How I Overcame "Treatment-Resistant" Mental Illness: Laura Delano’s Journey

Laura: 
Oh my gosh, what if it hasn’t been treatment-resistant mental illness through all these years? What if it’s been the treatment?

Bret: 
Welcome to the Metabolic Mind Podcast. I’m your host, Dr. Bret Scher. Metabolic Mind is a nonprofit initiative of Baszucki Group where we’re providing information about the intersection of metabolic health and mental health and metabolic therapies such as nutritional ketosis as therapies for mental illness.

Thank you for joining us. Although our podcast is for informational purposes only and we aren’t giving medical advice, we hope you will learn from our content and it will help facilitate discussions with your healthcare providers to see if you could benefit from exploring the connection between metabolic and mental health.

Laura Delano spent years, decades as a psychiatry patient. She said her life, her job was being a psychiatry patient and really had very little meaningful quality of life, but she was able to take matters in her own hands and eventually de-prescribe, taper off her medications. And it’s that personal experience that she has now turned into a nonprofit and in a consulting business and building an entire community to help others understand the role of medications and the place and the way to de-prescribe or taper these medications.

It’s such an important topic within psychiatry. Medications have their place, but are they the end all, be all treatment for long term? And how do we safely and effectively ask that question and implement strategies to get their lives back? And this is Laura’s journey.

This is what she did personally and now is giving back to the community. It’s such an inspiring story that I hope you really enjoy this interview with Laura Delano. Now just be warned, she does talk about her personal experience with suicidality and a suicide attempt. So, if that is something that is triggering to you, please be aware that we do discuss this.

Now, here’s the interview with Laura Delano.

Please remember before we get started, this is an interview with an a fascinating individual to share her experience and her journey. None of this is medical advice. We’re not establishing a provider-patient relationship or giving any medical advice at all. This is simply information for people to learn from and to address with their healthcare team.

So please do not make any changes to your lifestyle medications without addressing it with your healthcare team. Laura Delano, thank you so much for joining me at Metabolic Mind. 

Laura: 
Thanks for having me, Bret. 

Bret: 
Now, as part of this whole interview and discussion, we’re going to get into your story and your history and your experiences because there’s so much there.

But give us the brief 30 second overview of who you are, and then we’ll get into the details. 

Laura: 
Sure thing. So I founded a nonprofit organization called Inter Compass Initiative. Our mission is to help people make more informed choices about psychiatric drugs, psychiatric diagnoses, and tapering off psychiatric drugs.

And so I’m no longer in the executive director role there, I was for a while. I also have been working as a consultant with individuals and families for about 13 years now around tapering, taper support, helping people find life beyond meds once they’re off. And I’m the author of Unshrunk: A Story of Psychiatric Treatment Resistance, which will be published on March 18th, 2025.

Bret: 
Excellent. Thank you for that intro. And yeah, talking about your nonprofit and the work you’re doing now, but it’s all rooted in this personal experience going back all the way to when you were an adolescent and a teenager. And it was well documented in an article in the New Yorker in 2019 that we will link to so people can read about it.

But give us sort of the overview of your experience in the whole psychiatric medicine world and the diagnoses, the medications, the progress or lack of progress. I know it’s a very detailed story, but give us sort of the summary of your experience. 

Laura: 
Sure. So the quickest way to say it is that I basically grew up psychiatrized is the word I like to use. I spent my teens and twenties going increasingly deeper into the diagnostic paradigm. Originally, one diagnosis became two became three. One medication became two became three. And it started when I was 13 with basically my parents not knowing what to do with their angry, defiant, self-injuring daughter who had fallen apart rather quickly before their eyes.

So, I was sent to a therapist. The therapist eventually referred me to a psychiatrist, and this was in the mid 1990s just as the juvenile bipolar disorder phenomenon was taking off.

And I was told that my anger and irritability were symptoms of mania, which is how they differentiated juvenile bipolar disorder from adult bipolar disorder. And that, of course, my despair were symptoms of, and self-injury and all of that, were symptoms of depression. That began what was a 13 year journey into basically becoming a professional patient.

I resisted at first in high school. I could tell that my struggles were responses to the stressors on my plate to the environment that I was in. And so I refused initially to accept that there was something wrong with me. I saw my struggles as an important response to the world around me. But by the time I got to Harvard as a freshman, I just I spun out.

My fall, freshman fall there, I stopped sleeping. I was doing drugs. I was acting wacky. I was up until the wee hours of the morning with racing thoughts about the meaninglessness of life. I was still injuring, self-injuring, and I eventually grew so desperate for relief from all my struggles that I resigned myself to what I had been told years earlier.

And I thought, there must be something wrong with me because I made it to a school like Harvard. I have everything going for me. There’s nothing visibly wrong here that should be causing me to be struggling so much. And so it was at that point, at age 18, when I was just so desperate for answers and relief that I voluntarily took myself back to the mental health system.

And from there until the very end, basically at age 27, my purpose became treatment and being a good patient and taking whatever meds I was told to take, tracking my symptoms. I saw incredible top doctors at top hospitals. And so my parents and I really took for granted everything we were told because we were able to get me the best care on offer.

And with each passing year that I was a good patient, basically, my life just felt progressively more apart. I managed to make it mostly through college, was struggling all along to the point where I had to take a year off. I had my first hospitalization because I was really suicidal.

Managed to finish college, but was really struggling. Moved through my twenties unable to really work, take care of myself. My physical health was getting progressively worse with each passing year. By the time I was in my mid twenties, I was on five medications. I was on an antidepressant, an antipsychotic, a mood stabilizer, a sleep aid, and a benzo.

And I was in chronic pain. My weight, I had gained 70 pounds. I couldn’t think I was, I couldn’t function socially. All I had was being a patient basically. That was the only purpose. and at that point I was told.. 

Bret: 
Let me interrupt for one second. I’m sorry, because I, and there’s a light at the end of the tunnel, obviously, and we’re going to get there.

But, so I don’t want to dwell too much, but I want to go back to the way it was documented in the New Yorker, and the way you’re explaining it, that they put you on Prozac and up the dose, which made you sleepy. So they put you on provigil to make, to give you more energy, but then you couldn’t sleep. So they put you on Ambien.

So it seems like it was this cycle of drug upon drug. And then you were diagnosed with bipolar, but then you were diagnosed with borderline and that meant more drugs. And it was drug upon drug. And looking back, so you said, you were a professional patient.

What do you think the goal of treatment was for your doctors and what did you think the goal of treatment should be? 

Laura: 
Oh, that’s a great question. The goal for me was being compliant. I had no, I had no vision of a future for myself where I was actually thriving in my life or working, having a family.

I was, by the time I was in my mid twenties, I was so convinced that I was so severely sick that basically my life was about managing my illness, which basically meant doing what my doctors told me, going to therapy, doing groups, doing DBT, CBT. But there was no why for it because I believe that I’m never going to emerge from this.

This is all that my life has. So, I just, it was almost like I was going through the motions of all of these treatments that were proffered to me, but not ever thinking there was a through, that there was another side beyond it. And I think for my doctors, I obviously don’t know what was in their heads, but they were all, almost all of them, were incredibly kind, well-meaning people who really cared about me and wanted to help me.

And I think we’re seeing me through the lens of their largely reductionist training, which basically had them reducing me into lists of symptoms to intervene upon with more meds. And I did have a lot of therapy and so I was also talking about my struggles and seeing psychiatrists who were also doing therapy work with me.

So It wasn’t that I was just seeing a psycho-pharmacology once a month to get a refill. I was also getting to know my doctors. They were getting to know me, but it was all on this with this underlying assumption that I had incurable mental illness and that it was getting worse and worse to the point where I was treatment-resistant.

And so that story, I think infused the way I was seeing myself and the way my my doctors were seeing me as well. 

Bret: 
Yeah. So when you’re labeled as you are, treatment-resistance and gosh, it just seems so deflating. Like, you’re saying, this is my life and there are points where you’re, based on the story, where you were just willing going to give up. And tell us about your mindset about that, about being labeled treatment-resistant, but then also let’s eventually get to how you got past that and how you saw the light at the end of the tunnel and came through.

Laura: 
Yeah, so by the time I was 25, I had never been able to hold down a job or live independently for any stretch of time. My days consisted mostly of, if I wasn’t barely holding on a part-time job, I was in a program of some kind, partial hospital program or outpatient program, and my days were just, so my life had been reduced to this small, small fate of managing my illness and being good at getting my treatment.

And so I realized I’ve poured all these years of my life into this treatment, into being a good patient, into doing what my doctors are telling me will help me, not kill myself basically, and look where it’s gotten me.

I am trapped in a body that doesn’t feel like mine. I have no friends. I have no purpose. If this is all that’s in store for me for the rest of my life because I’m so sick that this treatment that I’ve been relying on isn’t even going to be able to help me, then what’s the point in being alive? And so I realized I can either just be in and out of psych wards and programs for the rest of my life, or I can kill myself.

And I ended up choosing the latter. And to this day, I hold that choice with a lot of respect because my decision to end my life made a lot of sense given the story I was believing about what my life would look like. And, of course, the problem was that I was believing in a false story. And, and so yeah, when I was 25, that was when I, when I I tried to kill myself and then it took me another couple years to have, what I think of as my kind of, wake up from all of that. 

Bret: 
Yeah. I really like the way you phrased that though, the story you were believing, but that was a false story clearly .Here you are having started a nonprofit and you were the executive director of that nonprofit, and you’re married and like completely different life.

So, clearly the story you were telling yourself of what your future was not true. But how do you know that in the moment? And that’s what’s so difficult and just heartbreaking about the position that you were in, especially when your doctors, like you said, they’re so well-meaning, they’re so caring.

But when their toolkit consists of just a certain number of tools that don’t work, like then what? So now looking back, I guess it’s a hard question, but what do you think could have been done differently now that you have the hindsight? 

Laura: 
That’s a great question. I think, of course, to go all the way back to the beginning, when I was a 13-year-old girl coming up against puberty, against an existential crisis in which I realized I didn’t know who I was.

I didn’t see the greater purpose in my life. I was just, I felt programmed to get good grades and be a good athlete, but what was the meaning behind it all? Those were the experiences that got me, or originally sent to a therapist, and I think what that message, what that action taught me, the message that it sent to me when I was sent to a therapist was that I was the problem and I needed to be intervened upon.

And so I think if I had, whether it was some older girls, maybe a few years older who’d been through their own crises, or it was just more visible in the cultural milieu around me, that it’s actually a really healthy thing to wake up at the onset of puberty and ask yourself like, who the hell am I?

What is this world I’m in? What’s the point to being alive? If I had seen that message somewhere that actually these struggles you’re having are really wise and meaningful and philosophical, really then maybe I could have hung in there and had the confidence or the curiosity to explore them further.

But I think because I felt this was in the mid nineties, no one was talking about this, these issues, I felt completely alone. My parents felt completely alone. It almost was inevitable that I’d get sent to a therapist. And then in terms of all the years of treatment, I think about all those kind therapists and psychiatrists, who I just, I think understandably were seeing me through their own very singular lens without stepping back to reflect on the trajectory that I’d been on, leading up to me meeting them. And, of course, they did at the level of, oh, your family relationships, your school, those shape how you feel.

So it wasn’t that they didn’t talk to me about my life, but they were just taking for granted that I had a disease in my brain, basically. Or at least that’s how I experience them. And from that premise, how can you grow and change and transform when you’re operating under the assumption you have a fundamentally defective brain that’s incurable?

Bret: 
And then especially when the medications being given to try and help that brain have so many other side effects and it, gosh, it’s just so hard to know, okay, maybe there were some beneficial effects of the medications, but when you pile one on top of the other, on top of the other, then the side effects mount up?

And then how do you differentiate symptoms of a mental illness versus side effects from the medications? And so eventually you are able to weather this whole storm or get through this whole jungle of symptoms and medications. And you said it was a couple years later that you had your awakening and then you get to the point now where you are now.

So. How did you get from your awakening to where you are now? Let’s get to that part of the story. 

Laura: 
Yep. So, it was 2010. I was 27 years old. I was on Lithium, Lamictal, Abilify, Effexor, and Ativan, which I thought of as a sophisticated. The word sophisticated was often thrown around somehow with my polypharmacy regimen.

I was going to day treatment every day at the hospital, all day groups. And around that time, I had three experiences happen that showed me a side of the mental health system i’d never previously experienced before, which is the power that mental health professionals have to strip a person of their basic civil liberties, basically force coercion.

And so I was made to take, first I was hospitalized when I wasn’t ready to be hospitalized. Then I was made to take a drug that I didn’t want to take. And then a little while after that, when I was super tranquilized by the drug I didn’t want to take, I slept through a therapy appointment and the police were called to do a wellness check on me.

And so these experiences dislodged my previously unquestioning faith in all of these mental health professionals to care for me. I just had assumed all along, this whole system is all about care and that’s it. And I realized it’s also about control and I just hadn’t seen that before. So that got me questioning my relationship. And then not long after, I began questioning my relationship to the whole system.

I stumbled upon a book by Robert Whitaker called Anatomy of an Epidemic, which for anyone who isn’t familiar with it, in a nutshell, is written by a medical journalist who makes the case that long-term use of psychiatric drugs is actually, on the whole, disabling us.

That if you actually look at the evidence base, first of all, you realize these drugs were approved on the basis of short-term trials that last on average six to eight weeks. Yet, most of us at this point go on to take them for years. There’s zero evidence base for polypharmacy, yet so many of us are on multiple drugs. If you follow people over time, on these medications, you find that they’re often getting worse, physically sick, metabolic dysfunction, cognitive issues, vocational issues.

And I read this book there, I was on five drugs and it all hit me in this agonizing and incredibly profound moment that, oh my gosh, what if it hasn’t been treatment-resistant mental illness through all these years? What if it’s been the treatment? And so at that point I clicked with a new emotion really that I hadn’t felt, and as long as I could remember, and it was curiosity about possibility.

Like what if it’s not just psych wards or suicide? What can my life become? And that began the rest of my life that’s brought me to where I am today. 

Bret: 
Yeah, and that’s such an important concept in anything, in medicine. You could talk about heartburn medications or psychiatric medications or even pain relief medications that they’re meant to be short-term.

They’re studied and designed to be short-term with the goal being, let’s find what the cause is so we can eventually get you off the medications. But no question, when someone is acutely psychotic or experiencing psychosis or experiencing mania or severely depressed, the medicines can have a profound role in helping that.

But that’s not the same thing as saying 20 years of this medication is going to keep you well. And what’s interesting for some people, they do well. But for many, they don’t. And that’s where this concept, like you’re bringing up, saying, okay, we’ve got you treated, but now let’s figure out what could be an underlying cause and see if we can get you off the medications and back to life.

So that’s the transition it seems like that wasn’t happening for you, but your curiosity brought this on for yourself. You’re curious, you want to explore this, you say you want to try and get off your medications. What was the response from your care team? 

Laura: 
My very large team at that time was not excited about the idea at all, and they managed to defer my withdrawal for a few months. And let’s talk about it next month, let’s talk it on it next month.

And then eventually I realized this is my body, this is my life. I’m not going to wait to get permission from them. And so I shifted my orientation to my doctors at that point and took back some power and agency after never having any. And I basically said, I’ve made the decision to come off, regardless of what you say, I would love your support, but I’m going to do it with or without you.

And so at that point, I would say they, my treatment team, allowed me to do it, but they were definitely not emotionally supportive. And I recall often feeling as though they were waiting for this to fail and me to come back so that they could say, I told you so. They were not invested in this for me at all.

So I really had to do this on my own and I had no idea what I was doing. This was back in 2010, so there was very little information available on tapering, how to do it properly. So I came off five drugs in basically six months, which is basically cold turkey having, thinking that was taking a long time.

And so I had a brutal experience, for me, not everyone. Some people can come off of these drugs and have minimal, if any, issues. But a lot of people, and we don’t know the numbers, it’s an area of needed research, a significant percentage of people do have a hard time. And the challenge is that for so many people, when they come, when they make the decision to come off their meds, they don’t realize that their central nervous system has become dependent on the drugs.

So that when they stop them, they’re going to experience, they experience withdrawal symptoms and those withdrawal symptoms often look like various symptoms of mental illness. And so people find themselves in a situation where they’re off their medication, they feel horrible, and then they say, oh, this, if this is who I am off of my meds, like I must need my meds, I’m going to go back on them.

And so I definitely felt I was already not doing well on drugs. I had a lot of adverse effects off the drugs. Everything went haywire and all my existing difficulties were magnified, and migraines, spontaneous vomiting, boils breaking out on my skin chronic either constipation or diarrhea. My metabolic function was, which had been, really poor for years, just went even more haywire, just paranoia, intense racing thoughts, horrible, insomnia. For a while, it was brutal, but that curiosity and really at that point, the outrage that I felt because the more I learned about the various beliefs I’d been assuming were true about myself that I was now learning maybe weren’t, the more angry I got. And so I just kept at it and I had the support of, I happened to be born into a family who could provide for me materially and take care of me. So I was able to make it through a rapid withdrawal, a rapid taper.

A lot of people aren’t able to and they end up reinstating, and it took a few years really for me to feel like I was living, which was a new feeling because I hadn’t felt that way since I was a kid for the most part. 

Bret: 
Yeah. So a couple points to really emphasize there. You said you went off five meds in six months, which felt like a really slow and long time, but really is the same as going cold turkey.

And I think we really have to emphasize that when you’ve been on medications for years and decades, that you don’t come off in months then, and I think that’s, or shouldn’t come off in months necessarily because of the withdrawal problem. So I think that’s really important to emphasize.

Before we continue, I want to take a brief moment to let our practitioners know about a couple of fantastic free CME courses developed in partnership with Baszucki Group by Dr. Georgia Ede and Dr. Chris Palmer, both of these free CME sessions provide excellent insight on incorporating metabolic therapies for mental illness into your practice.

They’re approved for a MA category one credits, CNE nursing credit hours, and continuing education credits for psychologists, and they’re completely free of charge on mycme.com. There’s a link in the description. I highly recommend you check them both out. Now, back to the video.

And then the next part is you felt like you were living, so you talk about diarrhea and constipation and headaches and nausea, but on the other side, you felt like you were living.

So tell us about that awakening, and tell us what that felt like. 

Laura: 
Gosh, I love talking about this part of my story. With the passage of time, I would say from one year off, two years off, three years off, my body slowly recovered. So my digestive issues slowly began to resolve, my sleep cycle returned.

I could tell my ability to handle stressors got increasingly more resilient. You know what? The parts of my central nervous system, GABA, my GABA system, the fight-or-flight response just slowly lessened an intensity and so all of those kind of physical signs of recovery and healing happened.

But really where the coming alive part, I think, happened most for me was in coming back into my body, which had been under the influence of so many potent drugs for so many years. And I have these vivid memories of moments where I’d be walking around outside and I’d suddenly look at my hands and I’d touch my fingertips and I’d say, these are my fingers.

Whoa, look at the snow. Look at the sun. And I wa it was as though I was seeing and feeling for the first time, and I hadn’t even realized I’d been missing it because it had been my baseline of just feeling numbed, disconnected. That was my normal, and what I thought was my illness.

So I think it was when I came back into my body and my vitality and kind of a reintegration of myself that I felt here. And I think the real freedom, recovery, whatever word you want to use, really came when I learned how to be with myself, which of course is at the heart of this whole thing. I, as a kid, was feeling such intense emotions and having such disturbing thoughts.

I, of course, as a kid, didn’t have the resources that I needed to bear that, to be with it, to process it, to work through it. And then all the years that followed, as I became more and more psychiatrized, I just increasingly lost the capacity to stay present with myself because I was so afraid of my pain. I was so afraid of my mind, so afraid of my suffering, and that fear just propelled me into the arms of the mental health industry and took me so far from myself.

And so I think it took a few years, but I would just literally just sometimes sit on my couch feeling walloped by my mind and these thoughts, and these horrible, this anxiety or the visceral sensations in my body of what was probably akathisia. And I would just say to myself, you just have to sit with this.

Sit with this. Sit with this. You’re strong enough, you’re strong enough. And I just practiced staying present, and obviously, no human being can just sit in suffering indefinitely. But once I realized I actually am strong enough and I don’t have to be afraid of my mind, that was all I needed to start living because I was no longer giving all of my power to these outside external sources, whether it was my pills, my doctors, McLean Hospital, New York Presbyterian Hospital, all these places.

I was now realizing I actually have what I need inside of me, and of course, you can’t do this alone. Mutual support was a huge part of my journey. Finding my way to other people who’d walked this path before me being of service to the people who were coming up behind me who were starting to come off their own meds.

So I didn’t do this alone, but. I did it independent of outside experts. It was really from sourced from within me. Yeah. 

Bret: 
And that’s such an important part though, about coming from within you, but with support because the way you describe those feelings of sitting on the couch with the akathisia is like, how does anybody get through that on their own?

That sounds so challenging, and just to believe that there is something on the other side, you really need to hear from others who have gone through it to support you, to believe that it’s worth it. And again, going back to the timeframe, it was years. It wasn’t overnight, it wasn’t weeks, it wasn’t months, it was years.

And to be able to have that kind of patience and that resolve for so long, I think that’s where the support really does come in. Transition now to what you’re doing? How you’re providing that support? How you’re giving back? How you’re providing for the community, the people coming behind you, like you mentioned?

Tell us about that. 

Laura: 
So a few years in to being off my meds, I should back up. Right around the time I finished coming off of my meds, I started a blog. I called it, at the time, Journeying Back to Self. And then eventually I renamed it, Recovering from Psychiatry. And I just basically was, I realized if I’m going to actually take myself back from this psychiatrized life that I’ve been living, I have to take my story back, too.

And I have to write my own story. If everything that I’ve been believing about myself might not actually be true, what is true for me and what actually happened, like what the heck just happened these past 14 years? So I started this blog, putting myself out there, trying to make sense of it all, and I began to hear from people all around the world.

And again, this was back in 2010, so there was very little public conversation online about all of this. So people found their way to me, people desperate for help, parents, spouses, people on meds themselves. And just over time, the more that I just basically helped people, but not from a place of credentialed expertise, really, from what have I learned on my own journey, what information have I read up on that has been helpful for me. What resources have I turned to? And I basically would just pass that on. That was what the help that I was offering looked like. The more I realized there’s something here I could actually, if I’m in a build an independent life for myself and people are reaching out to me for help, why don’t I start a consulting business?

And so I began consulting with people who were looking for information, resources, support. And eventually, having done this work for a few years, I realized at the heart of all of this is the issue of informed choice. I and my parents were never given the information that we needed to make a meaningful choice about any of this, and I realized nor is almost anyone else out there when it comes to being given a psychiatric diagnosis and being given medications.

And I thought to myself, how can I take what I’ve learned and the resources that I have at my disposal? Because I come from, because I have the really, at the heart of it’s a class issue.

I have resources I’ve been able to take all these years to rest and heal. I have my education. How can I turn all this into something that might help someone else? So I decided to start a nonprofit organization called Inner Compass Initiative that would basically give all of this information for free to people, everything that I was never given, and that would also help people connect with alternative ways to cope with their withdrawal symptoms or just with their struggles generally.

And perhaps, most importantly, that would help connect people to one another, to provide mutual support to one another. So the nonprofit we launched in 2018 and have been slowly growing ever since. And now you know, we have a big year ahead of us. I think the changing climate in our culture as more people wake up to the need for good information on tapering meds, for alternative ways to navigate distress. I think hopefully our nonprofit can help serve people who are wanting more in that arena. 

Bret: 
Yeah, it’s really striking how you say that there was such a hunger out there from people that people were looking for this information and reaching out to you. And so almost without even knowing you could serve this role for people because there was such a lack of information.

So yeah, fast forward to where we are now. I’ve been fortunate to interview a number of people on our channel here about withdrawal and tapering, whether it’s Dr. Horowitz or Dr. Yosef or even Dr. Georgie Ede. We’ve had a lot of discussions about tapering, but now you’re tapped into this whole community and this whole world of people trying to figure this out.

I’m sure there are so many, but what are some of the main lessons or some of the main take homes that you’ve learned from the community that you share as part of your support? 

Laura: 
So I think when it comes to lessons learned for people on meds themselves, if I was going to go back and talk to me back in 2010, what do I wish I could have told myself back then?

I think it starts with preparation and which starts with getting informed. So taking time to learn about the drugs that you’re on, reading the actual drug label, not the consumer pamphlet that you’re given at the pharmacy. Educating yourself about dependence. The fact that your central nervous system, if you’re on these drugs for any length of time, can completely reacclimate itself to the presence of this drug, such that when you try to come off of it can set off these cascading withdrawal symptoms.

Learn about what withdrawal might look like for you so that you can assess that risk for yourself. And then I think getting informed about the taper itself. What does it mean to taper slowly? And that slow is usually far much slower than people think. Some people can come off relatively fast.

And here I am, I came off five drugs in six months. It was incredibly dangerous. I would not recommend it to anyone, but people sometimes can and do get off going fast. But the trade-offs and the risks are so extreme that it’s a decision to really take seriously. So what does it look like to taper slowly? And then I think before you actually embark on your taper, really pausing, and this is usually when I’m working with people who are wanting to come off, I always start here with them.

What are the beliefs that you have about yourself, your suffering, your struggles, the meds, the word medication? What does that. What meaning does that have for you as opposed to psychiatric drug or psychotropic drug?

Look at your resources, your support system, the relationship you have to your prescriber. Look at your lifestyle. What food are you putting into your body? What products are you putting onto your skin and around you in your home? Are there tweaks that you can make? There’s so much work to do before you actually start the taper to optimize the chances that it will go well.

Then I think when it comes to the actual taper itself, the most important thing is that the person coming off the meds is in the driver’s seat of what the taper looks like. Because how the person feels along the way is what should determine the speed. And sometimes people say, I’m going to do my taper in 11 months. You have no idea how it’s going to go.

It’s possible that you could, it’s possible that you couldn’t. But listening to your body every step of the way, how are you feeling? How’s your sleep? How’s your mood? If things seem to be going south, that might be a sign that you’re going too fast.

So ensuring that the person is ready to take that responsibility for themselves, I think is really big, because at the end of the day, it’s all about agency. Personal responsibility, which when you’ve been a psychiatrist person like me at least feels like a foreign concept. 

Bret: 
Yeah, it’s a good point about having agency and personal responsibility, but like you said, it, for a lot of people it’s going to be foreign in the beginning and also feeling lost. Are my symptoms a recurrence of my psychosis in mania or are they withdrawal? So that’s an area where it’s so important to be working with your prescribing physician. But as with your experience, your prescribing physicians weren’t overjoyed with the concept of coming off the medications. And you had to put your foot down and say, I’m doing it with or without you. But so what kind of advice do you give to people to work with their prescribing physician, with their healthcare team to make sure it’s done safely, but maintaining agency, maintaining control, but not doing it completely on their own on an island?

Laura: 
Yep, in an ideal world, the prescriber gets fully on board emotionally and informationally with the taper. I will say to people, make sure that your prescriber really understands dependence and that dependence is not addiction. This is not about you misusing or abusing your meds.

This is about a purely physiological phenomenon in your body, and they need to be aware of that. Make sure that your prescriber understands about hyperbolic receptor occupancy rates and that the changes, in the dramatic changes, that happen at lower doses with smaller, if you’re up dosing a person on their med, you’re going to have dramatically more impactful effects on the receptors at lower doses.

And the higher you get, the more redundant drug there is basically. So similarly, when you’re coming down, when you’re helping your patient come down, it’s not about, It’s about keeping the rate of receptor occupancy decreasing as steadily as possible.

It’s not about decreasing the amount of drug steadily. 

Bret: 
So you don’t just go from 20 to 10 to 5 to off. But as you get lower, you have to go even slower because like you’re saying, the hyperbolic response and the occupancy rate percentage, yeah. 

Laura: 
And I think this is such a big thing for prescribers who I’ll often hear from people who say, my prescriber told me I’m only on five milligrams of drug X. It’s a negligible dose, I should be able to jump off. But when I try, I had panic attacks and they’re telling me I’m having a relapse. So this is such a key thing that prescribers really do understand that low subtherapeutic doses are actually from a receptor perspective, not at all the case.

And so I think so if the prescribers are willing to really get on board with all of that, that’s great. But oftentimes for understandable reasons, prescribers aren’t. They’re afraid of liability or they’re afraid of just not having the bandwidth or time or resources to help their patient, which is a very understandable concern.

I couldn’t imagine how hard it would be to be a psychiatrist who maybe sees my patient once a month, maybe even for 15 minutes, to take on that big, significant process of helping them get off when you’re only seeing them once a month. I totally get why psychiatrists are afraid of this. And so that’s where the support system around the person becomes so big because it’s a reassurance not just to the person coming off. But also to the psychiatrist who can say, okay, I’m not going to see you for a month, but I know you have your withdrawal buddies, you have your family, you have a lay person, consultant, or coach, or you have a good therapist who gets withdrawal. I got, I’m with you. I think it’s important to recognize that understandable fears that the psychiatrists themselves have and that they are in a hard situation. And that’s an actual, in an area where I think psychiatrists, and this would be a question for you.

I often wonder if the risk of liability was somehow removed from the table here, when it came to decision making around helping people taper off, how many more psychiatrists would be up for this? I think that’s a big obstacle, understandably. 

Bret: 
Yeah. it’s an excellent question.

There’s that old saying, unfortunately, sometimes you only get to be wrong once. If the result is someone dying prematurely, you don’t get a second chance. And so that fear is legitimate. That’s legitimate fear for a doctor. And yeah, I can see how they have to wrestle with that, but I really like how you’re saying you’ve got your withdrawal buddies, you’ve got your de-prescription buddies, you’ve got your community. Building that community I think is so important to take some of that off the physician because it’s hard work.

It’s easy to write a prescription. It’s hard work to walk somebody through day by day, week by week, coming off prescriptions. But if they have that community, if they have that support, you can take some of that off the physician and make it just a smoother process, in general. So I really like how you explain that.

And then I got to ask, there are questions of what can help support people physically, what can make it easier? And so our founder, Jan Baszucki, put out a post on x or a quiz, sorry, a poll asking, do you think ketosis has made, can or has made it easier to de-prescribe and come off medications?

And the majority of people said yes. Now, it’s not a randomized controlled trial, but it raises the question and there’s some potential physiologic mechanisms of how that can be. What do you think when you hear something like that? Like maybe the changing your diet and getting into the physiologic state of ketosis might make de-prescription and tapering physiologically easier?

Laura: 
it’s so interesting because in, so in the past 15 years that I’ve been doing this work, and especially I would say in the last 8 to 10, I have seen so many people in the withdrawal community find their way to, not necessarily full keto, but removing gluten and dairy paleo. This began about 10 years ago.

I would, I saw more and more people saying, whoa, when I removed gluten, dairy, processed sugar, inflammatory foods for my diet, like everything became so much easier to manage. My withdrawal symptoms weren’t as intense. I’m feeling like I’m healing faster, all of that, and so to watch Metabolic Mind and the broader metabolic psychiatry movement, really taking shape in recent years has been so exciting to see from my perspective on the outside, so to speak, of working adjacent to the mental health system.

Because in my own life, I didn’t mention this, when I was talking about how I coming alive at three years in, that was also the year that I got really serious about what I was putting in my body. I was so destabilized up until that point that binge eating processed sugar was sometimes all I could do to make it through.

But by the time I was a few years in, I had healed enough from pharmaceutical trauma really that I was able to actually start making better choices for myself, for my body about what I was putting into it. And I removed gluten, I removed dairy. I haven’t ever done full on keto. I’m like totally open to it at some point once I’m through breastfeeding, toddlerhood, all of that.

But I saw profound changes when I removed inflammatory foods from my body and that was just the first layer of the onion for me. Because then I began to realize how much power I had in the choices I was making, not just about food, but about everything that I was engaging with on a day-to-day basis in my household, consumer products more broadly, I realized there’s so many, there’s so many things that we engage with on a day-to-day basis that we don’t even realize are disrupting our natural vitality as human beings.

And so my philosophy became, and to this day is as much as I can in this modern world, what did my hunter gatherer ancestors, what would they have done in this situation?

And now, plus can I get back to replicating that basically? 

Bret: 
And not just how they ate, because it’s dramatic the impact food can have, but moving your body on a regular basis. You don’t have to run a marathon. Move your body on a regular basis. Sleep, wake cycle, circadian rhythms, all these things which you know, I’m sure doctors are aware of and probably at some point gave some lip service to you, might want to improve your diet and improve your physical activity.

But that’s very different than saying this is crucial to your care or your tapering effect. And this is going to have a dramatic impact on your body and your mind. Really elevating it to the top level of care, I think, is so important. So I’m glad that you’re seeing that experience in yourself and in others.

Yeah. 

Laura: 
And it’s such a good.. 

Bret: 
Yeah. Go ahead. 

Laura: 
Oh, sorry. No, please. I was just going to say, it’s such a good point, Bret, because my mindset through my entire time as a psychiatric patient was that lifestyle, oh yeah, that’s nice. Sure, sure. Get moving my body. Sure, sure. Eating well.

But do you not understand that I have a serious brain disease here? What is that really going to do for me? I was convinced that I just was at the mercy of faulty brain pathology, that all of these little lifestyle things, ah cute, okay, whatever. But what is that really going to do for this brain disease?

And so I think that shift away from this reductionist, chemical imbalance, oh, it’s just unfortunate, faulty brain pathology to this much more complex context dependent understanding of suffering and emotions and the mind, especially with what you’re putting in your body, which is literally the seed of your consciousness.

It’s just, it’s a profound, simple shift that has life changing impacts. 

Bret: 
Yeah. I think that is a great way to end it with that just powerful statement that you just had and about the lack of belief or lack of agency in yourself. Like it’s a brain disease, how is this going to help?

But no, we have to completely reframe that whole discussion and thought process and I really like how you said that. So you mentioned your book coming out, and you mentioned your nonprofit. So where can people find you to learn more about your story and about your support systems and communities?

Because it’s so important. 

Laura: 
Thanks, Bret. So you can find me at my website, lauradelano.com. My book. Unshrunk: A Story of Psychiatric Treatment Resistance is available at all fine booksellers shortly. We’re in end of February here, so by the time this is up, maybe it’s even already out. Our nonprofit, Inner Compass Initiative, you can find at theintercompass.org.

And in addition to a lot of information about diagnoses, medications, tapering withdrawal, we also have a community called Inner Compass Exchange, which we host on Mighty Networks, and it’s a really wonderful place to find other people who are on this journey away from what you know, psychiatrist or this reductionist way of understanding themselves, as faulty brains basically needing meds for life. And I should say, make really clear that we are by no means anti-medication.

This is about informed choice and about getting what you need and knowing all the options on offer to you so that you can decide for yourself. Given your own life circumstances, your own resources, your own needs, what the next best step is for you? Which may be medications, it may not be. We’re totally agnostic on that.

Our only agenda is ensuring people’s choices are informed. So we hope you’ll join us there and and it’s such an honor to be on this channel with you, Bret, and the work you’re all doing is so disruptive to that reductionist brain pathology model and I’m really excited to see where you all go in the coming months and years in this really exciting time.

Bret: 
thank you so much, Laura, and thank you for sharing your story and being so personal and taking that experience to really help others and give back to the community. It’s so vital and so needed and just so impactful. So thank you very much, and we’ll link to your book and we’ll link to your website because people definitely need to check you out and learn more.

So thanks again. 

Laura: 
Bret, great to see you. 

Bret: 
Thanks for listening to the Metabolic Mind Podcast. If you found this episode helpful, please leave a rating and comment as we’d love to hear from you. And please click this subscribe button so you won’t miss any of our future episodes. And you can see full video episodes on our YouTube page at Metabolic Mind.

Lastly, if you know someone who may benefit from this information, please share it. As our goal is to spread this information to help as many people as possible. Thanks again for listening, and we’ll see you here next time at The Metabolic Mind Podcast.