Tapering & Stopping Psychiatric Medications

The Psychiatrists, Psychiatric Nurse Practitioners and other mental health providers at Fine Tune Psychiatry, have experience in tapering patients (when appropriate) down or off of psychiatric medications. This is not a service for all patients, and it’s not uncommon to start this process, only to realize that psychiatric medications are necessary for one’s stability.

Psychiatric medications such as SSRIs, SNRIs, benzodiazepines, and even Buprenorphine play a vital role in managing anxiety, depression, substance use treatment, and other mental health conditions. However, there are instances where psychiatrists (and other medical professionals) overly prescribe. There are also instances where a patient requires medication for a discrete period of time, but then could potentially come off of said medication. It’s unfortunately not uncommon for patients to continue with treatment, without realizing that it’s no longer necessary, or be unable to stop, due to withdrawal symptoms.

Patients visiting our mental health professionals will discuss taking psychiatric medications for mood, anxiety, sleep or addiction for years (or even decades), and express uncertainty about the medication’s current benefit. They may also state that when they try to stop, they experience “brain zaps,” muscle twitches, insomnia, anxiety, fatigue, GI distress, or other issues, even after just one missed dose.

Sometimes, worsening symptoms indicate a continued need for medication, while in other cases, these symptoms result from withdrawal effects that can be managed effectively with professional guidance.

Specialized Expertise in Medication De-prescribing

At Fine Tune Psychiatry, our prescribers work closely with patients to evaluate whether ongoing psychiatric medication is necessary or if a carefully monitored tapering plan is appropriate. Dr. Pagnani, our Medical Director and Founder, has a special interest in this area of medicine, and trained on a unit at Johns Hopkins Hospital, where tapering was a focus.

Working with Compounding Pharmacies for Precise Dosage Adjustments

We partner with compounding pharmacies to create customized medication dosages, allowing for smaller dose reductions than commercially available pills permit. This precise tapering method helps reduce withdrawal symptoms that often arise when stepping down between standard pill strengths. Dose reductions can be as minimal as 1 mg or even 0.1 mg (or lower) in some cases, enabling smoother transitions while tapering off psychiatric medications.

Medications That Can Be Tapered Using Compounded Formulations Include:

• SSRIs: Zoloft (sertraline), Paxil (paroxetine), Celexa (citalopram), Lexapro (escitalopram), Prozac (fluoxetine)
• SNRIs: Cymbalta (duloxetine), Effexor (venlafaxine)
• Benzodiazepines: Klonopin (clonazepam), Xanax (alprazolam), Ativan (lorazepam), Valium (diazepam)
• Others: Remeron (mirtazapine), Buprenorphine (Suboxone)

We also offer tapering and de-prescribing support for medications such as Ambien (zolpidem), Lunesta (eszopiclone), Tricyclic Antidepressants (TCAs), and more.