Guest Blog: Dr. Amy O’Donnell on De-Prescribing

*Dr. Amy O’Donnell from Nature’s Flow Psychiatry is one of our Professional Partners.  She is our recommended provider for holistic psychiatry.  We invite you to read her blog below to learn more about her holistic approach to psychiatry.

How to find a de-prescribing psychiatrist to help you stop your psychiatric medications? 

A de-prescribing psychiatrist describes a mental health doctor with a particular expertise and focus on helping you decrease your psychiatric medications. As more people are prescribed and continued on medications like antidepressants and as we learn more about the long-term risks of some of these medications, de-prescribing has gained in awareness (well, a little). 

Prepare yourself, here’s an alarming statistic: In a 2023 international survey about people’s experiences coming off their antidepressant, 71% of respondents said that they found their doctors advice unhelpful with reasons for this including that doctors suggested withdrawal from antidepressants wasn’t even possible. The people in this survey were members of peer support groups for people withdrawing from antidepressants. To me, this lack of awareness about the effects of antidepressants among doctors is concerning. And so it makes a lot of sense that you think carefully about what provider you would like to work with if you are hoping to decrease or completely come off your psychiatric medications. 

Here are some tips on how to find that right provider for you:

1. Knowing why: The pros and cons of de-prescribing

Every medication decision you make comes down to an evaluation of the pros vs the cons. What are the risks of the medication change and what are the hoped for benefits. The main risks of de-prescribing are withdrawal and relapse. The main benefits of de-prescribing are less risk of long-term side effects and stopping a medication you may not need anymore. For example, some long term risks of antidepressants include: persistent sexual side effects, in the elderly falls, fractures, and hyponatremia, possibly (the evidence is mixed) increased risk of cognitive concerns and mortality. Your de-prescribing provider should have a risk vs benefit discussion about your medication to help determine what dose of medication makes the most sense for you.

2. Knowing how: The different methods for de-prescribing

Once you and your provider have made the decision together to decrease your dose of medication, the next question becomes how. The vast majority of people should not abruptly stop their medication.  Part of determining the best taper strategy involves understanding your personal risk for severe withdrawal and relapse of the original condition that caused you to take the medication in the first place. People at high risk should consider hyperbolic tapering, those at lower risk can consider a faster or linear taper. Your provider should be familiar with compounding, where a specialty pharmacy can create a specific dose of almost any psychiatric medication for you. Prozac bridging, where you switch your antidepressant to prozac and then taper prozac can also be a useful tool. Additionally, holistic interventions can be incredibly helpful – things like supplementation, modifying diet, optimizing sleep can help support your brain as it transitions off psychiatric medications. Your provider should be able to discuss with you the various strategies and how they have personalized the tapering approach specifically for you.

3. Knowing who: Listening to your perspective 

Last but not least, it’s key to find a psychiatrist who you feel understands and hears you. The process of de-prescribing especially if you’ve been on your medications for a long time can feel daunting. Questions like who are you off of psychiatric medications. Figuring out how to cope with withdrawal symptoms like anxiety or irritability, but still keep living your life. Balancing the urgency to get off medications you don’t want to take with doing so safely and effectively. A lot of important and challenging things can come up during the de-prescribing process, so having a psychiatrist who feels supportive, knowledgeable and understanding cannot be understated. 

Learn more about Dr. Amy O’Donnell

At Nature’s Flow Psychiatry, I practice an integrative approach to de-prescribing. This means that I aim to look at your whole person and treat you using the best of all available treatment choices including both traditional and alternative. This looks like considering options such as – supplementation, botanicals, nutrition, movement, mind-body-spirit connection, therapy, different medication taper approaches, sleep and stress optimization, lab work up, health technology, alternative medicine like acupuncture (and the list goes on). My goal is always to set you up for success in both the short and long term. You can learn more about psychiatric de-prescribing on my blog or consider a free 15-minute meet-and-greet call to learn more about potentially working with me, learn more at www.naturesflowpsych.com. 

*Guest Author: Dr. Amy O’Donnell is the owner of Nature’s Flow Psychiatry, a boutique integrative psychiatry practice serving adults in FL and PA (soon NY and TX too). She helps people de-prescribe as well as holistically manage anxiety, mood and women’s mental health concerns. Learn more at www.naturesflowpsych.com, IG: @naturesflow.psych.