It’s important to work closely with a prescribing physician when discussing medication changes because every person is different and tapering strategies must be tailored. Dr. Bret Scher, MD, spoke with Dr. Georgia Ede, MD, a Harvard-trained, board-certified psychiatrist who specializes in nutritional and metabolic psychiatry, and Matt Baszucki, who used nutritional ketosis in conjunction with other therapies to lower his medication dosage and improve his bipolar I symptoms.

Read on for an excerpted conversation among Dr. Bret Scher, Dr. Georgia Ede, and Matt Baszucki.

Dr. Bret Scher: When you hear someone say they want to get off their psychiatric medications, what do you think? What goes through your mind as a clinician?

Dr. Georgia Ede: Some people are able to eventually completely taper off all of their psychiatric medication, some people are able to reduce the number of medications they’re taking or the dosages of the medications they’re taking, and some people are able to use a ketogenic diet instead of medications. If you haven’t already started a medication, sometimes starting a ketogenic diet can allow you to avoid needing to take psychiatric medications in the first place.

Dr. Bret Scher: What are the general guidelines you advise when you talk to someone about the timing of this process?

Dr. Georgia Ede: The earliest time frame that I like to begin looking at potentially reducing one of the medications is 6-12 weeks after they have been on the ketogenic diet. The earliest, at least in the epilepsy literature, is usually four weeks in. I like to wait at least six weeks. Ideally, I like to wait twelve weeks. The reason is that, at twelve weeks, you are more likely to be looking at a new equilibrium for your body and your mind to really be in a solidly new place, different from where they were before, metabolically and chemically.

Dr. Bret Scher: What are some of your concerns of going too fast? Are there concerns with going too slow?

Dr. Georgia Ede: No concerns with going too slow, unless a medication is really giving you a lot of side effects. How quickly is “too quickly" depends on the person. Some people can stop these medications within a few weeks. Others may take many months and they have to go down extremely slowly in tiny increments. It’s very individualized. If you stop those medications abruptly, it can cause a lot of psychiatric distress.

Dr. Bret Scher: What advice do you give to people on what they should be monitoring in their own life?

Dr. Georgia Ede: Having a lot of experience can help you figure that out. It’s not foolproof, but having a lot of experience can help you tell the difference between what a withdrawal symptom is and what is a sign that the medication may need to be continued.

Dr. Bret Scher: Will physicians and/or psychiatrists be able to do this with their patients?

Dr. Georgia Ede: There is a lot of hesitance about working with somebody who is on a ketogenic diet because there’s not a lot of familiarity, so it can feel uncomfortable. If you’re a clinician who doesn’t have any experience or knowledge about these diets. Work with somebody who might know something more about ketogenic diets. Though if the person is already stable on a ketogenic diet, you don’t need any special knowledge about a ketogenic diet to taper a psychiatric medication.

Dr. Bret Scher: Next, let’s hear from Matt Baszucki about his personal and ongoing journey with his medication tapering.

What was your motivation and thought process for tapering your medications?

Matt Baszucki: I remember the point when I realized I might be able to taper these was, I would say, about 2018 when I had a moment of insight and I started to establish some healthy habits, like exercising regularly and taking better care of my sleep.

What I realized was that some of those habits could serve as buffers, where if they were in place and they were consistent, I might not need as much medication. I was able to start to come off an antipsychotic and the benzodiazepine I was on, Ativan. I ended up doing a cross-taper over to Valium, and then coming off that.

I was coming off some of them and, with the help of the psychiatrist, was playing around with different medications. We just couldn’t find the right balance. I didn’t go on keto until 2021.

When I really started to put the sleep hygiene, the exercise, and some of the other organic mood stabilizers in place and really take them seriously was when I realized I might be able to get off some of these.

Dr. Bret Scher: How’s your quality of life changed since you’ve been able to taper your medications?

Matt Baszucki: My experience of life now, having gotten off some of these – not all the way off, but off them enough to the point where I can more or less live – it’s just next level. I’m so excited to see what’s going to happen when I eventually get off them because maybe I am still sedated to a certain extent, and I don’t realize it. I would encourage people out there to really give this a shot. I did it under the supervision of a psychiatrist, very slowly. I think this is such an important point.

If you enjoyed reading this, take some time to watch the full conversation in the YouTube video linked here.