The Carlat Psychiatry Podcast Psychopharm Secrets: Coming Off Meds
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Jun 23, 2025 An intriguing discussion uncovers the 'placebo flip' phenomenon, where patients find unexpected relief after stopping medications. The dialogue dives into the complexities of tapering off drugs like lithium, highlighting the risk of delayed relapses. Psychological factors influencing patient experiences during medication discontinuation are also examined. Additionally, the conversation sheds light on the underdiagnosis of tardive dyskinesia in chronic depression patients and introduces an AI tool, TD Screen, poised to revolutionize detection methods.
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Patient Feels Better After Stopping Meds
- A patient with chronic mental illness felt better after stopping medication and regained confidence.
- Months later, relationship issues and depression returned, leading them back to the doctor.
Understanding the Placebo Flip Delay
- The placebo flip gives patients a confidence boost that they can manage without meds.
- Relapse often takes months, delayed by improved mood and stress triggers.
Evaluate Patient Reports Carefully
- Be skeptical when patients say they felt better off meds without documented side effects.
- Use anxiety rating scales to show patterns of improvement on meds and worsening off.