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Coming off psychiatric drugs

Explains issues faced when coming off medication, how to approach it, techniques for gradual reduction, possible withdrawal symptoms and how to tell the difference between withdrawal and relapse.

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Is coming off my medication right for me?

People take psychiatric drugs for a variety of conditions and for varying lengths of time. Some take them for relatively short periods, but, depending on the diagnosis, some may find they are expected to take medication for long periods – perhaps indefinitely.

If you are taking psychiatric drugs and feel that you no longer need them or do not wish to take them for a long period, you may want to see if you can manage just as well, or get on better, without them.

Some reasons why people have said they wanted to come off medication:

  • I feel it has done its job, and I no longer need it.
  • I have found other ways of coping with my mental health problem and want to try and manage without medication.
  • The medication is not helpful.
  • The medication has unwelcome side effects which make it hard to tolerate.
  • I’m worried that the medication may affect my physical health.
  • Medication makes me lose touch with my feelings.
  • I would like to start a family and am afraid the drugs may affect my baby while I’m pregnant or breastfeeding.

Alternatively, you may find your medications helpful and feel that the advantages outweigh the disadvantages.

Some reasons why people have decided to stay on medication:

  • Since I found a drug that suits me, I have been getting my life back together.
  • I feel I benefit from taking the drug and so it’s worth putting up with the side effects.
  • My doctors think I should continue with it, and I value their advice.
  • My family would be really worried if I stopped taking it.
  • I need to stay well for my baby.
  • I think I still need it at the moment, but might consider coming off at another time.

Weighing up the advantages and disadvantages of coming off

It’s very important to think about the decision to come off medication and whether it is right for you. You might find it helpful to use a decision chart, like this example:

Coming off medication Staying on medication
Advantages
• I can drive again.
• I will have more energy.
• I might lose some weight.
Advantages
• I’m quite stable at the moment – why rock the boat?
• I don’t want to risk the withdrawal effects.
Disadvantages
• I might have another breakdown.
• My partner will have a go at me.
Disadvantages
• I don’t feel truly myself.
• My sex life is affected.

You could make a chart like this for yourself, and think about the advantages and disadvantages from your own point of view. Write down the things that are most important to you.

If you decide to try coming off your medication, you will need to approach the process carefully – find out what the possible risks of doing so may be, and get support. It is never a good idea to just stop taking medication you have been taking for more than two or three months, without thinking carefully about the decision, and discussing it with people you trust.

Who can I talk to about my options?

Your doctor

Ideally, the best person to talk to about stopping or continuing your medication will be your GP or psychiatrist. However, you may find that some doctors are reluctant to agree to withdrawal, and they may also not have much experience or knowledge about the best way to go about it. Guidance published for doctors tends to suggest that drug withdrawal is easier and can be done more quickly than is often the case. But if you want to change your prescription in order to help you come off, you will need to discuss this with your doctor or nurse prescriber and get their agreement.

My psychiatrist explained the risks of coming off lithium, but after some discussion about the pros and cons, he agreed to support me. I gradually reduced the dose, as he had recommended, over a six-month period and when I had a wobble mid-way, he helped me to overcome my anxiety and encouraged me to complete the process.

Local support groups

Other sources of help are local self-help, peer support or ‘coming off’ groups and programmes. They may be run by local Mind associations, or by the Hearing Voices Network (see ‘Useful contacts), for example.

Coming off medication may form part of what’s called the ‘Recovery approach’ to mental health problems. Support may be available from Recovery and Wellbeing centres if you have any in your area.

Can I refuse medication?

In normal circumstances, you can only receive treatment that you have specifically agreed to. You should be given enough information about the expected benefits and possible harms of medication or if there are any alternatives to it. This allows you to make an informed decision about whether to take it or not. This is called ‘informed consent', and needs to include information about possible withdrawal problems. Some drug information leaflets (which should come with the medication) include this information when withdrawal problems are well known. But with other drugs, particularly antipsychotics, drug withdrawal may not be mentioned.

Even after you have given your consent, it doesn't have to be final and you can always change your mind. Your consent to treatment is vital, and treatment given without it is considered to be bad practice.

However, you can be given medication without your consent if you are detained in hospital under the Mental Health Act. But you should still be given the drug information and, if possible, you should have an opportunity to discuss it and to consent to it. It is also more difficult to decide for yourself about treatment if you are under a Community Treatment Order. (To find out more about consent to treatment under the Mental Health Act, see consent to treatment.)

If you have taken medication for some time and have decided that you do not need or wish to take it any more, you can make your own decision to stop. You do not have to tell your doctor; although you need to if you want them to help with the withdrawal process. It may be easier to come off with your doctor’s help, but it is not essential, and you may prefer not to consult them.


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