Abruptly stopping psychiatric medications can lead to unwanted side effects, but by working with a professional, you can get off your medication safely.
Many people have a dark view of medication withdrawal. They may have read or heard scary stories about uncomfortable side effects or come across startling headlines related to the dangers of discontinuing various drugs.
But it is possible to safely discontinue any medication, including psychiatric ones.
You can try some strategies, such as discussing your plan with a mental health professional, to help manage any unwanted side effects.
Stop your medication for the right reasons
“Timing is everything,” according to Dr. Michael Banov, medical director of Psych Atlanta in Georgia and author of the book “Taking antidepressants: Your comprehensive guide to starting, staying on, and safely quitting.” Just because someone wants to stop taking their medication doesn’t mean they’re actually ready, Banov says.
There are several reasons people may decide to stop taking their medication. Banov says that they might:
- feel better and think they don’t need treatment anymore
- feel pressure from family and friends
- read something about a medication that scares them
- be afraid the medication will affect their personality
Sometimes people want to stop after making major changes in their lives, such as getting a divorce, moving, or changing jobs. But, according to Dr. Banov, this could be “the worst time” to stop.
Additionally, some mental health conditions require taking medication indefinitely.
How long a person takes a psychotropic medication depends on their condition, their response to treatment, and their personal situation, according to Dr. Ross Baldessarini, professor of psychiatry and neuroscience at Harvard Medical School and director of the psychopharmacology program at the McLean Division of Massachusetts General Hospital.
For instance, some people living with depression may take an antidepressant for 9 months to a year and see an improvement in symptoms. Others may need 2 to 5 years, and some might be “so genetically loaded for depression that they may need to stay on them indefinitely,” Dr. Banov says.
Don’t stop your medication abruptly
“Stopping abruptly is especially dangerous,” Baldessarini explains.
Depending on the medication, stopping abruptly or “cold turkey” can cause a variety of distressing reactions, such as:
- mild to moderate early discontinuation symptoms with antidepressants
- rapid return of the symptoms being treated
- potentially life threatening seizures with a high dose of benzodiazepines
A mental health professional may suggest a strategic plan where you taper or reduce the dose slowly based on your health and how long you’ve been on the medication.
Consider if you’ve received a thorough assessment
A comprehensive assessment is often required prior to stopping a medication.
Among other indicators, a doctor will likely consider “your current clinical condition and life circumstances, your past clinical history, reasons to consider stopping versus continuing treatment, side effects and the presence of stressors and supports, as well as the dose and the length of time you’ve been taking a medication,” Baldessarini says.
You and your doctor will discuss these indicators along with how they plan to discontinue the drug.
There is no firm, established rules for discontinuing psychiatric medications. But one major rule of thumb is gradually reducing the dosage whenever possible.
“We still don’t know for sure how long is long enough to reduce doses safely,” Baldessarini says. “Still, the slower the dose reduction, the greater the chances of preventing the return of symptoms of the condition for which treatment was started.”
“Very slow discontinuation is particularly important when a person has been taking high doses of a medication over a long time,” he adds.
Discontinuing multiple medications is like peeling an onion, Baldessarini says. He states that he usually leaves the most essential medication for last. Then reduces doses of one or more optional or supplemental medications slowly and gradually.
Stopping all medications at once isn’t safe.
Dealing with small, final doses is tricky when dropping from a low dose to nothing. Doctors may decrease the dose to one pill a day or one every two days or split the pill in half, he says.
Pill-splitting can be helpful. You can find pill splitters at your local pharmacy.
Don’t expect stopping medication to be a quick process
Gradually and safely discontinuing a medication doesn’t happen in a few days.
“Some medications, including antidepressants, may not show benefits for several weeks when they’re started,” Banov says. “It seems best to avoid discontinuing faster than over several weeks.”
If you’ve been taking a medication for years, Banov recommends reducing the dose, stepwise, over at least 6 weeks or more. While this may be a conservative practice, he says that “sometimes you might not detect a change for a few weeks, but later, problems may arise.”
Discontinuation symptoms usually occur within days of stopping a medication, but recurrence of the condition being treated can be delayed for weeks after initially feeling well.
In bipolar disorder, Baldessarini and his research team found years ago that the rate of discontinuing ongoing treatment determines the risk and timing of recurrence. Initially, their research found that the chance for recurrence after discontinuing lithium was reduced by one-half or more when slow dose reduction over several weeks was compared to abrupt discontinuation.
Gradual discontinuation of antipsychotic drugs also may result in a lower chance of recurrence in schizophrenia, according to a 2019 study
In a 2010 study, Baldessarini and his colleagues found that stopping an antidepressant abruptly or only over several days resulted in a much greater chance for depression or panic than gradual discontinuation over 2 weeks or more.
If you’re switching from one medication to another, you can be more aggressive than when discontinuing altogether, Banov says. You may be switching medications because of ineffectiveness or side effects, and a new medication is commonly introduced as the previous one is gradually removed.
This way, he says, there’s little concern about withdrawal symptoms or recurrence, assuming that both medications have similar effects or belong to the same class.
If you’re switching classes, it’s usual to “cross-taper” the medications, meaning you take both medications for a while, and then the dose of one is reduced while the other is increased.
Because people may not experience symptoms for weeks or even months after stopping a medication, Baldessarini notes that closely monitoring during and following the discontinuation of the medication may be required for several months.
Your doctor may prescribe another medication
If you’re taking a relatively short-acting antidepressant, such as paroxetine (Paxil) or venlafaxine (Effexor), and you experience bothersome symptoms, your doctor may recommend a long-acting antidepressant, such as fluoxetine (Prozac), for a time.
The long-acting medication may then be gradually discontinued to limit the chance of withdrawal symptoms.
Baldessarini says, “The principal byproduct of the metabolism of fluoxetine has an extraordinarily long half-life or duration of action and can take weeks to leave your system.”
This method isn’t well established for discontinuing other psychotropic medications, including antipsychotics and mood stabilizers, so the best option might be to “discontinue such medications gradually, with close clinical monitoring by your doctor,” Baldessarini says.
See a qualified mental health professional
Discontinuing psychotropic medications is a process that requires a comprehensive assessment and collaboration between you and a mental health professional.
How do you know if the doctor is qualified?
First, try to make sure they have experience or specialty training and certification to treat your condition. Banov recommends asking the following questions:
- Are you familiar with various options for treating me and for discontinuing treatment?
- Do you feel comfortable treating me during discontinuation?
- About how often have you treated this condition and discontinued the medicines I’m taking?
If you tell your doctor that you’d like to stop taking a medication, and they agree without question and without doing a thorough assessment, consider getting a second opinion, Banov says. Again, the decision to stop a medication isn’t made lightly.
If you haven’t started a medication yet, Baldessarini encourages you to ask the following questions:
- Can you give me an idea of how long I’ll be taking the medication?
- What are the common side effects?
- What is the cost?
- When and how do I come off the medication?
“A major problem with taking and stopping a psychotropic medication is that many people are excessively passive about taking advice,” Baldessarini says. “We tend to view doctors as ‘all-knowing.’ But doctors can’t adequately do their jobs if you don’t ask questions and aren’t active in the conduct of your own treatment.”
Additionally, the following strategies may also help when it comes time to discontinue a psychiatric medication:
- Lead a healthy lifestyle: Baldessarini and Banov underscore the importance of engaging in healthy habits, including a regular sleep and activity schedule and a nutritious diet. Attempts to discontinue a psychotropic medication aren’t likely to go well if you’re under stress, overworked and sleep-deprived.
- Participate in regular physical activity: Exercise can provide a significant antidepressant effect, according to a 2021 review. “Mild to moderate depression may do about as well with exercise or talking as with medication,” Banov says. Exercise also has other benefits, including helping you cope with stress and ease anxiety. Try to pick physical activities you genuinely enjoy.
- Seek psychotherapy: Baldessarini and Banov also stress the importance of participating in counseling or psychotherapy, regardless of your mental health condition. “Many research studies have demonstrated the value of such approaches, alone or in combination with medications, depending on the nature and severity of your condition,” Baldessarini says.
- Be flexible: You may attempt to go through the discontinuation process with your doctor, but still might not be able to stop your medication. “This is no badge of shame,” Banov says. “The goal isn’t to be medication-free but to be well.”
There may be several reasons for stopping a medication, and these will be unique to you.
You may be feeling better, or the side effects are so bothersome that you want to stop or discontinue your medications. Concerns about the potential stigma of taking psychiatric medications or fear of becoming dependent on them may also be reasons you might want to stop.
Baldessarini and Banov view medication as one of many treatments for mental health conditions, and each medication is tailored to your unique needs.
If you want to stop taking your medication, consider discussing this decision with a mental health professional. With the right support, you can safely stop taking your medication and find the right treatment plan for you.
Last medically reviewed on October 10, 2022
- Baldessarini RJ. (2016). Personal interview.
- Baldessarini RJ, et al. (2013). Chapter 38: Latency, discontinuation, and re-use of lithium treatment. Lithium in Neuropsychiatry: The Comprehensive Guide. London: Taylor & Francis.
- Baldessarini RJ, et al. (2010). Illness risk following rapid versus gradual discontinuation of antidepressants.
- Banov MD. (2016). Personal interview.
- Moncrieff J, et al. (2019). Randomised controlled trial of gradual antipsychotic reduction and discontinuation in people with schizophrenia and related disorders: The RADAR trial (research into antipsychotic discontinuation and reduction).
- Viguera AC, et al. (1997). Clinical risk following abrupt and gradual withdrawal of maintenance neuroleptic treatment.
- Xie Y, et al. (2021). The effects and mechanisms of exercise on the treatment of depression.