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Coming Off Psychiatric Drugs

Disclaimer:

This publication is based on a Mind UK publication and the original version may be found here: https://www.mind.org.uk/information-support/a-z-mental-health/

Thank you to Mind UK for sharing their valuable content with us. Content included in Mental Health A-Z is made available free of charge and does not form part of any commercial activity. The adaptation has been done independently by Mind HK and is intended for general information purposes only.

Withdrawal symptoms 

As all psychiatric drugs change brain and body chemistry, they may all cause withdrawal symptoms, especially if you have been taking them for a long time. You will not necessarily get any withdrawal symptoms when coming off, but many people do. The symptoms differ to some extent between drug types. 

Information on the withdrawal effects of different types of drugs is given in the following sections below: 

Antidepressants 

Antipsychotics 

Lithium and other mood stabilisers 

Sleeping pills and minor tranquillisers. 

How can I tell whether I have withdrawal symptoms or my mental health problem is coming back?

Symptoms caused by drug withdrawal Symptoms caused by relapse
  • usually happen very soon after you start to come off. This is related to half-life – in a drug with a long half-life, withdrawal effects will be delayed by as much as two weeks.
  • are delayed, and are not related to the half-life of the drug
  • are often different from anything you have had before
  • are the same as the symptoms you had before – when you first started the drug
  • go as soon as you re-start the drug
  • get better slowly if you re-start the drug
  • will eventually subside without treatment if you don’t re-start the drug
  • continue indefinitely without other treatment

Switching drugs to help withdrawal

If you are taking a drug with a short half-life and having problems with withdrawal symptoms, it may be possible for you to switch to a related drug with a long half-life, which should be easier to come off. You will need the help of a doctor to switch drugs because your prescription will need to be changed. 

Tranquillisers and sleeping pills

The benzodiazepine tranquilliser with the longest half-life is diazepam (Valium/Stesolid/Valpam). If you are coming off one with a short half-life you could switch to diazepam. 

Some people also use diazepam to help come off the ‘z’ sleeping pills, which act in a very similar way to benzodiazepines. 

Equivalent doses for benzodiazepines and ‘z’ sleeping pills
Change to 5mg of diazepam (Valium/Stesolid/Valpam) from: 

  •  chlordiazepoxide 15mg 
  •  lorazepam 500mcg (0.5mg) 
  •  lormetazepam 0.5–1.0mg 
  •  nitrazepam 5mg 
  •  zolpidem 10mg 
  •  zopiclone 7.5mg

Antidepressants

The SSRI antidepressant with the longest half-life is fluoxetine (Prozac). It may be helpful to switch from a drug with a short half-life (such as paroxetine) to fluoxetine and slowly withdraw from that. As fluoxetine takes a little while to build up in your system, some specialists suggest starting it while you lower the dose of the other drug, taking both drugs together for a week or two.

Equivalent doses for SSRI antidepressants and venlafaxine
Change to 20mg fluoxetine liquid from: 

  •  citalopram 20mg 
  •  escitalopram 10mg 
  •  fluvoxamine 50mg 
  •  paroxetine 20mg 
  •  sertraline 50mg 
  •  venlafaxine 75mg

When coming off antidepressants, an alternative to fluoxetine is to switch to clomipramine 100mg/day. 

Antipsychotics

Drug switching techniques may be used with antipsychotics but you would need advice from a psychiatric pharmacist or psychiatrist on which drug to switch to. 

Lithium and other mood stabilisers

You would need advice from an experienced psychiatrist or psychiatric pharmacist on whether this technique would work for mood stabilisers, and which drugs might be suitable to switch to. 

It’s possible that you might be advised to switch to antipsychotic medication.

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What is iACT Service?

Improving Access to Community Therapies (iACT®) is one of the services from Mind HK. Trained Wellbeing Practitioners will offer initial assessment and early intervention for people dealing with mild to moderate symptoms of depression, anxiety, or other emotional difficulties.

 

The service includes 6-8 sessions of low-intensity psychological support, the flexibility of the service allows individuals to receive free and timely support when needed.

If you’re aged between 18 – 65 and are facing some emotional challenges, we would like to invite you to take an online assessment for us to gain a better understanding of your current emotional struggle.

 

If you’re eligible, we’ll get you connected with a Wellbeing Practitioner within two weeks to sort out the next steps.

The service runs for about 3 months and includes 6-8 support sessions, tailored to your needs.

 

We encourage you to attend all sessions and actively practice the tips and exercises provided by your Wellbeing Practitioner.

We take your privacy seriously. Your chats with the Wellbeing Practitioner are confidential.

 

We won’t share any of your info unless you’ve provided consent or if there are risks detected.

This programme isn’t suitable for people facing emergencies, major setbacks, or those diagnosed with serious or complex mental health conditions.

 

If you’re having thoughts of suicide or self-harm, this programme might not meet your needs, so please seek help right away. You can check out Mind HK’s “Find Help Now” page for immediate information and services.

Most of our Wellbeing Practitioners have backgrounds in psychology or counselling and are passionate about mental health. They’ve gone through about 140 hours of intensive training and completed at least 120 hours of supervised clinical practice over 9 months to ensure the quality of service.

 

They’re trained by accredited local experts in the mental health field, including clinical psychologists, counselling psychologists, counsellors, and psychiatrists. Plus, we regularly check how effective our services are. All service outputs and performances are subject to consistent monitoring.

Who is suitable for participating in this programme?

This programme welcomes anyone between the ages of 18 and 65 who may be feeling lost or facing emotional difficulties. Please note that this programme is not suitable for individuals diagnosed with severe or complex mental health conditions.

This programme is not suitable for individuals diagnosed with severe or complex mental health conditions, but suitable for those who experience mild to severe moderate anxiety, mild to moderate depression, or other emotional challenges. If you are currently experiencing a major setback or even having thoughts of suicide or self-harm, please visit the “Find Help Now” page on our Mind HK’s website for immediate information and services.

After signing up, our Wellbeing Practitioner will contact you within two weeks to schedule a convenient time for a 45-minute conversation, either via video or phone call, according to your preference. During the conversation, the Wellbeing Practitioner will understand your current situation and help you gain a better understanding of your emotional state based on the questionnaire you filled out during application. Additionally, they will provide recommendations for appropriate community resources based on your needs, helping you take an important first step in taking care of your mental health.

Although the intervention procedure is mostly standardised, Wellbeing Practitioners will work flexibly with clients to address individual presenting problems and unique characteristics.

Our Wellbeing Practitioners are trained to support people who experience mild to moderate mental health difficulties primarily. This programme is not suitable for the situations mentioned above. If you are currently experiencing a major setback or even having thoughts of suicide or self-harm, please visit the “Find Help Now” page on our Mind HK’s website for immediate information and services.

Your conversations with the Wellbeing Practitioner are absolutely confidential. Any information about you will not be shared with anyone without your consent unless you or others are at immediate risk or the Wellbeing Practitioner has reason to believe that you may be in imminent danger.
Supervisors will monitor trainees’ development throughout the placement to ensure that they are meeting the required level of competency to pass the training course at the end of the placement.

Yes, it is necessary to book an appointment in advance by filling out the form. Additionally, you can select one of the five stores yourself. We will allocate clients to different Wellbeing Practitioners based on their chosen location.

Before having the conversation, we will ask you to fill out a basic questionnaire for preliminary screening assessment. This screening process aims to ensure that the training received by the Wellbeing Practitioners is sufficient to meet the needs of the individuals receiving the service. If it is determined after the screening assessment that the service is not suitable for you, Mind HK will provide alternative recommendations to ensure your safety and support.

For adults who are suitable for this service, all Wellbeing Practitioners have received training on how to identify and respond to safety and risk issues. If you have any concerns about the support process, the Wellbeing Practitioners have appropriate measures in place and will develop response plans based on the urgency of the situation. They can also access support from clinical practitioners from Mind HK or participating organisations.

What private training does Mind HK provide?

Mind HK provides 4 themes of mental health training, including: Supporting Self, Supporting Others, Family Wellbeing and DEI (Diversity, Equity and Inclusion).

 

Check out the brochure here for more information.

Mind HK provides a wide range of standardised mental health training, which can be tailored to different circumstances. Chat with our team to explore more! 

Our trainers come from a diverse, accredited pool of clinically experienced professionals. Check out our trainers’ biographies here.

Yes, the Mental Health First Aid class of Mind HK is internationally accredited by the MHFA International. The content and certification is delivered by trainers certified from the Mental Health Association of Hong Kong. You can find out our trainers accreditation here.

We are here to support your mental health education journey! Reach out to us and chat with our team.

Withdrawal symptoms

Withdrawal symptoms 

As all psychiatric drugs change brain and body chemistry, they may all cause withdrawal symptoms, especially if you have been taking them for a long time. You will not necessarily get any withdrawal symptoms when coming off, but many people do. The symptoms differ to some extent between drug types. 

Information on the withdrawal effects of different types of drugs is given in the following sections below: 

Antidepressants 

Antipsychotics 

Lithium and other mood stabilisers 

Sleeping pills and minor tranquillisers. 

How can I tell whether I have withdrawal symptoms or my mental health problem is coming back?

Symptoms caused by drug withdrawal Symptoms caused by relapse
  • usually happen very soon after you start to come off. This is related to half-life – in a drug with a long half-life, withdrawal effects will be delayed by as much as two weeks.
  • are delayed, and are not related to the half-life of the drug
  • are often different from anything you have had before
  • are the same as the symptoms you had before – when you first started the drug
  • go as soon as you re-start the drug
  • get better slowly if you re-start the drug
  • will eventually subside without treatment if you don’t re-start the drug
  • continue indefinitely without other treatment

Switching drugs to help withdrawal

If you are taking a drug with a short half-life and having problems with withdrawal symptoms, it may be possible for you to switch to a related drug with a long half-life, which should be easier to come off. You will need the help of a doctor to switch drugs because your prescription will need to be changed. 

Tranquillisers and sleeping pills

The benzodiazepine tranquilliser with the longest half-life is diazepam (Valium/Stesolid/Valpam). If you are coming off one with a short half-life you could switch to diazepam. 

Some people also use diazepam to help come off the ‘z’ sleeping pills, which act in a very similar way to benzodiazepines. 

Equivalent doses for benzodiazepines and ‘z’ sleeping pills
Change to 5mg of diazepam (Valium/Stesolid/Valpam) from: 

  •  chlordiazepoxide 15mg 
  •  lorazepam 500mcg (0.5mg) 
  •  lormetazepam 0.5–1.0mg 
  •  nitrazepam 5mg 
  •  zolpidem 10mg 
  •  zopiclone 7.5mg

Antidepressants

The SSRI antidepressant with the longest half-life is fluoxetine (Prozac). It may be helpful to switch from a drug with a short half-life (such as paroxetine) to fluoxetine and slowly withdraw from that. As fluoxetine takes a little while to build up in your system, some specialists suggest starting it while you lower the dose of the other drug, taking both drugs together for a week or two.

Equivalent doses for SSRI antidepressants and venlafaxine
Change to 20mg fluoxetine liquid from: 

  •  citalopram 20mg 
  •  escitalopram 10mg 
  •  fluvoxamine 50mg 
  •  paroxetine 20mg 
  •  sertraline 50mg 
  •  venlafaxine 75mg

When coming off antidepressants, an alternative to fluoxetine is to switch to clomipramine 100mg/day. 

Antipsychotics

Drug switching techniques may be used with antipsychotics but you would need advice from a psychiatric pharmacist or psychiatrist on which drug to switch to. 

Lithium and other mood stabilisers

You would need advice from an experienced psychiatrist or psychiatric pharmacist on whether this technique would work for mood stabilisers, and which drugs might be suitable to switch to. 

It's possible that you might be advised to switch to antipsychotic medication.