Psychiatric medication withdrawal and the ketogenic diet

I talk about medications on the blog, not because I am a prescriber, or because I am advising people on their medications. I talk about medications on the blog because my clients talk about their experiences with medications. And this might be the case for any therapist listening to their clients.

But my clients transition to ketogenic diets as a treatment for their mental illness. And when they do that, some of my clients are on psychiatric medications when they begin. And what most often happens, is we have to talk about their medications in the context of their ketogenic diet. Because ketogenic diets change brain chemistry. And this means I have to work with them and their prescriber to monitor symptoms so that the prescriber can adjust medications.

Some people will be upset that I am even discussing the possibility of people going off their medications. They may think me sharing my experiences with clients is irresponsible. But I think people have a right to know that there is a possibility they do not need medication. I think people have the right to know that medication is not comprehensive mental health care. And it is not sufficient for mental health. Medications in and of themselves are not healthcare, because the focus is on symptom reduction. They do not bring you back to your former state of health.

If we just call every disease chronic and progressive, I guess that absolves us of trying to fix root causes. It makes the paradigm of the medication model seem sane. But what if specific disorders that are classified as chronic and progressive, only look that way because we don’t look for root causes anymore. What if they are chronic and progressive because the psychiatric medications are terribly insufficient treatment. And maybe if we do something else, other than medication, a lot of these chronic and progressive patients would improve.

I see many people who were told they had chronic and lifelong psychiatric diagnoses improve.

Some people would see my sharing of client stories to be “anti-medication” and, therefore, anti-standard of care. They would want you to think this makes me alternative medicine. Someone spreading woo-woo and taking advantage of really sick people who just need medications. Because surely, whatever is being done in current mainstream medicine must be the very best care people can receive.

But it is not about anti-medication; it is about acknowledging a medical system that is not set up to provide comprehensive medical care that attempts to fix the underlying causes of psychiatric disease.

You have been told that you need medication in order to feel better. That there are no other good, evidence-based options. That was a lie. Whether intentional or not, it was information that harmed you because it excluded knowledge and options that may have helped. 

We really do have the knowledge to do better than that. We actually have the knowledge to work to fix root causes, nutrient deficiencies, and essentially a lot of the biological mechanisms causing mental illness. We even have good, evidence-based methods of psychotherapy that have a better chance of working well the healthier we get our brain. 

It’s just that throwing meds at you is easier. You are being short-changed on your care. They don’t want to pay for functional testing, targeted supplements that don’t have profitable patents or even simple nutritional analysis that would be needed to fix the underlying conditions causing your symptoms. 

Where I practice in Washington state, the public assistance insurance options funnel people away from psychotherapy and medication management for mental illness. Medication is considered more cost-effective. 

But your healing should not be about their budget limitations. And if you have private insurance, it really shouldn’t be determined by the level of profit they promised their investors.

You have to accept that the current medical model in this country is a business. If we don’t acknowledge that medicine is using a business model in this country, we will not be able to veer away from that model and find real healing for ourselves.     

You may be on medication now, and/or you attempted to go down or off of the medication. And when you started getting symptoms again, your prescriber or therapist may have told you that it was because you lowered or stopped your medication.

And that might be the case.

But just as likely (if not more likely) is that your symptoms were part of a discontinuation syndrome or withdrawal symptoms from the medication you were trying to reduce or stop. In other words, the increase in symptoms you experienced as you lowered your dose may not be proof that your brain is broken and can not work without medication.

Discontinuation syndromes and tapering withdrawals

Psychiatric medication discontinuation syndromes and withdrawal symptoms are much more common than people think. 

• In 2019, a literature review found that antidepressant withdrawal produced severe effects in 46% of cases.
• Persistent post-withdrawal disorders exist, causing sometimes irreversible symptoms, after medications as common as selective serotonin reuptake inhibitors (SSRIs), serotonin and noradrenaline reuptake inhibitors (SNRIs), and antipsychotics.
• Many patients who try to stop taking psychiatric drugs fail because of intense withdrawal symptoms. 
• In one study, over half of those who tried to withdraw from psychiatric drugs had such severe withdrawal symptoms that there was a 50% dropout rate during the study.

And I want to assure you the people prescribing these medications know about these withdrawal syndromes. They are well-documented in the research literature. 

“It is not uncommon for the withdrawal effects to last for several weeks or months,” Davies and Read wrote in the Journal of Addictive Behaviors. One reason the systematic review made news: its conclusion directly contradicted guidelines on antidepressants issued by the American Psychiatric Association and the UK’s National Institute for Health and Care Excellence.

Mad in America (discussing) Davies, J., & Read, J. (2019). A systematic review into the incidence, severity, and duration of antidepressant withdrawal effects: Are guidelines evidence-based?. Addictive behaviors, 97, 111–121. https://doi.org/10.1016/j.addbeh.2018.08.027

Proper and medically ethical informed consent is not given to the majority of people who are put on psychiatric medications. Nobody talks about how easy or how difficult it may be to taper off or what some of the side effects of discontinuation would entail. Often, even if you go to another prescriber looking for help on tapering your psychiatric medications, you may find they are nervous or unwilling to help you accomplish this. 

Why might I need a psychiatric medication adjustment while on the ketogenic diet?

When people go on ketogenic diets, they often need titration from their psychiatric medications. Sometimes just to lower doses, and sometimes they discontinue medications because they do not need them anymore. Sometimes it happens fast, and sometimes it happens really slowly. But for those on ketogenic diets, being able to find someone to help monitor psychiatric and other medications is a very real need. It’s something we have to be able to talk about. 

I work hard with my clients to help them find prescribers near them willing to monitor and/or be available to adjust medications as needed because that is what everyone deserves. But I know that not all of you have access to that, as much as I would want it for you. 

And I am not a prescriber. So even if you work with me, I cannot and will not ever advise you on your medication or provide you assistance on tapering. But I very much want you to have as good and as helpful of information as possible.

If you do not have the support of a medical professional with training on safe psychiatric medication tapering, it is going to be important that you find help.

How to find the help you need to taper psychiatric medications on a ketogenic diet

The following are online resources that can help guide you and/or help you find a knowledgeable prescriber to assist with tapering and adjusting psychiatric medications:

• The Withdrawal Project (not Keto specific)
• Mad In America – Withdrawal Resources (not Keto specific)
• Diet Doctor – Adjusting medications on a low-carb diet
• Diet Doctor – Low carb and mental health: Getting started and managing medications

Also, there are things you can do to help reduce the intensity of withdrawal symptoms from psychiatric medications.

One really helpful thing is to use a very comprehensive, higher-dose broad-spectrum micronutrient formula with a balanced amino-acid supplement (BCAAs are not a balanced amino acid profile for people with mental illness). Psychiatric medications deplete micronutrients. So don’t start your titration at a nutrient deficit. Amino acids are used to build neurotransmitters and antioxidants. A good one I recommend is Amino Replete from Pure Encapsulations.

You can find both of these products as Hardy’s Naturals. My clients generally use the following two products. These are NOT affiliate links, but I do have a 15% discount code you are welcome to use: MentalHealthKeto

https://www.hardynutritionals.com/products/daily-essential-nutrients-360

https://www.hardynutritionals.com/products/balanced-free-form-aminos

As you can see, these are not the doses you would find in a grocery store vitamin. The intakes of these micronutrient formulas have been made specifically for psychiatric issues. You need higher levels of nutrients to heal your brain and make neurotransmitter adjustments as you come off your medication.

If you are on psychiatric medications and decide just to throw Hardy’s into the mix to try to help your brain work better, this is a legitimate tactic.

However, be warned.

As these supplements work, your medication will still possibly need tapering and adjustment. Because your brain will most likely start to work better, and the nutrients will help your medications work better. And then you get potentiation effects. Meaning your current dose of medication may be too high for how well your brain is working now. And you may think the side effects are from the vitamins when really your meds are now too high for your needs. 

I have seen the withdrawal from psychiatric medications become easier for many people when they use a ketogenic diet. I think it is because of the improved brain energy and functioning that occurs. So that is a very powerful option if you want to use it to help reduce or try to eliminate your medications.

Some people use a razor to carefully shave off the tiniest amount of their medication every few weeks or months in order to manage withdrawal symptoms as they titrate down. It is the last few milligrams that, for many people, are the hardest and seem to cause the most difficult withdrawal symptoms. 

This all means we have to discuss medications. You may want to know all your options before using them. Not everyone likes taking their medications. They don’t feel good on them. Or they never wanted to be on them for life. They might want the right to be able to come off them long enough to see how they feel. They deserve to have someone work with them on withdrawal symptoms so they don’t confuse those symptoms with their normal baseline mental capacity or state of mind.

If you or a loved one identify with any of these scenarios, it is my sincere hope that you found this information validating, potentially hopeful, and even helpful on your healing journey. 

If you would like to read other posts that discuss medications, you may enjoy the following:

Do I need help doing keto if I have a mental illness?

Can keto treat my depression without medication?

Ketogenic Diet Treats Alcoholism

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References

Brandt, L., Bschor, T., Henssler, J., Müller, M., Hasan, A., Heinz, A., & Gutwinski, S. (2020). Antipsychotic Withdrawal Symptoms: A Systematic Review and Meta-Analysis. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.569912

Carey, B., & Gebeloff, R. (2018, April 7). Many People Taking Antidepressants Discover They Cannot Quit. The New York Times. https://www.nytimes.com/2018/04/07/health/antidepressants-withdrawal-prozac-cymbalta.html

Cohen, D., & Recalt, A. (2020). Withdrawal effects confounding in clinical trials: Another sign of a needed paradigm shift in psychopharmacology research. Therapeutic Advances in Psychopharmacology, 10, 2045125320964097. https://doi.org/10.1177/2045125320964097

Cosci, F., & Chouinard, G. (2020). Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications. Psychotherapy and Psychosomatics, 89(5), 283–306. https://doi.org/10.1159/000506868

Davies, J., & Read, J. (2019). A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addictive Behaviors, 97, 111–121. https://doi.org/10.1016/j.addbeh.2018.08.027

Groot, P. C., & van Os, J. (2020). How user knowledge of psychotropic drug withdrawal resulted in the development of person-specific tapering medication. Therapeutic Advances in Psychopharmacology, 10, 2045125320932452. https://doi.org/10.1177/2045125320932452

Honig, J. (2021, January 10). Finding One’s Way Through Withdrawal. Mad In America. https://www.madinamerica.com/2021/01/finding-ones-way-withdrawal/

Lane, C. & PhD. (2020, October 28). The Reckoning in Psychiatry Over Protracted Antidepressant Withdrawal. Mad In America. https://www.madinamerica.com/2020/10/reckoning-antidepressant-withdrawal/

User Perspectives on Professional Support and Service Use During Psychiatric Medication Discontinuation. (n.d.). springermedizin.de. Retrieved February 18, 2022, from https://www.springermedizin.de/user-perspectives-on-professional-support-and-service-use-during/20024842