Psychiatric medication tapering in Washington State

Why tapering deserves real expertise

Most psychiatric training covers how to start medications in depth and how to stop them barely at all. The result is that many people are told to "just cut the pill in half for two weeks" — a pace that, for some medications, is far too fast and produces symptoms that get misread as the original illness returning.

That misreading is the central problem in deprescribing. Withdrawal from antidepressants, benzodiazepines, or antipsychotics can look strikingly like relapse: anxiety, insomnia, mood instability, irritability, physical symptoms. When it's interpreted as relapse, the medication gets restarted, and the person concludes they'll need it forever — when what actually happened was a taper that moved too quickly.

How we approach it

We use slow, individualized tapering, including hyperbolic dose reduction — proportionally smaller decrements as the dose gets lower, which reflects how these drugs actually occupy brain receptors. The final steps down are often the hardest, and they're exactly where a linear taper causes the most trouble.

Pacing follows your body, not a calendar. We slow down, pause, or hold when symptoms demand it. We also support the process directly: sleep and circadian stabilization, nutrition, nervous-system regulation skills, and treatment of whatever underlying condition led to the prescription in the first place.

Medications we help people taper

• Antidepressants — SSRIs and SNRIs, where discontinuation symptoms are common and often dismissed
• Benzodiazepines and sleep medications — where tapering must be especially gradual and abrupt discontinuation can be dangerous
• Antipsychotics — including attention to metabolic recovery afterward
• Mood stabilizers — with careful attention to relapse risk in bipolar spectrum conditions
• Stimulants — including planned trials off medication for ADHD
• Gabapentinoids and other off-label agents

What this is — and isn't

This is collaborative, shared decision-making. We are not an anti-medication practice; we prescribe every day and believe psychiatric medication helps enormous numbers of people. What we object to is medication continuing indefinitely by default, without anyone revisiting whether it's still earning its place.

Equally, we won't pressure anyone to come off something that's working. For some conditions — particularly bipolar disorder and psychotic disorders — maintenance medication substantially reduces relapse risk, and we'll say so plainly. Nobody should stop psychiatric medication abruptly or without support, and we won't help anyone do that.

Common reasons people come to us

• Side effects — weight gain, emotional blunting, sexual side effects, cognitive fog — that have started to outweigh the benefit
• Being on a medication for years without anyone revisiting whether it's still needed
• Previous attempts to stop that failed and were labeled relapse
• Being on several medications and wanting to simplify
• Pregnancy planning, or a life change that makes it worth reassessing
• Simply wanting to know whether life with less medication is possible

Getting started in Washington

Care is delivered by secure video across Washington State. If you're currently with another prescriber and just want an assessment of your options, a one-time consultation or second opinion may be the right starting point — you don't have to transfer your care to get an informed answer. Most major insurance is accepted; see our insurance page or read more about our tapering and deprescribing service.