Musings from a clinical psychologist
As a clinical psychologist, I frequently work with people who take psychiatric medication, sometimes more than one. Although I do not prescribe these medications, their place in my clients’ lives is an important part of my work. That responsibility is not lost on me.
Sometimes, following assessment, I refer a client to a psychiatrist to consider whether medication could support their recovery. At other times, a psychiatrist refers someone to me with medication already in place, so that we can begin the psychotherapeutic work.
Whatever the route, the collaboration matters. So does the care we give to each stage of treatment—including the point at which someone wants to stop their medication.
My plea is straightforward: if you are considering reducing or stopping psychiatric medication, speak to your prescriber first. The approach needs to suit the particular medication and your circumstances. Coming off deserves a conversation, a plan and support.
Psychiatric Meds in the 21st Century: A Cloudy Milieu
Psychiatric medication occupies a complicated space in our lives. For some people, it brings substantial relief. For others, the benefits are limited, the side effects difficult, or the experience of treatment disappointing. Sometimes a person has experienced all of these at different points.
Around these experiences sits a noisy public conversation: research findings, advocacy, commercial interests, personal testimony, professional disagreement and competing ideas about what mental healthcare ought to offer.
There are also unanswered questions. Our understanding of precisely how particular treatments produce their benefits remains incomplete. But uncertainty about a mechanism is not the same as having no evidence that a treatment can help. Equally, evidence that something helps some people does not tell us everything about what it will mean for the person sitting opposite us.
We need room for both confidence and humility. Clients should be able to ask, “Why this medication?”, “What are the alternatives?” and “What happens if I want to stop?” without feeling that they are being difficult.
If we cannot make room for those questions, we should not be surprised when people go elsewhere for answers.
Medical Vigilantism: Who’s Your Guru?
When trust in treatment falters, certainty can become very appealing. Someone, somewhere, will usually be willing to offer it.
The landscape of what’s on offer can feel crowded and confusing, whether someone is considering treatment for the first time or already taking medication. A person who comes across a “better” treatment may be tempted to abandon their existing regimen too suddenly, risking adverse effects. Established treatments, emerging research and commercially promoted experiences may appear alongside one another, sometimes with little explanation of their differences. A regulated medical treatment, a clinical trial and a retreat promising transformation are very different propositions.
Esketamine, for example, has authorised medical uses in the EU under clinical supervision. It should not simply be grouped with everything marketed as “alternative medicine”. Each intervention needs to be considered on its own evidence, risks and safeguards.
My concern is with what happens when certainty outruns evidence, or when a person in distress is left to navigate competing promises without reliable support. That is where a kind of “medical vigilantism” can take hold: everyone has an answer, but it is less clear who will remain alongside the person if things go wrong.
I continue to believe that psychology and psychiatry, when they work well together, can offer something valuable here. That requires a willingness to listen, to explain, to reconsider—and to take a client’s concerns about medication seriously.
So, Why Do People Suddenly Stop Their Meds?
One question repeatedly brings me back to this subject: why does stopping medication sometimes receive so much less attention than starting it?
Beginning treatment may involve an assessment, a discussion of options, a prescription and follow-up appointments. Yet the decision to stop can happen quietly, between appointments, without anyone else knowing that it was being considered.
Then comes the sentence: “Oh, by the way, I’ve stopped my medication.”
There are many possible reasons. Someone feels better and assumes the medication is no longer needed. Someone else is struggling with side effects, cannot afford an appointment, has run out of tablets, or does not feel their concerns have been heard. Others simply have not been told what stopping may involve.
Before interpreting the decision, we need to understand it.
Different psychiatric medications have different effects and different risks when reduced or stopped. With antidepressants, for example, the body adapts to their presence, and reducing them too quickly can produce withdrawal symptoms. These may include anxiety, dizziness, nausea, disturbed sleep, low mood and unfamiliar physical sensations.
For some people, symptoms are relatively brief. For others, they can be severe and persist for months or longer. A person’s difficulty with withdrawal is not a measure of how thoughtfully they approached it.
This also creates a difficulty of interpretation. Someone stops an antidepressant, feels distressed and concludes, “Clearly, I wasn’t ready. I must still be ill.”
That conclusion may be premature. Withdrawal can resemble the problem for which the medication was prescribed. However, a return of the original condition is also possible, and the two can be difficult to distinguish. The timing, nature and course of symptoms need to be assessed with the prescriber.
A difficult stop does not, by itself, settle the question of whether someone can eventually come off medication.
This is why tapering—gradually reducing a dose with an individual plan and appropriate monitoring—matters. The pace may need to change in response to symptoms. For medicines associated with withdrawal, abrupt stopping is generally avoided unless there is an exceptional medical reason, such as a serious adverse reaction requiring urgent assessment.
There is a psychological dimension worth exploring, too. What does taking medication mean to this particular person? Does it represent relief, dependence, reassurance, shame, an unwelcome reminder of illness, or something else entirely?
Might stopping feel like reclaiming independence? Might it express frustration that has not yet found words in the consulting room? Could it be connected to a familiar difficulty in sustaining care for oneself?
Possibly. But these are questions to explore together. We should not leap to an explanation such as unconscious self-sabotage before asking about side effects, practical difficulties, the advice the person received, and their own reasons for wanting to stop.
It is worth turning the question towards ourselves as clinicians as well.
Do we sometimes become less attentive when a client seems better? Do we assume that an improving person no longer needs us to ask about medication? Might we find it easier to recognise our usefulness during a crisis than during the quieter work of maintaining recovery?
We are, after all, made of the same stuff as our clients.
There have been times in my own practice when a client’s announcement has caught me off guard. “How did I miss that?” I have wondered. “Had I asked? Had I made enough room for them to tell me?”
These questions are uncomfortable, but useful. They remind me that an apparently settled treatment is still a treatment worth discussing.
Handing Back the Reins in ‘Health’
Part of psychotherapy concerns a growing capacity to make decisions, recognise one’s needs and take responsibility for one’s life. Decisions about medication belong within that process.
But agency cannot be measured by whether someone continues taking medication or manages to stop it. Either decision may be thoughtful and appropriate. What matters is whether the person can weigh the information, express their preferences and obtain the support they need.
Nor does greater independence mean having to manage everything alone. Knowing when to consult someone is itself an important part of caring for oneself.
Clinicians cannot anticipate every decision a client will make. We can, however, make it easier for clients to tell us what they are considering—even when they suspect we might disagree. That includes explaining the risks of stopping, taking concerns seriously and helping people access appropriate medical guidance.
If someone has already stopped abruptly, the immediate task is to understand what has happened and help them obtain the care they need. Any exploration of the decision’s deeper meaning should grow out of that conversation.
The reins matter. So does the support available to the person holding them.
My plea, then, comes from concern for the person who may otherwise be left frightened by a change they did not know to expect: please give the decision to stop the same care you would hope to receive when starting.
If you are thinking about reducing or stopping psychiatric medication, speak to the doctor who prescribes it before making changes. If you have already stopped, contact them promptly for advice. Severe symptoms or an immediate safety concern require urgent medical help.
You can read more about how I work alongside psychiatrists, and about my approach more generally, on my page about individual therapy.
Bryn O’Reilly is a South African-born clinical psychologist in Quarteira, in the Central Algarve, Portugal, offering therapy in English, in person and online. If you would like to talk, you can arrange a free introductory call.
Adapted from an article first published on LinkedIn.