The Possible Risks of Using Recreational Drugs, Supplements, Herbs and Other Substances with Psychoactive Effects During Psychiatric Drug Withdrawal

A lot of people seek out psychoactive substances such as alcohol, caffeine, marijuana or “natural” chemicals such as melatonin during psychiatric drug withdrawal, whether to relax, get energized, ease despair, get help with sleep, or feel relief from pain. While these substances are often used by many with no or minimal problems, people in the layperson withdrawal community have nevertheless found that using them in the midst of coming off or healing from psychiatric medications is unusually risky.

Drugs such as alcohol and cannabis are central nervous system depressants, meaning they tend to primarily disrupt the central nervous system in ways that slow it down. Drugs such as caffeine and nicotine are stimulants, meaning they tend to disrupt the central nervous system in ways that speed it up. Two other common drug classes are hallucinogens and opiates. Hallucinogens (or psychedelics) like LSD, mescaline, and psilocybin act on the central nervous system in ways that lead to alterations in consciousness, sensory experiences and thought perception. Opiates like morphine, codeine and Oxycontin are sometimes considered to be depressants, but predominantly act on parts of the central nervous system that control pain, sensation and physical functioning. Additionally, many supplements and herbs like Valerian Root, Kava, melatonin, GABA, 5-HTP and Ginseng, along with over-the-counter hormones such as progesterone cream, are often taken for their psychoactive properties—including similar, albeit usually milder stimulating or calming/depressant effects. (Of note, some non-psychiatric pharmaceutical drugs such as oral contraceptives, beta blockers, antihistamines, and even certain antibiotics can also have psychoactive effects.)

While we have these general frameworks for categorizing the common effects of these types of substances, what many in the lay withdrawal community report is that “all bets are off” when it comes to predicting what might happen when using them in the midst of psychiatric drug withdrawal. People have reported vastly different effects, outcomes and consequences—in fact, ones that often seem entirely paradoxical. For example, some in the midst of psychiatric drug withdrawal have reported that an occasional drink of alcohol can help ease stress, while others have found that even just a little alcohol ramps them up with anxiety or sends them plummeting into dark despair that can take weeks or longer to come back from. Some report that drinking a cup of coffee in the morning helps them get ready for the day, while others have found even the tiniest bit of caffeine to be intensely activating and a source of immense restlessness or even panic. Similarly, there are individuals struggling with sadness or agitation in withdrawal who find that using cannabis provides them with some temporary respite from their pain; others, however, find even a few hits can lead to suicidal despair. And while some people can drink relaxing bedtime teas such as Chamomile or Valerian Root and ease right into sleep, others have found that even “gentle” commonly used herbs such as these can set off anxiety and insomnia. 

Little is currently understood about why these unpredictable effects happen to so many people experiencing psychiatric drug withdrawal. It is likely that many factors such as a person’s life circumstances, stressors, and overall physical health play significant roles in these heightened risks. But there are also two clear biological factors that are almost certainly contributing.

First, most psychiatric medications can themselves affect the central nervous system primarily by having stimulant effects (like “ADHD” drugs and most antidepressants) or depressant effects (like benzodiazepines, antipsychotics, anticonvulsants and lithium) that over time can lead to structural and functional changes in the body and brain. (See TWP’s “Primer on Psychiatric Drug Dependence, Tolerance, and Withdrawal" for more information.) Consequently, when these stimulant or depressant drugs are removed—especially too quickly—the central nervous system can enter a state of hyper-sensitivity as it tries to reconfigure its structure and functioning to compensate for their absence. Adding into this mix other drugs or natural or artificial chemical substances that biologically amplify, slow down, or otherwise interfere with these processes can serve to re-agitate the very biological processes that one is trying to bring back into stability. w

A second factor is that many of these substances – including cigarette smoke, alcohol, caffeine, marijuana, and St. John’s Wort to name just a few – are known to act on particular enzymes that are responsible for metabolizing and eliminating psychiatric drugs and other toxins from the human body, potentially changing the levels of psychiatric drugs in the body at any time very significantly. Further, some people are genetically predisposed to being “poor metabolizers” of drugs and other toxins, which can amplify adverse reactions as well. See “Drug Metabolism, Substance Interactions, and Genetics— Their Importance for Safe Tapering” for more information.

So not surprisingly perhaps, some of the most commonly shared ‘words of wisdom’ in the lay withdrawal community relate to the importance of keeping activities in the central nervous system as simple and stable as possible during psychiatric drug withdrawal. The more stressors, stimuli, and possible triggers there are in the mix—especially psychoactive substances which directly disrupt central nervous system function—the greater the odds that a person’s central nervous system will become overwhelmed and overstressed, leading to new or intensified mental, emotional, and physical problems that may set a person back in their progress and prolong the amount of time it takes to heal.

With this in mind, many people in psychiatric drug withdrawal opt to avoid using psychoactive substances of any kind entirely or as much as possible. Many people find that this core tenet—Focus on simplicity and stability in the central nervous system over the course of tapering off and healing from psychiatric drugs—is what helps make the withdrawal journey go as smoothly and successfully as possible.