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Alberto Vásquez Encalada

Review of Withdrawal from Prescribed Psychotropic Drugs

in: Journal of Critical Psychology, Counselling and Psychotherapy, Vol. (2025) in print

The safe reduction and discontinuation of prescribed psychotropic drugs, especially antidepressants and neuroleptics, is one of the most pressing public health challenges of our time. The use of these drugs has increased significantly over recent decades, with the highest absolute growth rates observed in high-income countries (Brauer et al., 2021). However, relative growth is most pronounced in middle-income countries, particularly upper-middle-income nations, where access to and reliance on these drugs are expanding rapidly. Despite growing awareness of the risks associated with long-term use, healthcare systems have been largely inactive in providing structured, evidence-based support for those wishing to taper off these drugs. For many, this lack of support has led them to seek guidance from online forums or to navigate the process alone, often at significant risk to their mental and physical well-being. This situation has left millions of people worldwide – many of them long-term users – without the assistance they need, underscoring the urgency of addressing this systemic failure.

My personal experience mirrors the struggles of many. After years of using a cocktail of psychotropic drugs, I sought my doctor's support to taper off, only to be told that my improved condition was proof I needed them for life. Determined to reclaim agency over my care, I embarked on the tapering process alone, relying on the limited resources available online at the time. Despite taking precautions, the journey was fraught with challenges – insomnia, emotional turmoil, and physical discomfort became my daily reality for many months. How little I knew about psychotropic drug withdrawal! It was a painful and isolating experience, one I would not wish on anyone. How much easier – and safer – it would have been if both my doctor and I had been equipped with the knowledge and tools provided in this book, offering informed and appropriately tailored support throughout the process.

Peter Lehmann has long been a pioneering voice in the global conversation about psychotropic drug withdrawal and critical psychiatry. Since the 1980s, he has been a central figure in the international movement advocating for alternatives to traditional psychiatric treatments, particularly the overreliance on psychotropic drugs. His landmark works, such as Coming off Psychiatric Drugs: Successful Withdrawal from Neuroleptics, Antidepressants, Mood Stabilizers, Ritalin and Tranquilizers, have provided invaluable guidance for service users and professionals alike, at a time when few dared to challenge prevailing norms. A founding member of the European Network of (ex-) Users and Survivors of Psychiatry, Lehmann's contributions span advocacy, education, and practical support. His collaboration with critical psychologist Craig Newnes and other contributors in this book builds on decades of dedication to autonomy in healthcare decisions, informed consent, and the advancement of evidence-based practices for psychotropic drug withdrawal.

This book is an indispensable resource for professionals, service users, family doctors, activists, and families alike. It offers a comprehensive framework, grounded in scientific research and lived experience, for relatively safe tapering of psychotropic drugs such as antidepressants and neuroleptics. By addressing key topics such as hyperbolic tapering, rebound effects, and personalised care plans, the book underscores the importance of a methodical and supportive approach to withdrawal. It also highlights the growing evidence for rethinking current medical and psychiatric practices – acknowledging the potential harm of long-term psychotropic drug use and dependence while advocating for safer, evidence-based pathways to discontinuation.

What sets this book apart is its inclusivity – acknowledging the diverse roles of medical professionals, peer networks, self-help groups, and families in ensuring success. Its contributions are not limited to theoretical discussions but include practical tools and strategies, such as tapering strips, crisis management approaches, and family-centred interventions. It also provides insight into institutional strategies, including innovative models from humanistic mental health services, as well as community-based and online peer support initiatives. By offering this nuanced and pragmatic perspective, the book empowers all stakeholders to collaborate in creating a safer, more ethical landscape for psychotropic drug withdrawal.

The World Health Organization and the Office of the High Commissioner for Human Rights have recently echoed the need for safe and informed withdrawal practices. Their recent guidance on Mental health, human rights and legislation (2023) advocates for higher standards of informed consent for psychotropic drug use, including the explicit right to discontinue treatment (WHO & OHCHR, 2023). It calls on countries to establish support systems that enable individuals to withdraw safely, free from coercion or stigma. This book aligns with and strengthens this global imperative, bridging the gap between policy aspirations and on-the-ground realities.

I hope it reaches every mental health professional, family doctor, psychotropic drug user, Mad activist, family member, supporter, and friend across the world. It is a testament to the progress that can be made when knowledge, understanding, and lived experience come together. Let this guide inspire a future where withdrawal from psychotropic drugs is no longer a solitary struggle but a supported and celebrated choice – one that restores dignity, autonomy, and health to all who embark on this journey.

Alberto Vásquez Encalada
Co-director of Mad Thinking
Law degree from the Pontifical Catholic University of Peru, Master of Laws in International and Comparative Disability Law and Policy from the University of Galway, Ireland
Geneva, 20 January 2025

Sources

Brauer, R., Alfageh, B., Blais, J.E. et al (2021). Psychotropic medicine consumption in 65 countries and regions, 2008-19: A longitudinal study. Lancet Psychiatry. 8:1071-1082. Doi: 10.1016/S2215-0366(21)00292-3. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2821%2900292-3/fulltext [accessed 30 November 2024].

WHO – World Health Organization, OHCHR – United Nations High Commissioner for Human Rights (2023). Mental health, human rights and legislation. Guidance and practice . Geneva: WHO & OHCHR, p. 57. https://iris.who.int/bitstream/handle/10665/373126/9789240080737-eng.pdf?sequence=1 [accessed 30 November 2024].

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