Psychiatric Drug Withdrawal A Guide for Prescribers,
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After his training, he accepted a 2-year staff appointment as a full-time
consultant at the National Institute of Mental Health (NIMH). He has taught
at several universities, including the Johns Hopkins University, Department
of Counseling and most recently, State University of New York (SUNY)
Oswego in the Department of Counseling and Psychological Services.
He founded a scientific journal, Ethical Human Psychology and
Psychiatry and is on the board of others, including the International
Journal of Risk and Safety in Medicine.
He has testified before Congress, addressed numerous federal
agencies, acted as a consultant to the Federal Aviation Agency (FAA), and
given hundreds of seminars and conferences for professionals. His views
have been covered in nearly all of the major media from Time, Newsweek,
Wall Street Journal, and New York Times to Oprah, 20/20, Nightline, 60
Minutes, and dozens of network and cable news shows.
Dr. Breggin’s reform work has brought about significant changes
within the profession. In the early 1970s, he conducted a several-year-long
successful international campaign to stop the resurgence of lobotomy and
newer forms of psychosurgery. His reform efforts and his testimony in the
Kaimowitz case in Detroit led to the termination of lobotomy and
psychosurgery in the nation’s state mental hospitals, National Institutes of
Health (NIH), the Veterans Affairs (VA), and most university centers. A
public education campaign surrounding his 1983 medical book, Psychiatric
Drugs: Hazards to the Brain, led the Food and Drug Administration (FDA)
to require a new class warning for tardive dyskinesia in 1985. In the 1990s,
he was the single scientific expert for more than 100 combined Prozac suits
against Eli Lilly and Company. In 1994, his public education campaign led
the NIH to reform some of its research policies and to end the Violence
Prevention Initiative, a potentially racist program aimed at studying the
genetics and biology of inner-city children. His work initiated the reform
that led to the FDA’s recognition of numerous adverse reactions caused by
the newer antidepressants. The FDA warnings in 2004 about suicidality in
children and young adults and about a dangerous stimulant profile
involving agitation, akathisia, hostility, aggression, and mania, closely
followed the language of observations made and publicized by Dr. Breggin
over the prior 10 years.
Psychiatric Drug Withdrawal
A Guide for Prescribers, Therapists,
Patients, and Their Families
Peter R. Breggin, MD
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ISBN: 978-0-8261-0843-2
e-book ISBN: 978-0-8261-0844-9
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Library of Congress Cataloging-in-Publication Data
Breggin, Peter Roger, 1936-
Psychiatric drug withdrawal : a guide for prescribers, therapists, patients,
and their families / Peter R. Breggin.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-8261-0843-2 — ISBN 978-0-8261-0844-9 (e-book)
I. Title.
[DNLM: 1. Psychotropic Drugs--adverse effects. 2. Substance Withdrawal
Syndrome—prevention & control. 3. Risk Assessment. 4. Substance
Withdrawal Syndrome—therapy. WM 270]
615.7’88—dc23
2012026397
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For my wife Ginger Breggin,
a partner beyond all expectations and imaginings
Contents
Foreword Kathleen Wheeler, PhD, APRN, FAAN
Preface
Acknowledgments
Introduction: Hazards of Psychiatric Drug Withdrawal
The Center for the Study of Empathic Therapy
Related Books by the Author
Endorsements
1. A Person-Centered Collaborative Approach to Psychiatric Drug
Withdrawal
Relationship Between Prescribers and Therapists
The Person-Centered Collaborative Approach
Exploring the Patient’s Feelings
An Approach to Helping Patients in Need of Additional Support or
Guidance
Key Points
PART I: REASONS TO CONSIDER PSYCHIATRIC DRUG
WITHDRAWAL OR DOSE REDUCTION
2. Cautions in Assessing the Risks Associated With Psychiatric Drugs
A Rose by Any Other Name
Does FDA Approval Indicate a High Degree of Safety?
Drug Company Suppression of Critical Data
Relying on False or Misleading Information
Examples of Delayed Recognition of Serious Psychiatric Drug Adverse
Effects
Does It Take Weeks for the Drug to Work?
Listening to Family Concerns
The Importance of Varied Sources of Information
Key Points
3. Chronic Brain Impairment: A Reason to Withdraw Patients From Long-
Term Exposure to Psychiatric Medications
Basic Definitions
Symptoms and Characteristics of Chronic Brain Impairment
Confounding Factors
Comparison to Dementia and Organic Brain Syndrome
Illustration: He Was Afraid That He Had Alzheimer’s
How to Diagnose and Assess Chronic Brain Impairment
Other Psychoactive Substances
Frequency of Psychiatric Drug Chronic Brain Impairment
Biochemical Imbalance or Genuine Medical Disorder
What Causes Chronic Brain Impairment—Mental Disorder or
Medication?
Treatments for Chronic Brain Impairment
Recovery From CBI
Key Points
4. Antipsychotic (Neuroleptic) Drugs: Reasons for Withdrawal
Chronic Brain Impairment
Cellular Changes
Structural Brain Changes
Tardive Psychosis and Tardive Dementia
Acute Adverse Neurological Reactions
Tardive Dyskinesia, Tardive Dystonia, and Tardive Akathisia
Less Familiar Manifestations of TD
Children and TD
Neuroleptic Malignant Syndrome
Metabolic Syndrome
Children and the Metabolic Syndrome
Stroke and Death in the Elderly
Increased Mortality and Shortened Life Span
Efficacy of Antipsychotic Medications
Efficacy of Psychotherapy Alternatives
Key Points
5. Antidepressant Drugs: Reasons for Withdrawal
Chronic Brain Impairment
Apathy and Indifference
Antidepressant-Induced Clinical Worsening
Antidepressant-Induced Brain Dysfunction and Cellular
Abnormalities
Overstimulation and Mania
Antidepressant-Induced Suicide
Antidepressant-Induced Violence
Heart Disease Risk From Older Antidepressants
Serotonin Syndrome
Sexual Dysfunction
Obesity
Pregnancy and Nursing
The Elderly
Increased Death Rate
Children
Efficacy
Key Points
6. Stimulant Drugs: Reasons for Withdrawal
The Myth of Attention Deficit Hyperactive Disorder
The Class of Stimulant Drugs
The “Non-Stimulant” Stimulant
Antihypertensive Drugs
Dependence (Addiction) and Abuse
Chronic Brain Impairment (CBI)
Growth Suppression, Including Loss of Height and Weight
Behavioral Abnormalities
Depression and Apathy Induced by Stimulants
Obsessive-Compulsive Symptoms and Tics Induced by Stimulants
How Stimulants Work
Discouraging the Development of Self-Control and Self-Determination
Effectiveness
Key Points
7. Benzodiazepines, Other Sedatives, and Opiates: Reasons for
Withdrawal
Chronic Brain Impairment (CBI) and Dementia
Shortened Life Span
Dependence (Addiction) and Abuse
Abnormal Mental and Behavioral Reactions
Intoxication
Pregnancy and Nursing
Illustration: A Case of Long-Term Exposure to Alprazolam (Xanax)
Non-Benzodiazepine Tranquilizers and Sleep Aids
Opioids
Key Points
8. Lithium and Other Mood Stabilizers: Reasons for Withdrawal
Lithium
Effectiveness
Chronic Brain Impairment
Illustration: Loss of Quality of Life on Lithium
Other Mood Stabilizers
Antiepileptic Drugs
Lamotrigine (Lamictal)
Clonazepam (Klonopin)
Other Drugs Sometimes Prescribed Off Label as Mood Stabilizers
Pregabalin (Lyrica)
Varenicline (Chantix)
Key Points
9. Medication Spellbinding (Intoxication Anosognosia)
Medication Spellbinding
Extreme and Dangerous Reactions
Illustration: Murder Caused by Prozac
Key Points
PART II: THE DRUG WITHDRAWAL PROCESS
10. Withdrawal Reactions From Specific Drugs and Drug Categories
Distinguishing Withdrawal Symptoms From Psychiatric or
Psychological Reactions
Presume It’s a Withdrawal Reaction
Antidepressants
Newer Antidepressants
Tricyclic Antidepressants
Monoamine Oxidase Inhibitors
Antipsychotic Drugs
Benzodiazepines and Other Sedative Drugs
Stimulants
Lithium and Other Mood Stabilizers
Lithium
Other Mood Stabilizers
Drug Withdrawal in Children and the Elderly
Key Points
11. The Initiation Evaluation: Creating a Medication History While
Building Trust and Hope
Choosing to Use the Person-Centered Collaborative Approach
The Importance of the Psychiatric Drug History
The Difference Between Relapse and Withdrawal Reaction
Creating a Medication History
Four Common Scenarios Involving Long-Term Medication
First Scenario: Children on Multiple Drugs Starting With Stimulants
Second Scenario: Adults on Multiple Drugs Starting With
Antidepressants
Third Scenario: Adults on Multiple Drugs Starting With
Benzodiazepines
Fourth Scenario: Adults on Multiple Psychiatric Drugs Starting With
Antipsychotics
The Dependent Patient
Illustration: An Initial Evaluation in a Relatively Uncomplicated Case
Information Patients Want to Know Early in the Treatment
Patients Want to Know at What Point in the Withdrawal They Are
Likely to Experience Withdrawal Reactions
Patients Will Want to Know How Large a Dose Reduction Is
Required to Produce a Withdrawal Reaction
