Strategies for Tapering Off Antidepressants with Dr. Julie Holland

This episode of the Plant Medicine Podcast is the second conversation in a three-part series with Dr. Julie Holland. Dr. Holland is a psychiatrist specializing in psychopharmacology, and she is also the author of many books, including her most recent work Good Chemistry: The Science of Connection, from Soul to Psychedelics which discusses the neurochemistry behind human connection. She is also a medical monitor for several MAPS PTSD studies using MDMA-assisted psychotherapy and has worked for decades on US drug policy reform based on harm reduction principles. In addition to this work, Dr. Holland has nine years experience running a psychiatric emergency room as an attending physician on the faculty of NYU school of medicine and she continues her psychiatric work in her private practice in New York City.

In this episode, Dr. Holland talks specifically about the nuances of antidepressants and psychedelic medicine. As is commonly known, many prescription antidepressants have contraindications with various psychedelic compounds, meaning there are concerns regarding how people taking such medications will be able to also access psychedelic-assisted therapies.

Dr. Holland discusses the specific contraindications for individual psychedelic medicines and suggests some strategies for safely and effectively tapering off antidepressants in consultation with a medical professional. She suggests various wellness practices, such as regular exercise, as particularly helpful during the course of tapering, and even mentions situations where an additional antidepressant is prescribed to support the tapering process, stressing the complexity and delicacy of this process.

To give context to this discussion of psychedelics and antidepressants, Dr. Holland provides an overview of the history of psychiatry over the past forty years, showing how antidepressants came to prominence as a therapeutic tool. She also explores additional considerations, such as how things like hormonal birth control interacts with SSRI antidepressants on a psychopharmacological level. The common thread Dr. Holland weaves through this conversation is the importance of connection, both as support for the tapering process and as the end goal of effective therapeutic practice.

In this episode:

• Health and wellness practices which can act as support while tapering off an antidepressant in consult with a medical professional
• Contraindications between various psychedelics and antidepressants
• The difference between microdosing and macrodosing psychedelics while taking antidepressants
• Why falling in love can present a good opportunity to taper off antidepressants under supervision
• Why Dr. Holland sees the divide between recreational and therapeutic use as a false dichotomy in some cases

Quotes:

"There was a lot of hand-holding and de-stigmatizing back in the 90s, educating people around antidepressants. But twenty years later most of my work was really around people [who] had been medicated for ten, fifteen, twenty years and wanted to be off meds." [6:15]

"The people who really responded from MDMA-assisted psychotherapy who had PTSD were the people who'd never been on SSRIs. The people who had a muted response who didn't get as much better as the other group were the ones who had been on SSRIs." [9:47]

"Coming off of psych meds is no easy feat. You really have to do a gradual taper, there has to be somebody who is supervising you, and you've got to have other things in place." [10:42]

"You have to have somebody helping you… It's not the kind of thing you can really go alone. Getting off antidepressants requires somebody who knows what they are doing to help you." [14:16]

"Your brain learns to be sad, your brain learns to be anxious, your brain can learn to be at ease and learn to have joy." [21:31]

Links:

• Dr. Holland's website
• Good Chemistry: The Science of Connection, from Soul to Psychedelics
• Psychedelic Medicine Association
• Porangui