The Truth About Tapering Off Psychiatric Medications

Bret: 
If a patient walks into a doctor’s office and the doctor says, look, the guidelines say that your taper in your withdrawal should be very mild and short-lived, and then you have the exact opposite experience. You think, what’s wrong with me? 

Anders: 
If the document says that a withdrawal reaction is mild and brief and it lasts about two weeks, and then it mentions five to eight of the 80 different symptoms. We’ll get back to that. The list is long. Obviously, once those 14 days have passed and the symptoms have not resolved, then you’ll start thinking then it’s not withdrawal. And then you could categorize and then exactly what you said, it happens, then it’s me, then it’s a relapse.

Maybe there’s something’s wrong with me? And a lot of the work that we do in this community, us who help people off drugs, reversing that idea, cleaning up after psychiatry.

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.

If you’ve been on psychiatric medications for months or years and are thinking about coming off them and wondering how to do it safely, and what are a lot of the emotional and physical considerations, then this podcast is for you. I’m joined by Dr. Anders Sorensen, who’s a PhD in Denmark, who specializes in helping people come off of their psychiatric medications.

So, this isn’t to explore if you should or if you shouldn’t, but if you’ve made the decision to do it, he has some fantastic advice, both sort of the biological and physiological aspect of it and the emotional and psychotherapy aspect of it, about how to safely come off medications and then what to do once you’re off the medications because the journey doesn’t just stop when you’re off the medications. 

So, this interview with Dr. Sorensen I think is going to be helpful for so many, but just the quick disclaimer, this is not medical advice. We cannot tell you how to do it, but we can certainly give you general ideas and information to explore with your prescribing physician.

So, I hope you enjoy this interview with Dr. Anders Sorensen.

Dr. Anders Sorensen. Thank you so much for joining me at Metabolic Mind. 

Anders: 
Of course I’m honored to be here. 

Bret: 
Yeah. So I’m excited to talk to you about psychiatric medication withdrawal and tapering, and there’s so many important points to highlight in this discussion. Yeah, but first, before we get into all that, give us the high level who you are, why we’re talking, why I chose you to talk about this important topic.

Anders: 
Yeah. I don’t know why you chose me to talk about this. 

Bret: 
Good point. 

Anders: 
But I’m a Danish psychologist by training with a PhD in psychiatry, so that’s a funny hybrid. So I’m trained as an ordinary clinical psychologist doing the therapy work, the clinical work. And then I stumbled upon this area of research of problems coming off these psychiatric drugs.

So what I do on a daily basis is in my practice in Copenhagen, is I help people off psychiatric drugs, through withdrawal and onto the other side. That to me, and I’m sure we’ll get back to that, involves at least, two things. The actual taper, like the way to come off the drug without coursing severe withdrawal.

So the actual taper of reducing the dose down to zero, and then managing what’s beyond, like managing emotions, traumas, thought patterns, whatever arises without medication as a strategy. So, for me, coming off psychiatric drugs means both, and my work focuses on both. 

Bret: 
So, I definitely want to get into all of that, but again, first give us the background of why you chose this for your area of research in clinical practice.

Anders: 
Yeah, so it was really an observation and now here we’re 10 years back when I started practicing therapy where, long story short, what I was trained to do as a psychologist, and the emotion and the cognitive work, we wanted to do the trauma work was I found it struggling, difficult to do the work with clients on medication.

That’s not to say one is good and the other is bad, but there is some incompatibilities between the pharmacological and the psychological solution to emotional suffering. So, I just found it difficult to work with people’s emotions, for example, if they were not there due to the medication. And we can call it symptom reduction as much as we want.

And obviously it’ll feel relieving to have a kind of distance to our painful stuff and like it suppressed, numbed a little bit, but that’s not the same as the long-term solution. So, really it was just an observation. I found it hard, honestly, to do the work while there is medication in the picture.

And that’s when I, pretty early on, started helping people come off these drugs. And now we’re 10 years back where there was even less information on how to do that. And it was in that moment that I just realized in front of my eyes that these drugs were way harder to come off than I was just taught at university and that my clients were taught by their doctor.

So there was something off there like it just didn’t resemble anything what was in the books. And it was that very clinical observation that put me down this road, long story short, I decided to trust my clients, like the symptoms they described when trying to come off these drugs didn’t resemble what we were taught.

So that opened up a curiosity in me and that led to a PhD and the book and the work I’m doing now. So, I’m on the same path I started 10 years ago. 

Bret: 
Yeah, so that’s a great description of what brought you into it. Now one thing we have to get right off the bat is we talk about psychiatric medications as if they’re all one thing which they aren’t, right?

There are many different classes, many different effects, beneficial effects, side effects. And you also talk about short term and long term effect of psychiatric medications. So one of the things, maybe a misconception or a misunderstanding, when people talk about tapering and withdrawal and getting off medications, the assumption is psychiatric medications are bad, getting off medications is good. And it’s not cut and dry. So, give us a little bit of your perspective on that. 

Anders: 
Yeah. So first to say, I’m not here to, and frankly none of my colleagues in the field are here to, demonize psychiatric drugs, nor are we here to glorify coming off them.

People can have many reasons to come off them, but I think the field is slowly recognizing also on a political level that Intervening in someone’s brains with the chemistry, it’s a pretty deep, personal intervention, like people will have a say on whether to continue or not. As I said, I found it difficult to do the therapy while it was medicated.

So, that’s like from a clinical perspective, there’s an element there, but I’m not here and not even in my daily practice, not here to, tell people to come off. I’m just here to help when people, for whatever reason, want to come off and struggle in doing so for whatever reason, it might be withdrawal, it might be replacing the drug with something else. 

Obviously, if you’ve been used to, now I’m saying it at a broad sense, to having your emotions numbed, distanced, altered, whatever the drug does, good or bad, that transition to feeling it again, the emotions can be a tough transition, but also a beautiful one, a liberating one.

Yeah, and I don’t know if I’m going off track here, but it’s not about good or bad. And one very important message is that even when psychiatric drugs have been helpful for a person, even if they made lifesaving, they can still be tough to come off. It’s not the same equation. Like you can definitely take a drug that helps you a lot, but don’t be mistaken, your body fundamentally does not like it. 

It adapts regardless of what we think about the effect. So we can definitely separate the two questions of good or good versus bad and how to come off. Yeah. I hope that makes sense. 

Bret: 
And interestingly, I think the flip side of that is even more important if you started a medication Yeah, and it didn’t really help you, it still can be very challenging to come off, even if it didn’t help you all that much. So both sides. Yeah. 

Anders: 
It could be difficult because there are two completely different mechanisms at play. The body adapting to it, therefore needing gradual taper once you come off it, which we’ll get back to.

Yeah, but it can also be hard to come off even if it did not work. Had no effect or was clearly like doing, making things worse, which unfortunately is for a lot of people. Yeah. Yeah. 

Bret: 
Now, there are a number of concepts to explore, but one you already mentioned and what the research says about coming off of psychiatric medications versus sort of the experience of your patients and the community experience.

Yeah. So tell us about that disconnect. 

Anders: 
Yeah, so the disconnect is pretty straightforward really. It’s not that complicated because much of the definitions we have about what the withdrawal symptoms are, and we’ve looked at the, that was part of my PhD project to do a systematic review of guidelines.

So, I’ve looked at a lot of guidelines from all different countries, takes a lot to read them, but it’s interesting and you really get into the depth of things. So, the descriptions of withdrawal symptoms tend to be very mild. It would be sentences like mild and self-limiting or short lasting words like brief and mild.

And these are standard descriptions as you would find in most countries’ guidelines. Now those descriptions date back to short-term studies in the nineties. So, it is true that if you’ve only been taking a psychiatric drug for the eight to 12 weeks, that most clinical trials which is a point in itself that’s obviously different from the years in GS p Protium.

Obviously, if you just define the withdrawal symptoms from eight to 12 weeks of usage compared to the real life use of many patients, you’ll get a disconnect. And that’s what happens, really. And what we’re trying now and what’s happened in some countries, and I’m fighting the battle mainly back in Denmark here, is to update those guidelines.

And you would be amazed, or maybe you wouldn’t, about how hard that is to just present the evidence, present what’s in the guidelines, point out the disconnect and say, how do we get this evidence over here? It’s a machine to change that. 

Bret: 
Yeah. But, and I think that’s so important though to point out how the guidelines are framed in that they were created off of these short-term studies. Because if a patient walks into a doctor’s office, and the doctor says, look, the guidelines say that your taper and your withdrawal should be very mild and short-lived, and then you have the exact opposite experience. You think, what’s wrong with me? Or you might think I really need these medications and one doesn’t always equal the other.

So I think that’s so important that you point that out. 

Anders: 
Yes. That’s the problem in a nutshell because, and medicine, our doctors need to know a lot about a lot of things. Need a lot about much more than we others. So, they’re very reliant on guidelines. That’s how that specialty is built up. It wouldn’t work if each doctor had to plow through all the scientific literature.

Every time they saw something, they need to rely on guidelines. So, those documents are extremely important. So, if the document says that a withdrawal reaction is mild brief and it lasts about two weeks and then it mentions five to eight of the 80 different symptoms. We’ll get back to that. The list is long.

Obviously, once those 14 days have passed and the symptoms have not resolved, then you’ll start thinking then it’s not withdrawal, and then you could categorize. And then exactly what you said, it happens, then it’s me, then it’s a relapse. Maybe there’s something’s wrong with me and a lot of the work that we do in this community, us who help people off drugs is reversing that idea, cleaning up after psychiatry, I would say. And it’s a very sad moment for a lot of people. Imagine having done a lot of therapy, therapeutic work with yourself. Maybe you’ve changed some habits, maybe you’ve changed your life.

You’ve done a lot of good stuff for yourself. You’ve finally reached the point where you feel like dropping those drugs and coming off it can be a major step for people. Really, it’s a positive hope expecting good things, really being ready. And then just because you taper off too fast, because that’s what the guidelines say, all that story is just being completely turned around.

It’s, sad, really. 

Bret: 
Yeah, and I want to get into both the sort of mechanistic parts and the real life clinical part. But one of the interesting things I’ve heard you say about the mechanism is that the sort of at its core, drugs are synthetic. The brain is homeostatic and that sets up this challenge.

So, explain that for the average listener, what that means. 

Anders: 
Yeah, they’re synthetic in the sense that they’re not natural. They’re not naturally occurring in nature. They’ve been synthesized in labs, meaning put together by different compounds. That’s just what synthetic means, to mimic or alter the brain’s normal neurochemistry.

So, while serotonin and dopamine and histamine and GABA and all these different neurotransmitters, they’re natural, of course, but the drug itself isn’t. And it’s not that there’s serotonin in the drug, for example. And no, no one would say that there’s something in the drug in most antidepressants that makes the brain’s own neurotransmitters either increase or decrease.

And that’s what I mean by synthetic. And now the problem is to put it like, in a digestible version, the body knows that it realizes that we’re introducing an external substance. So, therefore, it starts fighting it, you could say adapting. It starts doing the opposite of what the drug does, and that’s what sets the ground for the withdrawal.

So yeah, just to get the basics. All psychiatric drugs, and obviously you mentioned that before, there are different categories. There are fewer categories than we would think, but there are definitely different categories, antidepressants, antipsychotics, antidepressants and antipsychotics, stimulants, and mood stabilizers.

It’s like the main ones and benzodiazepines. And while they influence different combinations of different neurotransmitters, it’s one overall principle. That’s what makes it so simple. So the blood, the drug is designed to penetrate the blood brain barrier, is what it’s called.

That’s there to regulate what enters the brain and what doesn’t. That’s what makes them work. So it enters the brain, either increases or decreases different neurotransmitters. They affect emotions, cognitions, bodily functions to different degrees. But it’s the same principle, and that goes for coming off it, too.

If you keep turning up a certain neurotransmitter for long, your body adapts and that’s really where withdrawal comes in. 

Bret: 
Yeah, and I like the word choice. I think is very interesting because you said the body will, which one, you said the body will fight against it or the body will adapt to it. So it’s the same process, but you could describe it in two different ways.

So, I think that’s really interesting. But how does that present clinically? Or does it present clinically? Yeah, as your body adapts to it or fights against it, how would you feel that or how would you change? 

Anders: 
Yeah, so, there are a lot of different words like fight it and adapt, I would say is the same.

It just means that we can’t just keep turning up or down neurotransmitters without the body adapting. Just as we can’t inflict heat on the body without it’s starting to sweat, like it’ll do stuff to regulate it down. And there’s also a limit as to how much cold you can introduce to the body without it starting to shiver and generate heat.

So, these are just examples that the body will do something to stay in the middle. It really likes to stay in the middle. It’s a homeostatic mechanism. The expressions of withdrawal then is two different things. That the body adapts does not mean that the effect fades necessarily. So, adaptation or what we could call dependence, physiological dependence, and tolerance are not the same thing.

So, with benzodiazepines, for example, for most people there will be a limit as to how long you can take them and still have an effect. You’ll lose the sedating effect after maybe a couple of weeks, and then you’d have to increase the doses. Now, there’s a little bit of debate whether that happens with the antidepressants or the antipsychotics.

I see it very rarely, I must admit, that you can definitely stay on an antidepressant or an antipsychotic for years or decades and have an effect. May change a bit, but the effect is still there. That doesn’t mean that the body hasn’t adapted. These are two very different things. Adaptation just means to use another normal word that the body has come to expect it because it’s a lazy system. It’s a primitive system. It’s constantly, whether that’s biologically or psychologically, it’s constantly trying to figure out what we’re doing to it, and then it just sets that course. 

Bret: 
So to bring this back then to the tapering, when you’re tapering the medication, you’re not only decreasing the dose of the medication. So, you’re not only just like changing the medication, but you’re also now changing the medication in an adapted brain. So, you’re decreasing the effect of the medication and you have to give time for the brain to readapt. So, it seems like that’s what can complicate the taper process as you describe it that way.

Anders: 
Yes. That’s where the idea of tapering comes in. So if you push a biological system like the brain in one direction, whether increased or decreased, doesn’t matter. Your body will have adapted by doing the opposite. If we increase serotonin, it will lower its sensitivity to serotonin. It’s called a down regulation.

It means that our body is basically saying you turned up the volume, i’ll put in earplugs. I’ll do something to reinstate the homeostasis. But from that point on, the body is just in a literary sense, dictionary sense depended. It now depends on you taking the drug in the same dose because if you change it, then the body has to change its balance too, and that’s what takes time.

So, withdrawal, really, one way to understand it is withdrawal is just a consequence of a drug leaving the body faster. Then the body can adapt. So there’s a time gap, and that’s where the idea of introducing a series of small steps for the body to get down to zero comes in instead of just stopping.

Because if you just stop from one day to the next, you’ll introduce for most people after long-term use too dramatic at change. Like the body has been used to this coarse, you’re going this way and withdrawal symptoms in that situation is pure communication from your body saying, hey, this was too much.

And it’s basically trying to get you to take the drug again. And if you do that, then symptoms will stop provided you take it within some window of reinstatement. We can maybe talk about that later. So, it’s communication, and you see this is what causes problems for people. You stop a drug, you get unwell, you start it again, symptoms for resolve. 

Now that creates this illusion of effect. The drug is still needed, and I should say at this point, this does not mean that the drug was not at once helpful. It could have been helpful at one point in your life. Then you could have fixed wherever that was, and now it’s creating this illusion because every time you stop, you get symptoms.

Ironically, those symptoms for most people, will not show when you taper off more slowly. That’s the whole idea, right? 

Bret: 
So, the concept then 

Anders: 
Does that make sense? 

Bret: 
Yeah, oh yeah, I think that makes complete sense. And it’s so important to understand because you could see how somebody would be like, oh, I must really need this medication because of that before and after effect. And, thus, the recommendation to go slow taper little bits and go slow. But that advice isn’t so helpful because it’s so general. But you can’t get formulaic to say two weeks reduced by x percent, two weeks reduced by x percent is not that formulaic. So it’s in between. So how do you work with people to help them better understand for them what slow means?

Anders: 
And what would usually happen without this information is that you go back on the drug and the story will be, okay maybe I’m not ready yet. Then that’s why I got symptoms. And then to do a lot of work and then return to tapering maybe a month, maybe a year after. And then just experiencing the exact same circle until we introduce an idea of maybe it’s withdrawal symptoms instead of a relapse.

Whatever relapse is. We can talk about that, too. But just to have these two overall categories, either it’s withdrawal, is your body’s signal to slow down. You’ve made too big a step, or it’s some underlying state that resurfaces and we could talk about later what that means then. So, now the idea is simply to taper slower, and I don’t really like the word slower that much because it’s not necessarily the time that’s the factor.

It’s the steps. It’s how gradual you do it. It’s how much you reduce the dose at a time. And this is where it gets a little bit complicated because yes, we cannot, and we will never be able to put up rules, like rigid rules, saying reduce by this or that many percentages every this or that week because how much we can reduce the dose without causing severe withdrawal. And I’m saying severe withdrawal because there will be withdrawal symptoms for most people.

The job, the purpose of tapering is, obviously if we can avoid them completely, that’s the goal. But for most people, it’s about minimizing them to a level where we can manage them. So, I’m saying with symptoms, not severe withdrawal, now how much you can reduce the dose to not cause severe withdrawal depends on what dose you’re at.

So, if you’re on a high dose, and this is where we could, if I could show you the occupancy curves, this would make sense, very visual, you can see that at very high doses, you can actually often cut quite a bit of chunks off your drug without causing withdrawal. And then there will be a point at moderate to set lower dose in bunny ears because they’re not low doses.

That’s the whole point. So, there will be a point where when you make a reduction, even though that reduction was not in terms of milligrams, bigger than the previous one. It suddenly hits harder because you’ve gotten down under that plateau on the occupancy curve. So, just to put an example, say you’re on a hundred milligrams of something and just translate it into whatever dose range your drug comes in.

If you’re on a hundred milligram and you taper down to zero by removing 10 at a time, meaning 90, 80, 70, 60, don’t do that. But if you were to do that, we have to understand that the next 10 milligrams remove are, in fact, stronger than the previous ones, even though both were 10 milligrams. So, for most people around, it could be anywhere between 30 and 60.

That’s the range for most people, I trust you. Those 10 milligrams, there will be a point where they suddenly hit much harder. And that’s because of the, that’s because you’ve hit the steep end of the curve. So, another way to say it, I hope this makes sense as a way, this doesn’t mean we don’t have anything to navigate by.

It just means it’s really difficult to set up rigid rules that apply for everyone. So, what we do know with absolute certain is there will come a dose where you will need to slow down and go very slowly or small reductions in the three to 10% reduction range. I don’t like these rules of thumb, but if I were to say something, it would be between the three to 10% dose reductions of your previous dose.

That’s where most people seem to be able tolerate or that’s where most people’s bodies would allow them to, I would say in that way. 

Bret: 
So, this is what a lot of people refer to as the hyperbolic tapering. 

Anders: 
Yes it’s hyperbolic tapering and it’s called that because of the shape of that curve.

So, you’ll see if there’s a a massive difference between taking nothing like zero milligram and a couple of milligrams, like it’s really potent drugs, and then that effect kind of tapers off the higher you go. So, another way to say it is that the majority of the effect of a drug is in a very small portion of the dose.

So, that dose must be tapered slower, and that’s what confuses a lot of people when you reach the lower doses. Maybe your doctor, ill-informed as many of them are, will call that a low dose. You could just stop. It’s just a low dose. It’s a placebo dose. So I’ve heard now, in fact, what we were able to show in these brain scans, we did a systematic review on the of neuroimaging, was that there is a huge effect of these small doses, and this is hardcore brain neuroscience like it’s bulletproof.

We could just measure an effect. And what I liked about that was that the withdrawal community has known this for decades. They’ve known that we need to go below the smallest available dose. Even half, even quarter of the smallest dose you could buy at the pharmacy is too potent for you to take the jump down to zero.

So ,they knew that we want, need to dissolve or cut or weigh or count beads way before academia did. And they’ve been historically like laughed off, like not taking serious that just the patient sitting with their little files really horrible, but now it was possible to show that they were right.

And I love what that happens every time because we could show there’s an effect of it. The drugs you can buy at the pharmacy are not made for tapering. They’re too potent. So you need to split them into smaller units yourself. And there’s a whole, and I go into very detail about that too in my book, and there’s a lot of details about that, online on how to do it because it has to be very precise.

Bret: 
And that’s what a lot of doctors unfortunately won’t offer. And that’s the disconnect. 

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But you made a reference I want to circle back to. So, you talked about the mild withdrawal symptoms, which you expect and can work with versus the severe withdrawal symptoms, which are the more concerning ones that you don’t want or just work with. So, tell me, tell the listeners, what are the differences there? What are the symptoms they may experience that you consider mild versus the more severe ones?

Anders: 
Yeah, obviously, there’s no objective measure of that. It’s a personal thing to decide whether you’re going to go through the symptoms you get, and endure them and manage them until they resolve whether the body adapts or whether you have to reinstate and go a bit lower.

But I would say for the very severe withdrawal symptoms, and you won’t doubt it if you have them because they’re very severe. Don’t play hero. Don’t tough it out because we know way too little about whether they can become permanent or at least last months or even years. We know they can do that.

So, if you, for example, like akathisia is the major one, it’s Greek for can’t sit still. It’s a medical term to describe the state where inner restlessness doesn’t suffice. It’s too low level of work, but it’s a kind of inner restlessness, anxiety, panic, feeling that some people describe as wanting to crawl out of their own skin, but not being able to, and that’s why you would find them constantly moving as the only solution to just relieving it a bit.

So, that is, obviously, don’t endure akathisia. Go back up. Give your body what it wants or meet it halfway and then go down slower. It’s communication from the body, obviously, if you find it very tough to sleep, very suicidal thoughts, very depressed. All of this can be withdrawal symptoms. A lot of pains, like very dizzy in a way that you’re unable to function.

Maybe that’s the cutoff for me, the threshold, whether the symptoms prevent you from doing your every day life. That’s where I put it most, mostly put it, that’s where, so, the symptoms may be the same threshold. 

Bret: 
It’s the severity of whether it crosses that threshold. 

Anders: 
It’s the severity. Yeah, it’s the severity. Yeah, exactly, and then it’s a personal decision, obviously within some limits, because obviously don’t play hero because they can become protracted in a way that the body will not accept the drug. Again, that’s the dark chapter of this, but back to the question, the level really, and the goal with tapering.

Obviously, is if we can avoid withdrawal completely, that’s the main goal. But because of how the drugs work at these very low doses, that can take years and years like so there definitely is an element of finding a level where the symptoms are manageable, meaning that you, know what they are.

It could be the same symptoms. It just wouldn’t reach the level of akathisia. It would maybe just be restlessness or anxiety or like a constant like jitter or or crying spells or tinnitus or a little bit of pain or some flu-like symptoms, forgot to mention those. A lot of the serotonins touch, so a lot of flu-like gastrointestinal symptoms.

But if you trust that they withdraw and say nothing about you, and that there’re just a transition between two doses, that if you overhear them for long enough, your body will adapt. And that’s when the withdrawal symptoms stop. So withdrawal is a sign that the body is trying to adapt from a step that was a bit too big for it to just go from one day to the next.

That’s why it needs to send symptoms for a couple of days or weeks. And then with the receptors are recalibrated, symptoms stop. So, if you can trust that and understand the mechanism, you’re not afraid of it. You have the support and you, and that’s where the psychotherapeutic element comes in, you know how to leave them alone. Like how to turn your attention outward and stay engaged in stuff. And that the symptoms tend to step in the background. That’s what we’re trying to go for if you ask me. 

Bret: 
Yeah. And you bring up an important point, the psychotherapy component of it. Not just saying, here’s how you taper and good luck, but working with the patient to help them get through it.

Yeah, and like their day-to-day experience. And that also leads me to the next question, which I really like that you talk about, and I haven’t heard as much of. There’s the taper part, but then there’s a what happens next once you’re off the medications? Yeah, and there’s this whole other chapter that is still part of it.

So tell us about that chapter. They’re off the medication so that you’ve helped them with through the taper and the withdrawal. Yeah, and now what? 

Anders: 
So that’s what I hope to bring to the conversation. I focus on both things, like how to come off and how to stay off. Meaning how to manage whatever emotions return.

Because remember, some of it is not withdrawal, like it would be too reductionistic an approach to take that everything when you stop a drug is withdrawal. All the emotions, all the symptoms, all the thoughts, everything, all symptoms just purely withdrawal. That would be to me too, as reductionistic and an approach a psychiatry does, calling it relapse, everything.

So, obviously, if you’ve been taking a drug that numbs your emotions, it’s not rocket science that when you remove the drug they resurface. It doesn’t mean that you just go straight back to the situation you were in years back. Most people have made changes to their life, so don’t hear this as saying that you get back to where you were, but you reconnect.

Or as I say in the book, you wake up to yourself and that can be a mixed experience depending on who and what you wake up to. And most people would describe that with some mixed feelings, like it’s mostly good. But it’s also not bad, but just unpleasant. Like it can be painful depending on where you wake up to.

And imagine just your own emotions. Emotions are strong stuff. They’re supposed to be because their signals. They’re trying to motivate us really. Emotion comes from even the Latin word emovere, which means to move. So, it’s even in the word they’re trying to motivate us to do things and there’s strong stuff, strong forces.

So imagine having been away from those, and maybe not completely away, but just having them numbed in one way or another or distorted and then returning, like even if it’s a completely normal emotional life, whatever that means, the transition can be tough. So, that’s where I use, I’m sure there are a lot of ways to do that.

I just happen to be trained as a psychologist. That’s where I use the psychotherapist to help people navigate that. And a lot of that work, obviously, we have a lot of fancy exercises and methods and stuff in the psychological toolbox, and they apply. But a lot of it is really talking to people about an emotion 101 almost.

What is an emotion? What’s sadness? What’s anxiety? What’s anger? What’s grief? What’s shaped it? But from a non-pathological point of view, like from basic affective science, I would say, what’s an emotion? I would usually use the metaphor of, hunger, for example. It’s pretty adaptive that hunger is unpleasant because it’s our body trying to make us seek out nutrition.

The body can’t move itself. It can’t walk up and get some nutrition. It has to motivate us to do it through something uncomfortable. It would be a silly mechanism, it was if it was pleasant. So, most people understand that our job is to decode it and do whatever the body is trying to tell us to do, just as we do with our babies and kids like they don’t have words yet, so we have to decode their behaviors. The exact same thing we have to do with ourselves. Now, hunger is pretty straightforward for most people, but emotions work in the same way. They talk in code, they try to motivate us to do things, and a lot of the work I would do often surprisingly often scaring.

Often I find myself sitting in a therapeutic chair talking very basic stuff about what emotions is because that helps people navigate it, and it changes your approach to the emotions. Returning also the painful ones when you understand where they come from and that fundamentally, however painful they are, all emotions want you, good, even pain, even anxiety, even anger.

So that’s a lot of the thing I would do in that because if you just have your emotions back and you don’t know what they are, you don’t understand them. Because for some reason we’re not taught in school, even though it’s forces that move all of us. And you don’t understand them and you don’t understand why you react to the world like you do.

Like you haven’t connected the traumas or the adversity you’ve been through and why you react in certain ways, like your triggers. Then it’s going to be one hell of an experience. Is not going to be a pleasant, and that’s really where the therapeutic element comes in, helping people navigate that.

Bret: 
Yeah, and I think that’s so important. We often say, yeah, it can be okay to taper, but taper to what? You don’t want to taper to nothing. Yeah, and replace it with nothing. And there are, you could replace it with many different things. So, obviously we talk about metabolic therapies and ketogenic therapies as a potential bridge or aid to taper or something to taper to. 

But therapy, psychotherapy is a very important part of that as well. And as your experience shows, can be a very effective taper, too. More work, something deeper work, and eventually more productive work in psychotherapy.

And so you mentioned how you found your work as a therapist challenging for people when they’re on the medications. And then how do you see them open up? How do you see the interaction and the effectiveness change when you now see them as they’re on, when they’re off the medications?

Anders: 
As long as you’re not afraid of the pain, it sounds so basic, but it’s important because they’re painful. So, our instinct is to fear it and rid ourselves of it. That’s the irony. We’re not motivated to do. What the emotions call for, we’re motivated for rid ourselves. The unpleasant element, meaning that we would be equally like immediately motivated as anything that could just remove the signal without providing what our bodies or souls or what to call it needs.

So, we’re also motivated by distraction or suppression or alcohol, drugs, rituals. Suppression of all sorts of things that work in the here and now, but only as long as we do it. And that’s really where most people get caught. Like I used the phrase to get caught in our own emotion regulation, like we get caught in short term strategies that harm us in the long run.

And reversing that is really the therapeutic element, as far as I see it. A major way to change is the, and this is many words, but the belief that there is an, so if we’re using fancy words, but an external or internal locus of control, we would say like the idea that you can control your own emotions.

You don’t get to choose what triggers you get and what emotions arise in you, what impulses or thoughts arise. That’s beyond our control. But how to manage that and what we do about it, and whether we do something, that’s completely within our control Now, it might not feel like that, and that’s really one of the definitions almost of what you in English call mental illness. 

We would call it emotional suffering in Danish, but this emotional suffering is when it gets, it feels uncontrollable beyond our control. That’s where we seek to outsource the element of control, whether that be to a drug or another person or an activity or a ritual or constantly staying busy, whatever.

Reversing that and finding like this inner control, which is there. Like our psyche can do amazing things if we know if we know how to use it. And that to me, I take the word psychotherapy very little, like it’s the study of how we can use our own minds, our psyche, naturally raw to regulate emotion and attention is a very, big thing there, like learning how to control your attention when you’re struck with strong emotion.

And the journey that most people take is they’ve been so used to doing it with a substance. They’ve been used to outsourcing that control and now they have to find it in themselves. And it can be extremely difficult at first, but very powerful and liberating, I would say, once you explore that. 

And like the whole third part of my book is an exactly a lot of psychotherapy. This is not to say, this is not to blame people for having so much pain that they need to suppress it with something. That’s part of why it’s so difficult. But the psychotherapeutic words work is finding that inner way of doing it, which is there. And ironically, a lot of that is really learning what not to do to our emotions.

Not grab onto them the painful ones and understand where they come from. Our job isn’t to make them go away. Our job is when we want to regulate them. Our job is to understand them and not feed them. 

Bret: 
Yeah, I think that’s a good differentiation. And I like how you talked about outsourcing. How outsourcing the feelings versus, internalizing it and addressing it internally.

I think that’s a good analogy there. 

Anders: 
Just to put it, what you said, like keto and stuff and lifestyle choices is also a part of the tapering to what, I don’t want this to sound that. Everything is just psychology and everyone has to go to psychotherapy and coming off the drug, but that’s just one element.

Obviously, lifestyle and nutrition are huge factors, and in fact, and that’s why I’m so honored to be here. The Diet Doctor, I think it was called, you were on that, right? 

Bret: 
Yeah, before, previously on the Diet Doctor 

Anders: 
Yeah. It was really, that’s the first resource I found back in 2017 when I first started keto.

So I really, I’ve experienced for myself how that, and there’s no way on earth that any of the psychological tools I know of would be able to fix that, how to say inner constant almost like a default, inner restlessness, subtle but all the time, when not on keto. Like I’ve had it my whole life. Starting keto was the first and only thing I’ve ever found that could make that not just go away, but disappear completely. This in, I don’t know how to explain, like an inner restlessness, constant jiggling, anxiety, I would call it before I knew that it was caused by diet. So, obviously, and if you don’t have that knowledge, you’ll start doing all your fancy psychotherapeutic attention training on that believing it’s anxiety when it’s in fact physiological.

So, in that way it’s, we need to work together. I just wanted to say that because 

Bret: 
No, that’s so important. Yeah. It’s such a great example, and that’s why we don’t just want dieticians and psychiatrists to understand metabolic psychiatry and ketogenic therapy. We also want therapists and counselors to also understand it because it, the two can work so synergistically together.

 I think that’s a great note to end it on. And look, I think this has been a great discussion, with a lot of really good description of how things happen and take home points of how to manage it. But of course, none of this is medical advice. This is all just sort of general advice for people to talk to their prescriber or to find someone like yourself who’s an expert at helping people taper. 

And you’ve referenced your book a couple times. So Crossing Zero: The Art and Science of Coming Off – and Staying Off – Psychiatric Drugs, which at the time of this recording is publication is coming soon. But where else can people find you and follow you, if they want to learn more? 

Anders: 
Yeah, that was a good question.

Most of my work and writing has been in Danish so far, but I’ve just actually with this podcast that this tour I’m doing now launched a Substack called Crossing Zero. It’ll be launched by the time this is out there. And an X profile, but there are no subscribers yet because I just made them. This is like my entrance into the international conversation.

Obviously, all my academic papers are in English and there are some webinars and stuff out there, but most of my work is in Danish. So really if people found this helpful or curious in any way, please come join me at my X and Substack. That’s where most of my English content will be. 

Bret: 
Great I really look forward to seeing all that content as you create.

Yeah. So thank you so much. 

Anders: 
Perfect. Thank you for having me. A pleasure. 

Bret: 
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