Question: I have been seeing a psychopharmacologist. He prescribed some medicine for me a few months ago. It helped a lot, and now I feel fine. I would like to stop taking my medication. I think I’m ready. But whenever I bring it up with him, he talks me out of it, or changes the subject. I’d like to do it the right way. Can you help?
Anne Fenton, MD: People often ask why they should be on a medication once they are feeling better.
You are right to bring this up with your prescriber. Part of his job is to explain how, when,and whether you should go off your medication. Part of your job is to communicate your thoughts about it, as well as your interest in his guiding you safely through the process.
Generally speaking, the protocol for discontinuing medication varies with the particular type of medication, the response of the individual, the onset and duration of the original symptoms, the persistence or recurrence of symptoms over the period of treatment, and many other factors.
There are also standard treatment guidelines for suggested length of treatment based on research studies. Researchers study the treatment outcomes of thousands of patients who have been on a particular medication. They continue to monitor these patients for symptom recurrence after they have discontinued their medicine. Researchers may review the results for groups of patients who were treated, say, for 6 months, a year, a year and a half, and two years. Then the patients are monitored after discontinuing their medications for 6 months, a year, a year and a half, and two. The recommended optimal length of treatment is based on which group had the lowest rate of recurrence over the longest period of time after discontinuing treatment.
Not everyone is able to discontinue medications indefinitely without recurrent symptoms. There are many people whose symptoms simply require continued, lifelong treatment. This is similar to any chronic medical condition.
Sometimes, people go off their medications and feel fine for a little while, but start to experience symptoms after a few months. It can often take that long before the effect of the medicine wears off, even though it is out of the system within a few days after discontinuing.
It is thought that the initial and rapid positive response a person may experience within the first few weeks of treatment represents positive changes in brain chemistry mediated by the medication. The longer, more stable positive changes result from physiological and anatomical changes in the brain that occur later as the brain recovers and returns to normal.
As you can see, your question does not have a simple answer.
When you and your prescriber feel the time is right to discontinue medication, it should be done carefully. You and your prescriber should work together closely to observe for any symptoms of withdrawal from the medication, or any recurrence of your original condition. The best and safest way to ensure your successful “medicine taper” is to do it slowly and carefully. Regular follow up even after discontinuation is recommended to monitor the possibility of recurrence and resume treatment if indicated.
It is also important to follow up with your prescriber at specified intervals over the two years following discontinuation. If you do have recurrent symptoms, you will be in a good position to get help before your symptoms take hold.