Suggestions

From doctors and peers – please do your own research!

• Advance Care Directives can be used to predict and minimise harm caused by withdrawal (eg preventing travel outside of the country during withdrawal)
• Syrups can be obtained for some meds to assist with tapering. Dissolving tablets in water (not suitable for all tablets, eg extended release) can also assist with graduating doses, eg. dissolve the medication in 100ml exactly of water, shake well, and discard a percentage of the water to taper the dose. Capsules of ‘grains’ or ‘sprinkles’ can be broken open and counted or weighed (using a sensitive scale, not kitchen scales) to taper. Compounding chemists can do this for you, there may be a small cost involved.
• Tapering is not always successful. This needs to be planned for and not construed as a failure of the individual, or an impossible outcome. Backup plans are essential – ie how will we know it’s not working and what will we do then? Options include suspending the next level of tapering, going back a step (ie increasing the dose to the previous ‘safe’ level, and other supportive measures.
• We have a protocol that seems to work well for people with whom we work that involves saturating the person with micronutrients (Empower Plus from truehope.com and high levels of EPA from fish oil from Metagenics or Nordic Naturals).  Generally, we have to reduce the dose during the three to four months of saturation because the micronutrients make the psych meds more effective.  There are other micronutrients we can add when this is not sufficient to relieve symptoms of discontinuation (amino acids, antioxidants, inositol, etc.).  We also emphasize exercise, stress reduction through yoga and/or meditation.  We generally reduce by 10% per month.