Disclaimer: This article explores a highly sensitive topic involving the tapering off of or weaning down certain mental health medications with the assistance of ketamine treatment and psychedelic therapy. Never make decisions like this without first consulting your clinical team that manages your mental health medications like: a primary care provider, psychiatric clinician, and psychedelic/ketamine therapy care team.
At Mindbloom, there are many clients who throughout their healing process in ketamine therapy state that they are feeling very good —sometimes better than ever before— and are curious about the possibility of tapering down, or discontinuing, the existing prescribed psychiatric medications they’re actively taking alongside the treatment.
With increased and adequate support, through the responsible use of psychiatric best practices and supportive techniques, it is possible to taper off of medications. This can result in either lowered dosages of existing medications, or the complete cessation of certain prescriptions. Though this is in the realm of possibility, it is a highly individual process and may not be appropriate for everyone.
This resource explores when tapering or cessation may be appropriate, and what the specifics of this process may look like. As always, if this seems resonant with your own interests, the first step is always consulting your current care team and bringing this topic into your healing discussion.
Tapering vs. Discontinuing Medications
It is seldom appropriate to immediately stop using any or all of your existing psychiatric medications —known as going “cold turkey”, particularly if you are feeling calm, strong, and happy. If a change needs to be made, the process of slowly tapering down or off of existing medications, guided by your care team, is the more appropriate route.
The process of tapering down medications can be challenging. Anti-depression or anxiety medications like selective serotonin reuptake inhibitors (SSRI’s) have a significant impact on your neurochemistry. Altering the specific balance of these neurotransmitters can instigate or bring back many of the symptoms you’ve been working to address, such as depressive tendencies, feelings of anxiety, mental fog, and potentially more serious symptoms such as suicidal ideation.
That said, some medications can also bring along side-effects such as drowsiness, lethargy, mental fog, depression, lack of appetite, or other effects that are generally undesirable —yet tolerated— because the net benefit of taking the medications outweighs the accompanying side effects. However, if an individual experiences deep healing and is feeling significantly better, it is understandable that the desire to taper off of some medications and find relief from the side effects that may arise.
Due to the complex nature of tapering off of psychiatric medications, this is a long process, and it is not always linear in nature. There can be significant periods of time staying and adjusting to a lowered dose before then continuing to taper the dose down. This should be known and expected when entering into this process.
Fortunately, when working alongside a care team, if you do notice the resurgence of any adverse effects, you can also address this by slowly returning to a suitable dose that addresses these issues. There are steps you can take to reverse any effects, which can help build trust and confidence in the process, knowing that you can simply return to where you started if anything comes up.
Utility & Durability of Ketamine Experience While Evaluating Medications
There are many reasons why ketamine treatment in particular is useful in the process of tapering or discontinuing psychiatric medications. It has to do with the phenomenological and neurobiological effects of ketamine treatment and the durability of the experience even after the dosing session has passed.
There are many resources that explore the beneficial neurobiological (physical) effects of ketamine in more detail, but the primary area of focus is that ketamine can have positive effects on the brain itself: increasing the overall health, growth, and resiliency of the brain.
Ketamine can facilitate this process through a few mechanisms:
- Upregulating Neuronal Production: Ketamine increases the production of new neurons, supplying the brain with healthy and vital neurons, the basis for more effective and harmonious connections in the brain.
- Upregulating Release of BDNF (brain-derived neurotrophic factor): BNDF, colloquially referred to as ‘fertilizer for the brain’ helps promote neuron growth, overall health, and ongoing maintenance. Providing both short and long-term benefits.
- Stimulating mTOR: mTOR regulates many processes involved in cell growth and healing worn out synaptic connections, and also stimulates activity/growth in the prefrontal cortex and hippocampus, essential areas for emotional regulation.
This means that over time, ketamine can help increase the overall health and resiliency of the individual brain — helping an individual regulate their emotions, create new behavioral patterns, and maintain this new baseline health in the long-term.
Alongside the neurobiological benefits, ketamine also presents immediate and long-term phenomenological effects, or mental / emotional effects.
Some of the phenomenological benefits include:
- Novel Insights: With dissociation comes a sense of being separate from yourself. With this perspective individuals can spot certain behavioral patterns, environmental triggers, or see how they act in a new way. These insights can catalyze short-term respite or long-term positive behavior/mood change.
- Embodied Feelings: The ketamine experience can induce a number of embodied emotions/feelings. For those with depression, having an embodied experience of calm, joy, contentment, or elation can be a powerful reminder or positive reinforcement that these states are possible for them. This can change long term outlooks and actions.
- Cognitive Distancing: Both during and for a brief window after a ketamine session, it’s possible that individuals may notice more ‘space’ between an external stimulus and their internal reaction to it. This space can provide the room to change behavior, remove automatic self-sabotaging habits, all of which are valuable in managing depression.
This combination of neurobiological benefits and significant phenomenological experiences creates a favorable context for individuals to feel better and move closer towards healing and wholeness. This experience in clients often creates the circumstances that lead them to begin questioning whether or not its possible to taper off of or discontinue their psychiatric medications.
This is paired with what is called the “durability” of the ketamine experience, in which these benefits are not only experienced within the dosing session, but can last for upwards of 7-10 days after a single dosing session.
If a comprehensive tapering schedule is paired with a ketamine therapy protocol, the positive benefits of ketamine treatment can help equip an individual to better handle the direct and side effects of tapering off of psychiatric medications.
Building Self-Support Skills and Resiliency
One of the important points in this process is that all of this work must be paired with the intentional act of building the skills and personal resiliency that can carry on and support the individual beyond any use of medication.
One of the most important components to a successful tapering program will be in actively building the skills and resiliency to support individuals in times of challenge, unexpected events, or when setbacks occur.
Some of the skills that can be helpful to cultivate are:
- Contemplative/reflective habits and rituals for continued growth and insight
- Emotional regulation techniques
- Somatic, body-based techniques for stress reduction
- Cultivating deeper relationships and communities of support
- Creating a welcoming and warm living environment
- Working to overcome any addictions or self-sabotaging behavior
- Asking for support when challenged
- Understanding the integration process for psychedelic therapy
- Moving towards meaningful work, authentic connection, and rediscovering joy and play in their day-to-day life
If the individual can build these skill sets, alongside the positive effects of ketamine treatment (like reduction in anxiety and depression symptoms), they are in good shape to begin the process of tapering. The ketamine treatment can give the support needed to help the process, while the increased confidence and skills ensure that the individual has what they need to better handle what life throws at them in the future.
This is where ketamine treatment and effective integration of the psychedelic experience from the dosing sessions become a very powerful asset for the individual. They are creating an adaptable, healthy brain, putting themselves in a neuroplastic state to adopt new patterns of behavior, and building skill sets for resiliency and growth for the long-term future.
Sensitivity & Working With Care Team
It is easy to read this and make the assumption that this is a straightforward and simple process. In some individuals that may be the case, but it’s not an assumption that can be granted as a natural part of the process. This is highly sensitive work, and must be done while working alongside a seasoned, well-trained, and compassionate care team.
Investigating resources for mood regulation, stress management, and psychedelic integration are assets to the process. Also, working with a licensed therapist to help process the experiences that are happening is also helpful for individuals making this change.
Despite the sensitive nature of this work, it feels important to say that although challenging, it is possible for some individuals to successfully taper down their psychiatric medications, or discontinue some of them entirely. It is always a unique process, and no result is guaranteed, but it is possible.
If individuals are prescribed psychiatric medications to help them cope with symptoms of anxiety or depression, and the individual is able to reduce these symptoms, and build the skill sets to help them manage their health moving forward, it stands to reason that they are then in a position where the psychiatric medications may no longer be necessary. They have served their purpose as a critical support in a sensitive and challenging time, and the individual can now embark on the process of slowly and intentionally weaning off of these medications.
Taking Control of Your Health
This work can also be an empowering step for many, as it is deeply rewarding to take full control and ownership of your mental health and your engagement with life.
This perception of renewed empowerment and possibility can also be a significant healing force for many individuals going through this process —reconnecting with their own innate power and possibilities in life.
And as responsible care providers, this is what should be desired for clients: making progress towards their own healing and return to wholeness. A return to their happiness, their power, their meaning, and their deep engagement with life.
If medications are required to assist that process, wonderful. It’s amazing that modern science has come to a point where that service can be provided. And if the next step on their journey towards wholeness is now an attempt to move away from the support that they once had, to stand once again on their own two feet, this decision requires and warrants serious care, consideration, and conversation. With the guidance, wisdom, and expertise available of course, but also honoring the individual's request to take full control of their health once again.
As mentioned, this is highly sensitive work. Never make a decision on these topics without first consulting your medical care teams and practitioners so that you have the support and guidance necessary. It is a reality that this process may not be possible for everyone, and it may not be a positive move towards others.
This is why it must be done with attention, with full awareness of the positive and negative potentials, and with the support and care of experienced practitioners.
With this said, ketamine treatment can present an opportunity for some individuals to attempt to taper off of existing medications, and for many reasons creates a favorable environment to do this sensitive work within. Whatever you choose, may it be for your health, healing, and wholeness.
This article is for informational purposes only and is not intended to be a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. If you are in a life-threatening situation, call the National Suicide Prevention Line at +1 (800) 273-8255, call 911, or go to the nearest emergency room.
Important FDA Safety Information
Ketamine is not FDA-approved for the treatment of depression or anxiety. Learn more about off-label uses here.
Side effects of ketamine treatment may include: altered sense of time, anxiety, blurred vision, diminished ability to see/hear/feel, dry mouth, elevated blood pressure or heart rate, elevated intraocular or intracranial pressure, excitability, loss of appetite, mental confusion, nausea/vomiting, nystagmus (rapid eye movements), restlessness, slurred speech, synesthesia (a mingling of the senses).
Do not proceed with ketamine treatment if any of the following apply to you:
- Allergic to ketamine
- Symptoms of psychosis or mania
- Uncontrolled high blood pressure
- CHF or other serious heart problem
- Severe breathing problem
- History of elevated intraocular or intracranial pressure
- History of hyperthyroidism
- Other serious medical illness
- Pregnant, nursing, or trying to become pregnant
Ketamine has been reported to produce issues including, but not limited to, those listed below. However, lasting adverse side-effects are rare when medical protocols are carefully followed.
While ketamine has not been shown to be physically addictive, it has been shown to cause moderate psychological dependency in some recreational users.
- In rare cases, frequent, heavy users have reported increased frequency of urination, urinary incontinence, pain urinating, passing blood in the urine, or reduced bladder size
- Ketamine may worsen problems in people with schizophrenia, severe personality disorders, or other serious mental disorders.
- Users with a personal or family history of psychosis should be cautious using any psychoactive substance, including ketamine, and discuss potential risks with your MindBloom clinician before proceeding with treatment.
- The dissociative effects of ketamine may increase patient vulnerability and the risk of accidents.
To promote positive outcomes and ensure safety, follow these ketamine treatment guidelines:
- Do not operate a vehicle (e.g., car, motorcycle, bicycle) or heavy machinery following treatment until you’ve had a full night of sleep
- Refrain from taking benzodiazepines or stimulants for 24 hours prior to treatment
- Continue to take antihypertensive medication as prescribed
- Avoid hangovers or alcohol intake
- Refrain from consuming solid foods within 3 hours prior to treatment and liquids within 1 hour prior to treatment
- Ketamine treatment should never be conducted without a monitor present to ensure your safety