Mental Health and Deprescribing

The causes are layered

Mental health symptoms rarely have a single cause. They usually sit across several interacting layers: biological, psychological, and social.

The biological layer includes factors such as nutrient status, thyroid and hormonal function, gut health, inflammation, and sleep. The psychological layer covers thinking patterns, coping strategies, stress, and past experience, including trauma. The social layer includes relationships, work, finances, isolation, and the broader conditions of someone’s life.

These layers influence each other. Two people with the same symptom can have very different underlying drivers. My focus is on understanding what is contributing for the individual, rather than defaulting only to medication. This means working carefully through the relevant layers to form a clearer picture and a more targeted plan.

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Coming off medication, carefully

For some people, the work includes carefully reducing or stopping antidepressants or other psychotropic medications when it is clinically appropriate. This is a particular focus of mine. It is rarely as simple as stopping.

Withdrawal effects are common and can include dizziness, disturbed sleep, increased anxiety, low mood, and sensory symptoms such as "brain zaps." These effects are sometimes mistaken for a return of the original problem, which is why a slow and well-supported process matters.

The way the dose is reduced is important. The relationship between dose and effect is not linear, so reductions that appear small on paper can have a significant impact at lower doses. I use a gradual, staged taper that is adjusted according to how the person is actually responding, rather than following a fixed schedule. This allows time for the system to adapt at each step.