Tapering and Stopping – “De-prescribing” – Psychiatric Medications like SSRIs, SNRIs, Benzodiazepines and Ambien.
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Psychiatric medications like SSRIs, SNRIs, Benzodiazepines and even Buprenorphine can be incredibly helpful for individuals struggling with anxiety, depression and other psychiatric illness. Patients should never make medication changes or stop a medication, without discussing and coordinating directly with their prescriber.
With that said, It is not uncommon for a patient to come into our offices and state that they have taken a medication for their mood, anxiety, insomnia or other difficulties for “Years” or even “Decades,” and for them to comment “I really do not know what this medication is doing for me anymore, or if I still need it, but when I try to stop it I feel terrible.” They may describe “brain zaps,” muscle twitches, insomnia, dizziness, fatigue or other symptoms of withdrawal, even after missing a dose by a few hours (let alone stopping for a few days). Sometimes a worsening of symptoms is suggestive that the individual DOES in fact need to stay on the medication for symptom management of a psychiatric illness. But sometimes, it is only a symptom of transient (albeit very distressing and possibly dangerous) withdrawal, that will pass with time, and can be minimized, when working with a provider who understands withdrawal from these medications.
Specific Training in De-Prescribing
The prescribers at Rittenhouse Psychiatric Associates can work with appropriate patients, to determine whether continuing previously prescribed psychiatric medications is indicated, or if it would be reasonable to start a trial of tapering a patient’s medications. Dr. Pagnani (the practice’s Medical Director and Founder) actually trained at The Johns Hopkins Hospital on a psychiatric unit where the tapering of medications was a focus. Dr. Pagnani now works closely and collaborates with the providers at Rittenhouse Psychiatric Associates, so that they too, can provide this service.
Utilizing Compound Pharmacies
Our providers can even work with compounding pharmacies (for many psychiatric medications) to decrease doses in smaller increments than manufacturer made medications can allow. It is not uncommon for patients to try to decrease medications with their current providers, and to run into difficulty due to significant withdrawal symptoms that occur when decreasing from one pill size to the next lower pill size, made by pharmaceutical companies. We can bypass this problem, by decreasing doses by even as low as one mg (or even a microgram in some cases!), albeit most tapers are a bit faster than that.
Medications that can be tapered utilizing local compounding pharmacies include:
SSRI’s: Zoloft (sertraline), Paxil (paroxetine), Celexa (citalopram), Lexapro (escitalopram), Prozac (fluoxetine)
SNRI’s: Cymbalta (duloxetine) & Effexor (venlafaxine)
Benzodiazepines: Klonopin (clonazepam), Xanax (alprazolam), Ativan (lorazepam), Valium (diazepam)
Other: Remeron (mirtazepine) & Buprenorphine (active ingredient in Suboxone)
Additional Medications That Patients can be seen for de-prescribing or tapering when appropriate:
Ambien (zolpidem), Lunesta (eszopiclone), Tricyclic Antidepressants (TCAs) and others.
It is important to note, that utilizing compounding pharmacies tends to incur additional costs (as insurance companies will typically not pay for compounded medications). However, we have found that most medications that patients see us for deprescribing will cost patients about 60 dollars a month out-of-pocket (for 30 pills) or about 90 dollars out-of-pocket a month for 60 pills. It is not uncommon for individuals to also only need compounded medications for a few doses (in-between manufacturer made (and covered) doses.
Schedule an Appointment at Rittenhouse Psychiatric Associates
267-358-6155 x 1
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