Psychiatric Medication Minimization Strategies: Part III

This series of posts is focused how to minimize your or your child's psychiatric medications ("psychotropics".) Parts I and II described various strategies that can help streamline or even eliminate medications. Part III covers how one goes about implementing these strategies, since trying to everything at once can feel overwhelming.

Guidelines to implementing medication minimization strategies:

1. Do one strategy at a time until it becomes routine. Try implementing a new strategy every 2-3 weeks.
2. Do the strategies from Parts I and II that'll give you the "most bang for your buck" first. In my experience, eliminating screen/electronic media for 3-4 weeks makes the biggest impact in the least amount of time, and has a positive cascade-type of effect on other areas, like sleep and concentration.
3. If sleep is not restful, none of the other strategies may work. Consider doing the electronic fast first then tackle sleep hygiene (strategy #2).
4. Once symptoms have improved and you and your doctor have decided to try tapering a medication, go s-l-o-w-l-y. Doctors sometimes feel pressure to make changes quickly, so don't be shy about asking your doctor to taper even more slowly than he or she is suggesting. The longer someone's been on a medication, the longer the taper should be. The longer and slower the taper, the more successful it will be. If you've been on a medication for years, your taper may need months (not weeks!).

   An 8 year old boy with ADHD and depression had been taking Prozac and Adderall for two years. His mother wanted him off of the Prozac, but each time their doctor tried to lower it, the boy became more irritable, so the previous dose was resumed. When they came to me with the same request, we decided to lower it by two milligrams a month and used the liquid form to accomplish this. After five months, he was successfully weaned from the Prozac.

   Even though five months may seem like a long time, sometimes that's what it takes.

5. Some medications are more harmful than others. The worst offenders are antipsychotics (also called neuroleptics), which are being much more commonly prescribed these days by pediatricians and internists due to FDA indications and mass marketing (think television commercials). They can be used for mood disorders, thought disorders, anxiety, tics and aggression.

   These drugs can cause weight gain, blood sugar and insulin resistance issues, and movement disorders. Although there is a place for them in psychiatry, these drugs have the biggest risk in the short AND long term. So put your energy here first. These drugs include Risperdal, Seroquel, Abilify, Geodon, Zyprexa, and older drugs like Haldol*.

6. Start the vitamin recommendations early on, since they are easy to start and need a few months to build adequate levels.
7. Track which strategies make the biggest impact. We all tend to get a little sloppy with discipline when things are going well, so it's easy to lose sight of what worked. Write it down!
8. Make a list of the strategies in the order you think you can/will approach them. This may change, but it'll help you feel like you're not leaving things out. Put reminders in your calendar, too.

Remember that health is always a work in progress and even implementing one strategy improves health. Nothing worthwhile is ever easy!

*Do not try tapering these drugs (or any other psychoactive drugs) on your own without working with your clinician, preferably a board-certified psychiatrist/child psychiatrist. If an individual has stabilized using antipsychotic medications and the drug is discontinued, there is always a chance of relapse; risks and benefits need to be weighed carefully in each case. If there is psychosis involved (hallucinations, paranoia, distorted thinking), antipsychotic medications may be necessary and may in fact prevent future episodes.