The Clinical Craft of Psychiatric Medication Tapering: Q&A with Anders Sørensen
“Withdrawal teaches you, as the clinician, that you don’t control the process. Successful tapering is inherently patient-led, and there’s a kind of humility in accepting that.”
Anders Sørensen, PhD, is a Danish clinical psychologist, author, and researcher. His work focuses on psychiatric drug withdrawal and hyperbolic tapering, and helping patients navigate the emotional landscape that re-emerges in the process. His 2025 book, Crossing Zero, outlines the scientific and clinical principles behind safe tapering and the emotional work that often follows. Sørensen has run a dedicated tapering and psychotherapy practice in Copenhagen for a decade and has published research on receptor occupancy, antidepressant withdrawal, and deprescribing in leading medical journals.
I’ve come to believe that clinicians who don’t specialize in helping people who are experiencing difficulties coming off their psychiatric medications (which includes most of us) can learn a great deal from those who do this work every day. Our clinical understanding of tapering is still developing, and the gaps in medical knowledge remain sizable. Current practices will evolve, probably in substantial ways, yet there’s real value in lessons acquired from the hands-on process of accompanying patients through a taper and witnessing how they fare. This Q&A with Sørensen grows out of this belief, along with my curiosity about the practical insights he has to offer.
Aftab: You run a clinic in Denmark focused on medication tapering and accompanying psychotherapy. How does regulation around medical practice affect what psychologists can do in your role—are you able to prescribe, or do you collaborate with physicians? What kinds of logistical challenges have you encountered in running the clinic, and how has the broader medical community responded to your work?
Sørensen: Yes, that’s right. What I do is help people taper off antidepressants, antipsychotics, and other psychiatric drugs safely, and support them psychologically as they rediscover life without them.
It all grew out of necessity. Back in 2016, I began speaking publicly in Denmark about prescribed drug dependence and psychiatric drug withdrawal—at a time when no one else really was. After a few media appearances, the emails started flooding in from people desperate for help. I realized the research we’d been doing at the Cochrane Collaboration, where I did my PhD, needed to become a real service.
So I opened my doors, first part-time alongside my research, then gradually full-time. When I finished my PhD in 2021, I dedicated myself fully to clinical work, writing and teaching.
In Denmark, psychologists can’t prescribe medication, so everything I do is built around collaboration. I always aim to work alongside the prescribing doctor. Ironically, most physicians here have never been trained in withdrawal or hyperbolic tapering, but many become genuinely curious once they realize it’s a whole research field in itself. Some of my most rewarding professional relationships have been with open-minded general practitioners who want to learn; every time knowledge about tapering spreads to another doctor, I’m happy.
I say aim to, because of course, collaboration isn’t always possible. Some doctors maintain that withdrawal symptoms don’t exist, and that tapering isn’t necessary. In those cases, clients often choose to proceed anyway—with my guidance and the careful support system we built around them.
I’ve studied the pharmacology of psychiatric drugs and receptor-level adaptation enough to feel fully confident advising on dose reductions. Building trust in the medical community has been a slow process. But once colleagues see that their patients can come off safely—and often thrive—attitudes start to shift. Over the years, the medical community’s response has evolved from skepticism to genuine curiosity, and today, I regularly publish and comment in leading medical journals on issues related to withdrawal and tapering.
Aftab: I’ve noticed that many people drawn to the topic of psychotropic withdrawal tend to share ideas that come from “critical psychiatry,” such as disease-centered versus drug-centered model, skepticism about the efficacy of maintenance treatment, doubts about diagnostic categories, and so on. In your book, you seem more measured, and you avoid taking extreme positions (which is what I liked about the book) but you’re still working within that broader tradition. I’ve written before about some of my disagreements with that critical perspective, and it’s probably not the best use of our time to get into those debates here. What interests me, though, is that, in my view, taking withdrawal seriously and helping patients taper doesn’t actually require one to adopt any particular theoretical stance towards diagnosis and medications. You describe your approach as trauma-informed and psychosocial, oriented “beyond diagnostic labels,” which I think has real value as one approach among others. But I’m curious, do you think medication tapering can also be done well by clinicians who work within a more medical, diagnostic framework?
Sørensen: I’m glad you picked up on that balance; it’s exactly what I aimed to achieve. I’m not interested in imposing a worldview on anyone, but in helping readers and clients reflect on their own: what their diagnosis means to them, how they make sense of their suffering, what role medication has played in their lives, and what it might mean to live without it. That’s why it takes nearly a hundred pages before I start giving practical tapering advice.
As a psychologist, that approach comes naturally. My role is not to tell people what to believe or do, but to help them ask better questions—questions that reopen curiosity. And the question of what their suffering and self-destructive behaviors represent is central to staying well after withdrawal.
In that sense, part of the taper work does indeed overlap with the critical psychiatry tradition, especially in challenging the idea that emotional suffering is simply a brain diseases or biological defect. True to the title of my book, I want to help people come off—and stay off—medication, in other words, to avoid relapse. Here, people’s beliefs about their suffering, about the patterns they fall into, and about their diagnosis can be critical. If someone believes their distress is caused by a biological defect, it can quickly block the deeper exploration needed to prevent relapse. Once you begin to see symptoms as responses to context (including inner context), life events, trauma, and meaning-making, new avenues for healing open up.
In essence, the work becomes about understanding the triggers and context around one’s episodes—whether depressive, psychotic, anxiety, burnout, or manic. And whether we like it or not, the medical model can become a barrier to that work, when it’s used as an explanation rather than a description of the problem.
But you’re right—helping people taper safely doesn’t require adopting a particular theoretical stance. The tapering principles I use can equally well work within a more mainstream diagnostic approach, as long as the clinician understands that although we call them “antidepressants” and “antipsychotics”, these drugs are not specific in their effect. Removing them often brings back the emotional capacities once suppressed by the medication, and our job as clinicians is to help the person navigate that. That return can be disorienting at first, but it’s also what many describe as the best part of coming off; the gradual re-emergence of feeling fully alive again.
The most important skill, regardless of framework, is distinguishing withdrawal from relapse. When someone deteriorates after a dose reduction, withdrawal must be considered a valid, stand-alone condition before assuming that an underlying condition or state has returned. Slowing down, stabilizing, and supporting the person through that period can make all the difference.
Aftab: For people going through medication withdrawal for the first time, what tends to surprise them most about the experience?
Sørensen: As long as clinical guidelines describe withdrawal as mostly “mild and self-limiting,” what surprises people most is the sheer severity and duration of the symptoms. The experience is difficult enough on its own, but what makes it devastating is how unexpected and poorly acknowledged it still is.
That’s usually when they start searching online and quickly find thousands of similar stories, validating their experience. Then they come across the concept of hyperbolic tapering, which suddenly explains everything: why they felt so terrible after stopping at the lowest standard dose, and why the process of coming off safely has to be much slower. Everyone is stunned by how sensitive the nervous system becomes at “low” doses, and how tiny the reductions must be to avoid withdrawal. Even after years of studying the data—and seeing it daily in my practice—I still find it remarkable how sensitive the body is to even minor changes in dose toward the end (which, of course, sometimes isn’t the end at all).
Aftab: From your perspective as a clinician, what’s the most challenging aspect of helping someone through withdrawal?
Sørensen: Pacing. Finding the tempo the nervous system can tolerate, and helping people accept that it might be much slower than they hoped. That’s sometimes the hardest part, because it can really interfere with people’s lives in ways they didn’t sign up for. The people I see want their life back. They want the process to be over. But the body doesn’t negotiate.
Even with receptor occupancy data and clear tapering principles, there’s always an element of trial and error. We can model receptor occupancy, but not the individual human nervous system. Each taper involves uncertainty; we never know which reduction will exceed a person’s capacity to adapt. That’s why rigid schedules—like “reducing X mg every Y weeks”—don’t work. Tapering must remain individualized and flexible.
Aftab: Within the prescribed harm and psychotropic withdrawal communities, what are the main points of disagreement or ongoing debate? What questions really divide people?
Sørensen: There are quite a few. One tension is around pace. Some hold very strictly to rules like “never exceed 5 or 10% reductions,” which I understand historically—it was a way to prevent harm in the absence of knowledge and data. But if you look at the receptor occupancy curves, those percentages don’t make sense across all doses. In practice, most people on high doses tolerate larger cuts in the beginning, and then, at some point, 5–10% becomes what the body allows. Sometimes it’s even less—3, 2, or 1%. The point is not to follow a number or a rule, but to match the taper to the person’s actual tolerance.
Another debate concerns how much structure is helpful. Some people end up creating long lists of what they can and can’t eat, do, or feel while tapering. It’s understandable—withdrawal can feel unpredictable, so control becomes a coping strategy—but sometimes the rigidity itself becomes a stressor. That said, in cases of protracted withdrawal or kindling, removing certain foods or substances can make a real difference. Sometimes it’s the thing that finally allows the nervous system to settle.
There’s also disagreement about microtapering versus cut-and-hold, that is, whether ultra-small daily reductions are superior to spaced, stepwise ones. Finally, there’s the ongoing discussion about supplements; how much they help, whether they help or hurt, and whether the nervous system can really be “sped up” at all.
Aftab: Would you agree that, even though current withdrawal practices, like hyperbolic tapering, are informed by theory, lived experience, and clinical observation, we still lack rigorous evidence from controlled trials about what actually works best? I often wonder what tapering would look like under blinded conditions. Do you ever think about whether some of the central ideas behind hyperbolic tapering would hold up in double-blind studies?
Sørensen: We certainly lack rigorous randomized controlled trials, but so do many of the everyday practices in mainstream psychiatry: polypharmacy, electroconvulsive therapy, and even long-term maintenance use of antidepressants and antipsychotics.
The discontinuation (or relapse prevention) trials are particularly problematic when assessed through standard Cochrane risk-of-bias methods, because the risk of confounding relapse with withdrawal is so high. In fact, that’s the RCT I’d like to see: a discontinuation trial that controls for withdrawal by using a pharmacologically informed, gradual taper, rather than stopping medication over a few weeks. If such a study showed that some of what we’ve been calling relapse was withdrawal, it would certainly challenge some long-held assumptions. I wouldn’t be surprised if that turned out to be the case.
Aftab: What do you think distinguishes the neurobiology of dependence on substances like alcohol, heroin, or cocaine—where “acute detox” can be effective—from the kind of dependence we see with prescription psychiatric medications, where that approach doesn’t seem to work?
Sørensen: The underlying homeostatic principle is the same, whether it’s alcohol, opioids, heroin, or psychiatric medication. The brain adapts to the presence of a substance and then reacts when it’s withdrawn.
With alcohol or heroin—or smoking, for that matter—acute detox often works in a way that’s very different from psychiatric drugs. It seems that the nervous system is able to reset relatively quickly once those substances are cleared. Withdrawal is still intense, but usually time-limited.
With psychiatric drugs, it seems that the adaptation runs deeper. Receptors, mitochondria, hormones, gene expression, and neural circuits can all adjust over long periods of exposure, and so the process of re-adaptation takes longer too. That’s why I never recommend abrupt discontinuation outside of short-term treatment. The risk is entering a state of protracted withdrawal, where reinstating the drug no longer helps—or can even make things worse through kindling effects—leaving the person trapped in a state the system can’t easily resolve.
Aftab: In your experience, what are the most common reasons people want to come off their psychiatric medications?
Sørensen: A classic is that they don’t feel like themselves anymore. Emotional numbing tops the charts, followed by cognitive dulling, sexual side effects, or simply feeling disconnected from their own emotions and motivations.
Some simply no longer need the drug effect; others find that the side effects have started to outweigh the benefits. Some want to become pregnant. Some are curious to know who they are underneath the drug, to feel life fully again. And more and more who come to me are worried about the long-term effects; and quite rightfully so, given how little long-term safety data we actually have.
Aftab: Do you have a sense of how many patients who successfully taper off medication with your help eventually go back on it? And apart from cases where the taper happens too quickly, are there particular clinical situations where you might actually recommend restarting medication?
Sørensen: That happens very rarely—but of course my sample is highly biased, so that statistic doesn’t mean much.
Some do, and that’s okay. The goal isn’t “never touch medication again.” It’s informed autonomy. Understanding what the drug does, what it doesn’t do, and being free to decide. Medication is a strategy, nothing more. I have huge respect for people in such despair and emotional pain that they feel the need to flatten or quiet their inner world for a while. And then we talk about that; about why it feels relieving to feel less, and how we might begin approaching that pain in other ways.
What happens more often is that people reach out when they start thinking about going back on medication—before they actually do, but when the idea begins to take hold because an inner pain or turmoil has reached a threshold. Then I always look at context: life stress, trauma or emotions resurfacing, changes in support systems, diet, sleep. Usually there’s a clear story there, and once we understand it, the need for medication often lessens on its own.
Aftab: How do you approach situations where mental health problems for which the person was taking medications return during a taper or after discontinuation?
Sørensen: First, by not assuming it’s a “relapse”. It can be three things: withdrawal, the emotional landscape reopening too quickly, or a reconnection with the underlying problem the drug was masking.
If they’re depressed, I explore what they’re depressed about. If they’re anxious, what they’re anxious about. If they’re psychotic, what they’re psychotic about. If they’re stressed, what they’re stressed about. If they’re manic, what they’re manic about. It sounds simple, but it’s surprisingly radical in a system that tends to pathologize everything instead of asking what it means.
I invite people to slow down and ask: What’s happening right now that could explain this response? Personally, I use trauma-informed frameworks like the Power Threat Meaning Framework to make sense of what’s emerging. Once you start asking those questions, the distress usually begins to tell its story.
Aftab: What do you think are some of the most common misconceptions about medication tapering?
Sørensen: My top five:
That low doses are low doses—and that jumping to zero from the smallest tablet is no problem.
That withdrawal symptoms prove you need the drug.
That tapering is simply about removing a substance, forgetting the emotional, existential, social, identity, and relational aspects.
That tapering can be done on a fixed schedule, when in reality, the nervous system decides the tempo, not our Western need for guidelines.
That withdrawal is rare and mild, and that reactions beyond that are purely psychological.
Aftab: Where do you see the science and clinical practice of tapering and discontinuation going in the next few years?
Sørensen: In five years, I hope withdrawal will no longer be an underground topic, but a routine part of psychiatric care—like rehabilitation is to surgery.
My best guess is that mainstream psychiatry will continue to downplay the problem for a while, as we’ve seen in the past with benzodiazepines and opioids, both once described as easy to stop. Eventually, lived experience and clinical observation become impossible to ignore, and the narrative shifts. I think we’re approaching that tipping point now. Hopefully, academic psychiatry will begin to engage with the issue seriously, conducting large, rigorous studies to quantify how many people on psychiatric drugs experience the kinds of severe withdrawals and years-long tapers we’re discussing here.
The clinical reality has already outpaced the science, but paradigms rarely change gracefully. Especially in the final phase, when anomalies pile up, systems tend to push back. That’s where we are today.
Meanwhile, practice is already moving ahead. We’re seeing specialized tapering clinics, digital tracking tools, liquid micro-dosing, and patient-led data collection that I think will shape future guidelines.
Aftab: What has been the most rewarding part of this work for you personally?
Sørensen: Watching people come back to life. Most psychiatric drugs affect a person’s emotional range and depth, often in ways that narrow it. Seeing someone rediscover their emotions, humor, agency, drive, and connection to their own needs and values—and helping them navigate the pain safely and confidently—is indescribable every single time, and it’s why I keep doing this work.
Many begin the process worried and leave with a depth of self-understanding and agency they never had before. I take the word psychotherapy quite literally: learning to regulate our inner world, emotions, and thought patterns through the psyche itself. How to process painful feelings, navigate old triggers, and step out of obsessive loops without suppressing or stimulating the mind first, but by learning to use the mind itself.
The metacognitive exercises I describe in the book to counter excessive worry and rumination are simple but powerful; they give people back a sense of agency they thought they’d lost. It’s hard work, but it’s profoundly human work. I honestly enjoy witnessing it every time.
Aftab: What kind of clinical humility is required in working with individuals tapering psychiatric medications?
Sørensen: I love this question. Withdrawal teaches you, as the clinician, that you don’t control the process. The nervous system does. Successful tapering is inherently patient-led, and there’s a kind of humility in accepting that. We can guide, support, and educate; we can know the pharmacology inside out, but we can’t rush biology with fixed schedules or strict guidelines. It forces you to listen closely and to stay curious.
I guess humility also means respecting the person’s experience over our own assumptions or professional dogmas while bringing our expertise to meet their lived reality in genuine collaboration.
If readers want to explore the topic further, that’s why I wrote the book, to offer a practical, evidence-informed framework for tapering and the emotional work that often accompanies it. Every conversation like this helps move the field forward. Thanks so much for the opportunity, Awais!
Aftab: Thank you, Anders!
This Q&A is part of a series featuring interviews intended to foster a re-examination of philosophical and scientific debates in the psy-sciences. See prior interviews here.
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This is a nice interview, but for someone who claims to study medication withdrawal, the ideas seem to track remarkably well with what lay people say rather than what researchers write.
Among the more dangerous things I have encountered in psychiatry, I would rank the myth of hyperbolic tapering just below akathisia. People get into terrible trouble with it. I personally know cases where women have spent close to half a decade in hyperbolic tapering loops. In fact, this kind of drawn-out process is more the rule than the exception.
The idea that drug effects can be meaningfully mapped to receptor binding profiles is demonstrably untrue. Most psychiatric drugs have multiple windows of effect. This has been known for a long time. Some drugs, such as SSRIs, do show sharp hyperbolic occupancy curves, but many others do not. Some are sigmoid. Many drugs also have state-dependent binding characteristics or compete with other chemicals.
It is also odd to talk about homeostasis in relation to psychiatric drugs, since it essentially repurposes the chemical imbalance narrative. It is contradictory to claim that the chemicals involved have nothing to do with the illness, except when they supposedly generate similar syndromes during withdrawal. Brain systems operate more on an allostatic principle. Receptors can upregulate and downregulate quite rapidly, assuming receptors are even the central issue. Saying there is too much serotonin (ironically the exact opposite of drug company marketing) is like saying there are too many letters in the postal system on a given day.
This is what I see happening in withdrawal groups. People have been on the medication a long time, they try to come off, and they experience significant withdrawals. Sometimes the withdrawals are truly horrific, but in other cases they are distressing mainly because the person expected to feel nothing. Regardless, they panic and, like a child stuck up a tree, they cling tightly to the branch. They begin lowering themselves slowly, resulting in a shaky descent with a lot of scraping and clawing. When they reach the lower branches, they become so overwhelmed by the myth of hyperbolic tapering that no amount of encouragement can coax them the rest of the way down. Instead, they spend another year or two, often on top of the year or two already spent, measuring out doses in ever smaller fractions. The entire process becomes a neurotic mess of emotion and terror. Eventually they come off and give full credit to the hyperbolic taper. Of course, there is no reason to believe the excruciatingly slow pace made any difference. There is simply no counterfactual.
The whole thing is like that Simpsons episode where Homer gets his arms stuck in two vending machines. Just before the paramedic amputates his arm, they notice that Homer is still holding onto the cans. Of course Homer feels foolish but he really did have his both of his arms stuck, it is just that when you are in a situation like that, and panicking, it is very hard to figure out what is actually going on. I believe that consumers can have excellent empirical insights and should be listened to a hell of a lot more, people know their own bodies. But in this kind of panic striken state, I'm not sure how easy it is to tell what is doing what.
But perhaps you think I am being unfair. In truth, tapering can be very difficult, and for some people slowing things down substantially can help. For others it simply increases their exposure to a drug that may be making them unstable or affecting other physiological systems. There is no evidence that 5 or 10 percent reductions are better than 15 or 20 percent reductions. Current ideas about hyperbolic tapering have no logical endpoint. People just go slower and slower until they are on fractions of a milligram, grinding pills into dust. In some cases, all-cause mortality seems more likely to catch up with them before they finish the taper. It is all very silly but also very sad and I truly feel awful for the people who go through it.
In my experience helping people in withdrawal groups, going a bit slower, perhaps half the original speed, is often as effective as a 10 percent reduction schedule, or at least the difference is not noticeable. That, combined with the judicious use of antidotes, usually gets people better much faster without them getting psychologically stuck. I am also not convinced from what I have seen that tapering speed has anything to do with protracted problems after withdrawal. I have actually seen more cases with ongoing issues among those who followed extremely slow tapers. It could be that the people who cannot go any faster are the ones most harmed by the drug, but it seems at least equally plausible that the harm was already done and dragging out the taper only increased exposure to the problematic medication.
This doesn't mean I don't believe that we can't improve taper schedules or that going much slower might indeed turn out to be a good idea. My issue is with the way "hyperbolic" tapering has reached heights of popularity that would make the marketing departments of drug companies blush.
I'm not a doctor. My wife developed the form of akathisia described by Teicher and Cole in the early 1990s. This event very nearly ended both our lives. I take this problem seriously which is why I don't want to see people go swerving from one dangerous myth to another.
The primary basis is comes from interviewing people who are part of a hyperbolic tapering group, who along with their terrifying tales of drug side effects and withdrawals tell me they feel pressured to follow a hyperbolic taper and they're too scared to speak up because the group will ridicule them and ostracise them if they criticise hyperbolic tapering, and to thank me for saying something that made them feel safe to try another way.
I don't know how widespread this issue is but it is clear that some groups latch on to the idea and it has spread far beyond SSRIs and benzos. Tapering is a terrifying process, hyperbolic taper gives people hope. Some people benefit from it tremendously, others become very stuck and spend years in a vicious cycle.
What people fail to recognise is that the notion is strikingly similar to the marketing language used by pharmaceutical companies who have constructed a narratives around "chemical imbalances".
I say it's a myth because it largely attempts to reverse engineer research that has been promoted and influenced by pharmaceutical companies.
The windows of effects of antipsychotic drugs were not established by the manufacturer's research but from psychiatrists talking to patients and observing them first hand. This sort of research is no longer done and is probably the reason no one noticed the new problems.
Nervous illness, otherwise known as neuroticism is a serious thing and I apologise for speaking flippantly about it. Many people with nervous illnesses are prescribed benzos and SSRIs, many of these people already suffer from severe medical anxiety and rumination. Hyperbolic tapering can become a source of great distress for them and they can easily become trapped in cycle of anxiety and despair. Due to how long the typical tapers can go on for, it is not unusual to see people go through this for several years.
I having nothing against hyperbolic tapering per se. If someone has been on a drug for a long time, it seems sensible to slow things down. But there isn't much evidence it works.
There are other problems, drug bioavailability is not consistent and the binding curves start to breakdown at lower doses. Add in the half life of the drug and in many cases at lower doses the variance is greater than the taper amount.
If we want solve this problem we need to believe people and help them figure out what is going on. But offering them new biologically plausible narratives isn't helping them. Hyperbolic tapering didn't come from victims, it came from well meaning doctors. The fact that some victims think it helped isn't very helpful. Better to listen to the ideas that came out of their experiences that are theirs and not put in their heads by others. Easier said than done.
Anyway, let's not fight. This is a problem to be solved. I'm as frustrated as you are.