Detoxing From Psychiatric Medication
Most psychiatric medications, even if FDA-approved for certain conditions such as depression or anxiety disorders, are only partly effective for the conditions for which they are indicated.
As a result of this, a patient will often be put on multiple medications to try and remedy their persistent symptoms. Many psychopharmacologists engage in this “polypharmacy” and often use “off-label,” unproven, sometimes habit-forming, drugs to try and treat their patients. Psychiatry does not have a panacea, and many conditions, including depression, anxiety disorders, Attention Deficit Disorder, insomnia, and addiction, are multifaceted.
Patients need a more balanced approach than just medication.
Despite this, because of pharmaceutical industry influence, poor training, good intentions, or even frustration, many psychiatrists prescribe multiple kinds of medications to manage their patients’ symptoms. In many cases, there is no evidence at all that polypharmacy is helpful; in fact, the American Psychiatric Association practice guidelines do not support this method.
Some patients are put on two or even three antidepressants at once or several different classes of medications to treat one set of symptoms. Most of this prescribing is “off-label,” meaning that these medications are not approved by the FDA or indicated for what they are being prescribed. Often, this leads to unnecessary dependence on toxic medications that cause serious side effects and dependence. There is more and more evidence pointing to long-term dependence on antidepressants. Addiction is too often the case when controlled substances like Adderall, Xanax, Klonopin, and Ambien are overprescribed.
Since being in practice, Dr. Megwinoff and Dr. Glazer have identified many adults and adolescents who are needlessly overmedicated by their psychopharmacologist and successfully detoxed them with a marked improvement in functioning and well-being.
Our philosophy is to simplify treatment; if you are on several different medications, there are likely better treatment options.
Because Dr. Glazer and Dr. Megwinoff do not meet with Pharmaceutical Representatives or “drug reps” or take consultation fees or gifts from drug companies, their medication decisions are always evidence-based and unbiased.
What is Drug Tolerance?
Many people currently struggling with prescription medication dependency were simply following a doctor’s orders for use. Unfortunately, even good intentions can take a wrong turn. Tolerance to the drug can develop rapidly, and in the case of opioid medications, it can happen in just five days.
Drug tolerance occurs when one’s brain and body are habituated to the effect of the drug. Users need more potent or more frequent doses to achieve the same effect. Taking more of the drugs will increase its efficacy for a while but also increase its habit-forming properties. Thus, chronic use of alcohol and narcotics can cause physical dependence.
When physical dependence has developed, uncomfortable withdrawal symptoms occur when the person stops taking the medication. In the case of sedatives like alcohol, Xanax, or Klonopin, withdrawal can be dangerous, causing seizures, autonomic instability, and sometimes death. Tolerance and withdrawal are essential elements of the cycle of many types of addiction.
What are Opiates?
Oxycodone and other opioids are highly addictive psychotropic drugs whose use is now considered epidemic in the United States. The street form, heroin, is an opiate derived from the seed of the poppy plant. Other kinds of opiates or opioids, such as oxycodone, morphine, hydrocodone, fentanyl, and codeine, are common prescription narcotics. These are synthetically created in a lab and prescribed to people as part of a post-surgery protocol or pain management regimen due to injury or other health ailment. Fentanyl is an incredibly potent synthetic opioid often used to mimic oxycontin or enhance the experience of other illegal drugs that has become a newer, fatal epidemic.
Opiates create a chemical dependency or addiction by stimulating the opiate neurotransmitters in the brain (the mu receptors), which produce feelings of euphoria. Oxycontin, though marketed as safe and nonaddictive and minimally abusable by pharmaceutical companies (notoriously Purdue Pharma), is highly addictive and is easily converted into an even more addictive short-acting drug by crushing and snorting the pills.
What Is Narcotic Abuse?
The term narcotic first referred to any drug that altered one’s senses or relieved pain. Today, the term mostly refers to opiates or synthetically derived opioids. They are powerful pain relievers and are now well known to be commonly abused and dangerous drugs in the United States. When used as indicated for short-term pain relief, patients are unlikely to become addicted to narcotics. However, some narcotics provide an intoxicating high when injected, snorted, or taken orally in strong doses. Narcotic abuse is the deliberate use of a narcotic medication beyond or without a doctor’s prescription, with the intent of getting high.
As this behavior continues, drug dependence begins as the body develops a tolerance to the substance; for a person to keep receiving the same sensations from the drug, stronger doses, increasing frequency of use, or both are required. Evidence of physical dependence begins when a person weens drug use or stops use, only to be met with intense drug withdrawal symptoms. These can be cumbersome, so much so that the least invasive option is to return to drug use.
Once physical or psychological drug dependence is in place, narcotic addiction brings specific psychological effects: compulsive behaviors focused on getting the drug, cravings, and continued drug use despite negative consequences such as legal problems, losing a job, and compromising important relationships.
Benzodiazepines
Almost twenty percent of Americans reported an anxiety disorder last year. In some cases, people are often overworked, overcommitted personally and vocationally, and seldom have enough time to engage in the self-care needed to relax, unwind, and naturally calm the mind. Many doctors will prescribe benzodiazepines for symptom relief of stress, anxiety disorders, and insomnia. Xanax and Klonopin are both highly addictive and commonly abused.
Benzodiazepines’ active ingredients collectively work to depress the central nervous system, reducing heightened symptoms of distress. They work specifically on the GABAA receptors in the brain. They are sedating and anxiety-relieving, as well as causing muscle relaxation. Short-acting benzodiazepines, like Xanax, can also produce some euphoria. Physical dependency on these drugs is common, and withdrawal can be extremely dangerous, often triggering seizures, and at times, it is fatal.
What Are The Symptoms Of Opioid Drug Withdrawal?
If a person stops using narcotics abruptly after they have become physically dependent on the drug, they will experience drug withdrawal symptoms, which may include:
- Abdominal cramping
- Anxiety
- Confusion
- Diarrhea
- Drug craving
- Enlarged pupils
- Goose pimples
- Irritability
- Loss of appetite
- Muscle aches
- Nasal stuffiness
- Rapid breathing
- Runny nose
- Salivation
- Sweating
- Tremors
- Vomiting
- Yawning
The symptoms of narcotic drug withdrawal aren’t always medically dangerous. But they can be unbearable, and at times, opioid withdrawal can be a life-threatening condition.
Detox Treatment for Narcotics and Prescription Drugs
During an outpatient medication-assisted treatment program, Suboxone, clonidine, and other medications can help prevent withdrawal symptoms during a process called detoxification (“detox”). After detox is completed and the body and the brain are rid of the drug, physical dependence on the drug has been removed, but psychological dependence may continue. This lives in the form of environmental triggers and cravings for drug use. And because drug addiction is a recurring disease, potential relapse in response to stress and other life circumstances will continually test the recovery process.
At Fifth Avenue Psychiatry, we provide a unique approach to treating drug addiction and the underlying mental health conditions that can fuel the disease. Our outpatient detox and behavioral health therapies provide professionals and executives the privacy and confidentiality they need in a discreet setting.
Through ongoing detailed health assessments and a personal approach to recovery, each patient experiences “treatment by design” to meet their individual needs in a manner that suits them best.
If a drug dependency challenges your loved one or you have concerns that your own drug use has exponentially shifted into addiction, contact us to discuss the matter in confidence and to schedule a consultation.
FAQs
When using prescription and over-the-counter drugs, it’s important to follow the dosage directions, keep your medicine in a safe place, out of reach of children and animals, and never share a prescription with someone else. Doing otherwise, you’ll run the risk of misusing or even abusing your prescription or over-the-counter drug.
When you no longer need a prescription, responsibly dispose of it or return it during a national “drug take-back day.”
The most abused prescription drugs include opioids (morphine, heroin, fentanyl oxycontin, codeine, methadone, and hydromorphone hydrochloride) prescribed for pain relief, benzodiazepines (Xanax and Klonopin) prescribed for anxiety or sleep problems, and stimulants (Adderall, Vyvanse). These drugs are not only the most commonly abused but also some of the most over-prescribed on the market.
Treatment for opioid dependence typically uses a combination of behavioral therapies, counseling, and medication. Therapies like motivational interviewing help target denial, Cognitive behavioral therapy can help with craving and drug-using behavior, and other combinations of therapy can help to target underlying causes of drug abuse. Medications like suboxone and methadone are harm-reduction forms of opioids that are prescribed to replace more addictive and dangerous opioids. Medications like Naltrexone or Vivitrol, its injectable form, can block the effects of opioid abuse and deter future use.
FDA-approved medications, Buprenorphine and Naltrexone, are used to block opioid receptors and reduce cravings. Buprenorphine is an opioid that replaces and blocks other more dangerous and addictive opioids. Naltrexone is a daily pill that displaces opioids from the mu receptor. Vivitrol is an injectable form of naltrexone that works for about three weeks to block opioids.
That all depends on what psych med you are taking. Once daily, psychiatric medications tend to have a half-life of about 24 hours. This means they should be completely gone from a person’s system 4 to 5 days after their last dose. In some cases, medication may take longer to be completely flushed from the body; for example, fluoxetine (Prozac) has a half-life of about a week and typically takes at least a month to fully leave the body.
When a person is taking too much of an antidepressant, mixing antidepressants, or unknowingly mixing a migraine medication or supplement containing serotonin with an antidepressant, it is called Serotonin Syndrome.
Serotonin syndrome in a mild form can cause shivering and diarrhea but, if severe, can resemble NMS with muscle rigidity, fever, autonomic dysfunction, and death if not treated. Both Serotonin Syndrome and Neuroleptic Malignant Syndrome are medical emergencies for which you should obtain immediate medical attention.
Unlike an uncomplicated withdrawal, which is mainly psychological symptoms like anxiety and agitation, a complicated withdrawal includes more physical symptoms such as seizures, delirium, autonomic dysregulation, and, in some cases, death.