Empty bottles: Easing clients off meds

What to know about discontinuation of psychotropic medications.

By Laurie Meyers

What is the practitioner’s role when a patient comes off medication? What should a psychologist do for a client who is experiencing significant side effects? And what about clients on multiple medications?

As the health professional who often has the most contact with a client, a psychologist may be in the best position to spot or even help prevent seriously adverse reactions to medication withdrawal-if he or she knows what to look for.

“Psychologists need to be on top of what patients are taking,” says John Sexton, PhD, one of 10 participants in the U.S. Department of Defense (DoD) 1991-1997 pilot program to grant psychologists prescriptive authority. “It’s important for us to know what is going into a person’s body.”

Discontinuation dilemmas

A particular red flag to watch for: It’s all too common for patients to abruptly stop taking medication on their own, which can have unpleasant or dangerous consequences, says Sexton, who is now working in psychological and counseling services at the University of California at San Diego.

Patients may not discuss discontinuing medication with the physician who prescribed the medication, or they may not pay attention to the tapering directions they are given, points out psychologist Michael Enright, PhD, APRN, who works in a primary-care clinic in Wyoming and can prescribe because he holds a nurse-practitioner’s license. So, it’s important for practitioners to consult with the prescribing physician when possible, to get information such as the original drug dosage and how long tapering should continue, he adds. Psychologists should also be aware of the following side effects associated with particular classes of psychotropic drugs:

• Antidepressants-Due to the short time they stay in the body, some selective serotonin reuptake inhibitors (SSRIs)-a class that includes drugs such as Zoloft, Prozac, Paxil and Lexapro-can cause a discontinuation syndrome with symptoms including nausea, headache, problems sleeping, tingling or shock-like sensations, and, in some cases, flu-like symptoms. Paxil and Effexor-which is actually a serotonin-norepinephrine reuptake inhibitor-are the most likely to cause the syndrome and Prozac is the least likely, Enright notes. These reactions can be uncomfortable, but are not generally life threatening, he says.


Post Acute Withdrawal Symptoms (PAWS)

Substance abuse has effects that last even when substance use has been stopped and acute withdrawal is over.

What are Post Acute withdrawal Symptoms?

Withdrawal symptoms that occur after the acute phase of withdrawal is over.

How long do they last?

It depends on how much stress a person experiences in early recovery and how much damage was done to the nervous system by alcohol or drug misuse.  Usually the symptoms last from six months to two years.

Why are they important?

Because PAWS can lead to relapse if not managed properly (e.g., “white knuckle sobriety”).

Types of PAW symptoms

  1. Difficulty in thinking clearly.
  2. Difficulty in managing feelings and emotions.
  3. Memory problems.
  4. Difficulty in recognizing and managing stress.
  5. Difficulty in sleeping restfully.
  6. Difficulty with physical coordination.

Managing PAWS

  1. Stabilization: talk honestly to people who will not accuse, criticize, or minimize about how you are feeling.
  2. Education: learning about all aspects of recovery from chemical dependency helps keep PAWS in perspective.
  3. Self protective behavior: you are responsible for protecting yourself from threats to your sobriety.
  4. Nutrition: three well-balanced meals a day, three nutritious snacks a day, no caffeine and sugar.
  5. Exercise: recommend that it be daily, to reduce tension.
  6. Relaxation: also daily, and includes having fun!
  7. Spirituality: means different things to different people.
  8. Balanced living: cannot afford to overdo some things and neglect others any more.

From Gorski T. and Miller M Staying sober — a guide for relapse prevention 1986

*Lancet* (Volume 371, Number 9629, 14 June 2008)
includes a review article: “Tobacco addiction.”

The article is by Dorothy K Hatsukami, PhD, Lindsay F Stead, MSc b, &
Prakash C Gupta, PhD.

Here’s how the article starts: “Lung cancer was confirmed to be caused
by cigarette smoking over 50 years ago, and since then several other
diseases have been added to the list of diseases caused by smoking and
involuntary exposure to cigarette smoke.1,2 However, the worldwide
production and consumption of cigarettes has continued to increase
unabated during this period. There are about 1.2 billion smokers in the
world, half of whom will die from diseases caused by smoking.3 Smoking
causes 5 million deaths per year, and if present trends continue, 10
million smokers per year are projected to die by 2025. The prevalence
varies greatly, from less than 5% to more than 55% in different
countries. It also varies greatly between men and women, so prevalence
in both sexes needs to be examined separately.”