage adjustments throughout the tapering progress.
  • As mentioned earlier, especially important is to let your prescribing doctor know about sudden changes such as suddenly not eating or sleeping or other changes. These can be road signs showing that changes in treatment may need to be made. If sleep becomes an issue, speak to your prescriber about drug-free sleeping aids to overcome the problem and keep your Lybalvi taper progressing.
  • Usually having the smallest dosage of pills to hand is useful for calculating incremental adjustments. However, in the case of a compounded drug such as Lybalvi, it may be more practical to transition to an equivalent dose of Zyprexa (olanzapine) as a first step, and ensure a point of stability is achieved before beginning the taper.
  • In the case of multiple medications, be sure to inform your medical team. A sequence of which drug to eliminate first can be worked out for optimum comfort and safety.
  • More information on specific tapering protocols can be found on our medication tapering pages.
  • We must emphasize the importance of not trying this on your own. Either seek inpatient care or find a practitioner to discuss your health goals with and work out a supervised Lybalvi taper program together.

What is Lybalvi Prescribed to Treat?

Lybalvi is classed as a novel antipsychotic medication and is FDA-approved to treat schizophrenia and Bipolar 1 conditions.7

There can be various off-label uses for antipsychotics such as PTSD conditions, anxiety, and minor and major depression, as clinical research shows. Often a diagnosis is not determined fully before a prescription drug is offered.8

Modify the Diet, Important Supplements Info

Diet can be a crucial factor in recovering one`s natural mental health and recovering during and after completing Lybalvi tapering. While drug therapy has its place in treatment, drugs are intended to mask symptoms, not fix them. Diet is a powerful therapy for neurotransmitter health, gut health, and CNS optimum function.

Foods that support these vital operations are important to include in the diet. Those foods that disrupt or impede health and healing should be avoided. In general, focus on unprocessed, chemical-free food. Avoid sugar, caffeine, refined carbs, and artificial sweeteners.

Include organic (where possible) green leafy vegetables, fresh produce, adequate portions of seafood, grass-fed beef, and other clean sources of protein. For gut health, include fermented foods such as yogurt and sauerkraut. Use the Mediterranean diet as a guide. Aim for 5 or 6 small meal portions over the day to avoid taxing the digestive system and to maintain even blood sugar levels.

Supplement the diet as informed by lab testing for specific deficits discovered. Common vitamin and mineral deficiencies that impact mental health include vitamins C, D, and B vitamins, magnesium, selenium, zinc, and many others that are available in supplement form. According to the Journal of World Psychiatry, vitamin B9 or folate, found in liver, beans, peanuts, and dark green leafy vegetables, is one of the most common deficiencies implicated in mental health disorders such as schizophrenia and major depression. Omega-3 fatty acids should also be included for improvements in natural mental health and physical health. Omega-3s surround each cell and are essential for innumerable vital functions in the entire body. Choose foods high in omega-3s such as salmon and other fatty fish and seafood, nuts, seeds, cod liver oil, and plant oils.13-15

Help for Insomnia during Lybalvi Tapering

Adequate, quality sleep is essential for mental and physical well-being. Some of the most effective strategies for improved sleep might take place during daylight hours. Get out for a walk in the fresh air and get sunshine on your skin regularly. Practice good eating habits. Avoid daytime naps to get your sleep routine under control. Avoid excessive exercise or stimulating media close to bedtime. Gentle relaxation exercises such as Qi Gong and Tai Chi and practicing mindfulness meditation, or a warm bath are good, especially before sleep. Caffeine should be avoided for some hours before bedtime. Research has shown that the half-life of caffeine extends with age, and may remain active in the system for far longer than one might realize. Safest is to avoid caffeine altogether, especially while tapering Lybalvi.

help for insomniaMany herbal and natural remedies have been shown effective in clinical studies for helping insomnia. Some of these include the amino acids L-arginine, L-lysine, and melatonin, as well as extracts of kava, or passionflower. Piper methysticum is another herbal remedy that has an anxiolytic or relaxation effect, but without the side effects associated with prescription anxiolytics.

Prepare the sleeping area so that once the sun goes down, the other strategies you put in place can provide their benefits. Changes can include revamping the sleeping area itself. Utilize soundproofing and comfortable earplugs if there are external noises you need to block out. Consider black-out curtains to minimize light to maximize natural melatonin production. Keep the bedroom well-ventilated and at a comfortable temperature. Get the electronics and blue-light devices entirely out of the bedroom, and turn them off completely for a period before retiring. Try sleeping solo if your partner`s snoring or movements are intrusive. A comfortable nontoxic mattress, pillow, and proper weight sheets can all be part of a vastly improved sleeping environment. Eat light in the evening and avoid excessive hydration some hours before going to bed. Some find melatonin supplements helpful. Valerian extract or chamomile tea are also popular natural sleep aids. After 3 days of taking milk and honey, patients experienced significant improvements to sleep in a clinical trial published in the Journal of Clinical Nutrition.

Though all this may sound like a job in itself, once you get a routine down that works well, it can become second nature, improve not only sleep but the overall quality of life, and can be quite pleasurable to practice every single day even after completing your Lybalvi taper. 3,9,6,18,20

The Importance of Cleansing Toxins for Lybalvi Tapering

Research shows that toxic exposures are often overlooked when searching for root causes of psychiatric disorders.11

At Alternative to Meds Center, clearing the body`s toxic load is a prime focus. The use of dry sauna and gentle chelation and other neurotoxin removal strategies successfully purge toxins from the body. The process is non-invasive, and gentle, and has produced consistently positive results for our clients who experience improvements in energy, mood, quality of sleep, and many other positive changes as part of their Lybalvi tapering program.

Correcting Antipsychotic-Induced Dopamine Supersensitivity

neurotoxin removalAntipsychotic medications have several typical outcomes after regular use. One of these is called drug-induced dopamine supersensitivity. Dopamine supersensitivity can lead to psychosis or other unwanted symptoms. Why this occurs is not completely understood, but is thought likely as a response to the restriction of dopamine transmission associated with antipsychotic medications. Dopamine supersensitivity occurs in roughly 70% of treatment-resistive schizophrenia patients according to a review published in the Journal of Psychotherapy and Psychosomatics. Dopamine is the reward chemical associated with pleasure. This is an important feature to recognize in the context of Lybalvi tapering. As dopamine transmission naturally increases with dosage reduction, the person may welcome this change with enthusiasm and want to continue reducing the dosage faster than can easily be managed. This is a case where there definitely can be “too much of a good thing.” Mania and psychotic symptoms can result and can be disastrous to the progression of the taper. Alternative to Meds Center has a comprehensive program of neurotransmitter rehabilitation that slowly corrects this phenomenon, and allows a taper to progress at a steady and manageable pace. Dopamine supersensitivity is one of the main reasons that the Ulysses contract is also in place, to navigate the taper process on an even keel during dosage reductions and in most cases, to be able to safely and gradually eliminate the use of medication entirely.5

Focus on Natural Mental Health at Alternative to Meds Center

resources at alternative to meds center sedona azAlternative to Meds Center has helped thousands of clients to reduce or completely eliminate antipsychotic medications safely, gently, and gradually. The process takes time and is not rapid. Sometimes rapid cessation may be needed for medical reasons, and we are not equipped to provide rapid cessation. But for the majority of clients seeking help with us, we can provide a safe and gradual Lybalvi tapering program that safely and comfortably navigates toward the client`s end goal.

Natural mental health is attainable using a comprehensive approach, and you can view many of our adjunctive therapies and strategies on our services overview pages. You will find out about Orthomolecular medicine, Equine-assisted therapy, therapeutic spa services, IV treatments, colon hydrotherapy, CBT and other counseling services, neurotoxin removal, acupuncture services, co-occurring disorders programs, neurotransmitter rehabilitation, peer support programs, and much, much more. We invite you to study these pages closely and understand the many pieces of the entire picture that we provide our clients in our beautiful, nontoxic, and compassionate facility.

We are here to help. Please contact us for more detailed information, including insurance coverage, length of stay, and other items that may be of interest to you or a loved one looking for safe and effective Lybalvi tapering help.

1. Horowitz MA, Jauhar S, Natesan S, Murray RM, Taylor D. A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse. Schizophr Bull. 2021 Jul 8;47(4):1116-1129. doi: 10.1093/schbul/sbab017. Erratum in: Schizophr Bull. 2022 Jun 21;: PMID: 33754644; PMCID: PMC8266572. [cited 2022 Oct 20]

2. Jeynes KD, Gibson EL. The importance of nutrition in aiding recovery from substance use disorders: A review. Drug Alcohol Depend. 2017 Oct 1;179:229-239. doi: 10.1016/j.drugalcdep.2017.07.006. Epub 2017 Aug 4. PMID: 28806640. [cited 2022 Oct 20]

3. Scott AJ, Webb TL, Martyn-St James M, Rowse G, Weich S. Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Med Rev. 2021 Dec;60:101556. doi: 10.1016/j.smrv.2021.101556. Epub 2021 Sep 23. PMID: 34607184; PMCID: PMC8651630. [cited 2022 Oct 20]

4. Oxford Reference, Ulysses Contract [cited 2022 Oct 20]

5. Chouinard G, Samaha AN, Chouinard VA, Peretti CS, Kanahara N, Takase M, Iyo M. Antipsychotic-Induced Dopamine Supersensitivity Psychosis: Pharmacology, Criteria, and Therapy. Psychother Psychosom. 2017;86(4):189-219. doi: 10.1159/000477313. Epub 2017 Jun 24. PMID: 28647739. [cited 2022 Oct 20]

6. Rada P, Avena NM, Hoebel BG. Daily bingeing on sugar repeatedly releases dopamine in the accumbens shell. Neuroscience. 2005;134(3):737-44. doi: 10.1016/j.neuroscience.2005.04.043. PMID: 15987666. [cited 2022 Oct 20]

7. FDA label Lybalvi (olanzapine and samidorphan) tablets, for oral use (approval 2021) [cited 2022 Oct 20]

8. Leslie DL, Mohamed S, Rosenheck RA. Off-label use of antipsychotic medications in the department of Veterans Affairs health care system. Psychiatr Serv. 2009 Sep;60(9):1175-81. doi: 10.1176/ps.2009.60.9.1175. PMID: 19723731. [cited 2022 Oct 20]

9. Toussaint L, Nguyen QA, Roettger C, Dixon K, Offenbächer M, Kohls N, Hirsch J, Sirois F. Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation. Evid Based Complement Alternat Med. 2021 Jul 2;2021:5924040. doi: 10.1155/2021/5924040. PMID: 34306146; PMCID: PMC8272667. [cited 2022 Oct 20]

10. Clapp M, Aurora N, Herrera L, Bhatia M, Wilen E, Wakefield S. Gut microbiota’s effect on mental health: The gut-brain axis. Clin Pract. 2017 Sep 15;7(4):987. doi: 10.4081/cp.2017.987. PMID: 29071061; PMCID: PMC5641835. [cited 2022 Oct 20]

11. Genuis SJ. Toxic causes of mental illness are overlooked. Neurotoxicology. 2008 Nov;29(6):1147-9. doi: 10.1016/j.neuro.2008.06.005. Epub 2008 Jun 24. PMID: 18621076. [cited 2022 Oct 20]

12. Głąbska D, Guzek D, Groele B, Gutkowska K. Fruit and Vegetable Intake and Mental Health in Adults: A Systematic Review. Nutrients. 2020 Jan 1;12(1):115. doi: 10.3390/nu12010115. PMID: 31906271; PMCID: PMC7019743. [cited 2022 Oct 20]

13. Firth J, Teasdale SB, Allott K, Siskind D, Marx W, Cotter J, Veronese N, Schuch F, Smith L, Solmi M, Carvalho AF, Vancampfort D, Berk M, Stubbs B, Sarris J. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta-analyses of randomized controlled trials. World Psychiatry. 2019 Oct;18(3):308-324. doi: 10.1002/wps.20672. PMID: 31496103; PMCID: PMC6732706. [cited 2022 Oct 20]

14. Lange KW, Global Health Journal, Omega-3 Fatty Acids and Mental health, Volume 4 issue 1, March 2020, pages 18-30 [cited 2022 Oct 20]

15. NIH Omega-3 Fatty Acids Fact Sheet, published July 18 2022 [cited 2022 Oct 20]

16. Santos MAD, Conceição APD, Ferretti-Rebustini REL, Ciol MA, Heithkemper MM, Cruz DALMD. Non-pharmacological interventions for sleep and quality of life: a randomized pilot study. Rev Lat Am Enfermagem. 2018 Nov 14;26:e3079. doi: 10.1590/1518-8345.2598.3079. PMID: 30462790; PMCID: PMC6248705. [cited 2022 Oct 20]

17. Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH. The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep Med Rev. 2015 Aug;22:23-36. doi: 10.1016/j.smrv.2014.10.001. Epub 2014 Oct 16. PMID: 25454674; PMCID: PMC4400203. [cited 2022 Oct 20]

18. Lakhan SE, Vieira KF. Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutr J. 2010 Oct 7;9:42. doi: 10.1186/1475-2891-9-42. PMID: 20929532; PMCID: PMC2959081. [cited 2022 Oct 20]

19. Nakata Y, Kanahara N, Iyo M. Dopamine supersensitivity psychosis in schizophrenia: Concepts and implications in clinical practice. J Psychopharmacol. 2017 Dec;31(12):1511-1518. doi: 10.1177/0269881117728428. Epub 2017 Sep 19. PMID: 28925317. [cited 2022 Oct 20]

20. Fakhr-Movahedi A, Mirmohammadkhani M, Ramezani H. Effect of milk-honey mixture on the sleep quality of coronary patients: A clinical trial study. Clin Nutr ESPEN. 2018 Dec;28:132-135. doi: 10.1016/j.clnesp.2018.08.015. Epub 2018 Sep 10. PMID: 30390870. [cited 2022 Oct 20]

Originally Published October 21, 2022 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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Lybalvi Tapering Guidelines, Timeline and Natural Mental Health
Medical Disclaimer:
Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.

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