Polydrugged? Which to taper off first?

 

This topic is not medical advice, it is simply sharing the collective experience of the Antidepressant community to give you talking points you can share with a medical practitioner who is knowledgeable about AD drug harm and tapering. 

 

Whilst some people only ever take one psychiatric medication, some many find themselves on more than one drug at a time. But when you decide it’s time to come off, which drug do you taper first?

 

Antidepressants and Benzodiazepines

 

Accelerators

These are drugs that make you feel more ‘up’ and alert, they can cause anxiety and reduce your sleep quality, this is generally speaking what antidepressants do.

 

Brakes

Brakes make your nervous system more depressed and are often sedative. 

Drugs like Benzodiazepines and ‘z drugs’ (which are often prescribed for sleep) are examples of this.

 

This is only a general guide; different people react differently to different drugs. 

 

The properties of an individual drug would also need to be considered, for example the antidepressant Mirtazapine is considered, at lower doses, to be a sedative drug and is often prescribed for insomnia, so it would be worth leaving this till after the more activating drugs. 

 

If you can sleep, you can not only cope with things better, but your body will heal quicker. 

 

Dr Mark Horowitz has said many times, publicly, that leaving the more sedative drugs to last is often the best thing to do.

 

These ‘brakes’ also act to hold back the activating effect of the accelerators. If you take the breaks off first it’s obvious what will likely happen the effects of accelerators will become greater.

 

As important as keeping the brakes in place till last is, it’s worth considering a couple of points

 

Don’t add extra drugs to your system.

 

When you have decided to come off your drugs it is likely because you don’t like the side effects or because you are getting nasty symptoms whilst tapering, these are both signs of an irritated nervous system. Adding additional drugs will likely further complicate your situation.

 

Addictive Drugs vs Physical Dependence forming drugs

 

Benzo-like drugs are considered addictive, because of this, in the Uk for example, doctors are often cautious about prescribing ‘z drugs’ like Zopiclone for more than 7 days. 

If you have been on a drug like this for some time it might seem a good idea to taper this first due to its addictive properties. However, the ‘addictive’ quality of these drugs is likely relatively negligible compared to the harm of taking the dependence forming antidepressants. 

Being on a cocktail of drugs is not an ideal situation and tapering these drugs safely requires carefully considered compromises.

 

Adverse drug interactions

 

If one of the drugs that you are currently taking is causing severe or significant side effects, or you feel that one in particular you have reacted adversely to, it may be worth considering prioritising tapering this one and allow yourself to stabilise, rather than following the "accelerators and brakes" logic above.

 

If you think one of your medications is interacting with another you can use the interactions checker here to find this out: https://www.drugs.com/drug_interactions.html

If one of your drugs is possibly causing an interaction with another you might consider tapering that one first.

 

A slow hyperbolic taper, of no more than 5-10% a month of your last dose, is the most sensible way to taper your drugs. However, if a drug is causing issues by interacting with other drugs you are taking it may be better to consider tapering that one much quicker to get off it sooner. This isn’t ideal and may require a long hold after to allow your system to recover before continuing to taper your other medications.

 

If you are experiencing life threatening symptoms from an adverse reaction to a medication this is the only time you stop it immediately. It is not advised to cold turkey an Antidepressant or Benzo under any other circumstance.

 

Altostrata from Surviving Antidepressants has an excellent post which inspired this one and I would highly recommend you go read:

 

Taking multiple psych drugs which drug to taper first - SA Link

 

Thank you so much for this. My docs have always done it opposite this..I got off the "brakes" first. Sigh. Better late than never!

5 hours ago, mars said:

Thank you so much for this. My docs have always done it opposite this..I got off the "brakes" first. Sigh. Better late than never!

My pleasure. This is common! Wish drs knew more. Hopefully in time they will.