We Know How to Support Withdrawal. We Just Don't Apply It to Psychiatric Drugs

First they told us how to start the drugs. Now, finally, someone is telling doctors how to stop them. That is the quiet revolution behind a new consensus statement from the American Society of Clinical Psychopharmacology: 45 voices from around the world, 44 recommendations, all addressing a question psychiatry has long sidestepped. When should you stop? Dr Joseph Goldberg, lead author, put it simply: doctors are trained to prescribe, not to withdraw. Another contributor was more candid: any fool can start a medication, but it takes real skill to finish with one.

This is progress. But it is only half the story. What actually happens when patients stop treatment? That remains largely unaddressed.

We already know how to do this. We just haven't.

The blueprint for responsible withdrawal already exists; it was designed for a very different kind of dependency. When someone detoxes from heroin or cocaine, they enter a specialised setting with medical observation 24/7. They receive evidence-based psychological support - CBT, relapse prevention, motivation techniques. Nutritional therapy, designed to correct neurological deficits; exercise programmes, proven to aid recovery; a multidisciplinary team involved every step of the way. All because society accepted one brutal fact: detox alone can be deadly.

Now, contrast this with what happens when a patient discontinues an SSRI, an SNRI, or a long-term benzodiazepine prescribed by their GP. Often, it is a slow taper (if they are lucky). Then a follow-up appointment weeks away, and perhaps a leaflet. The safety net is nowhere near as secure.

This gap is costing lives.

Withdrawal from prescribed psychiatric drugs can be every bit as severe as illicit detox: brain zaps, crushing anxiety, depression, disorientation, insomnia that drags on. Benzodiazepine withdrawal shares its neurological wiring with alcohol; it can provoke seizures and, in rare cases, be fatal. Reports of individuals with no prior suicidal thoughts dying during withdrawal are tragically common. Their suffering was overlooked by a system built to start drugs, not to stop them.

There are no dedicated psychiatric withdrawal clinics. No standard protocols encompassing medical monitoring, diet, and psychological care. Nothing remotely resembling the support given to someone coming off street drugs. The task force mentions "tapering" as if ticking that box completes the job. It does not. Slower does help, but it is a starting point, not a substitute for support.

Society accepted long ago that no one detoxes from heroin alone. Our nervous system makes no distinction between street drugs and prescribed medication.

Acknowledging when to stop is a big step. The challenge now is building clinics, protocols, and support networks that match the complexity of withdrawal. Until then, millions will face some of the most destabilising experiences of their nervous system - alone, underprepared, and still quietly told by the system that prescribed their medication that their distress is not quite serious enough to warrant proper help.

That must change.

This article references findings published in JAMA Network Open, February 2026, from the American Society of Clinical Psychopharmacology task force on deprescribing psychiatric medications.

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