Why So Many Prescribers Avoid Tapering

There is a part of psychiatry that many prescribers quietly avoid: helping patients come off psychiatric medications.

When we opened our practice in 2020, tapering was not the original focus. But after listing ourselves in a benzodiazepine tapering directory, we began receiving calls from patients across the country. Many could not find anyone locally willing to help them taper safely. Some reached out from states where we were not even licensed, simply because they had run out of options.

What became clear very quickly is that there is a significant group of patients whose experiences do not fit the prevailing narrative.

They were told withdrawal would last two weeks — perhaps a month at most. When symptoms persisted beyond that window, the explanation shifted. It was labeled relapse. Or anxiety. Or treatment resistance. In many cases, the solution was restarting the medication — sometimes at a higher dose.

But many of these patients were not relapsing.

They were experiencing withdrawal.

And modern psychiatric practice has limited space for that possibility.

The Discontinuation Myth

Psychiatric training typically presents starting and stopping medications as relatively straightforward. Taper schedules are often simplified. If the taper does not go smoothly, the framework itself is rarely questioned.

Instead, the patient’s diagnosis is reinforced.

Acknowledging prolonged or severe withdrawal forces a more uncomfortable question: if stopping a medication can destabilize someone for months — or longer — what does that imply about long-term prescribing practices?

That conversation complicates the narrative that medications are neutral tools we can adjust up or down without consequence.

The Chemical Imbalance Framework

For decades, the public was taught that depression is caused by low serotonin. Anxiety was framed as a neurotransmitter deficiency. Bipolar disorder was described as a dopamine imbalance. The message was simple and compelling: this is a biological defect, and medication corrects it.

If the imbalance is ongoing, then treatment must be ongoing.

This framework made medications feel not only helpful, but necessary — often indefinitely.

The issue is not that biology plays no role. It is that the “chemical imbalance” explanation was a dramatic simplification of extraordinarily complex neurobiology. It became culturally dominant long before the evidence supported such certainty.

Once that model is accepted, tapering appears inherently risky. If symptoms return during withdrawal, it seems to confirm that the imbalance has resurfaced. Restarting the medication feels protective. Very little space remains for another explanation: that the brain adapted to the medication itself, and that symptoms during taper may reflect that adaptation.

When lifelong treatment becomes the default assumption, deprescribing begins to look irresponsible.

The Problem of Uncertainty

Tapering also demands something our medical systems are not structured to tolerate: uncertainty.

When a brain has adapted to a medication taken daily for years, reducing it is not simply reversing a switch. New symptoms can emerge. Old symptoms can intensify. Paradoxical reactions can occur. There is no tidy algorithm to predict every response.

Medicine rewards clarity, efficiency, and standardized pathways. Tapering requires flexibility, patience, and humility — along with the time and support to navigate unpredictable reactions.

Most prescribers were never formally trained in this work. And many practice environments are not designed to support it.

So it is often avoided.

Not necessarily out of bad intent — but because it challenges prevailing assumptions and slows down a system built for speed.

Signs of Change

For years, there were few formal pathways to learn about withdrawal and deprescribing. Patients often turned to online communities before they found medical guidance.

That landscape is shifting.

In recent years, more trainees and early-career prescribers have begun reaching out with questions about withdrawal that do not align with traditional teaching. Many express that they have observed patterns in patients that were not adequately addressed in training.

Through mentorship and professional community-building, we are seeing a new generation of clinicians approach tapering with intellectual curiosity rather than reflexive dismissal. They are not anti-medication. They are not reckless. They are seeking to understand adaptation, withdrawal, and deprescribing with the same seriousness that prescribing deserves.

Six years ago, it was difficult to refer patients to clinicians with tapering experience. Today, there are more prescribers intentionally developing this skillset.

The resistance remains. Institutional change is slow.

But the field is evolving.

Tapering is not fringe. It is not a rejection of psychiatry. It is an expansion of it.

If we are going to prescribe responsibly, we must also learn how to deprescribe responsibly.

And the future of the field depends on our willingness to do both.

Dr. Marissa Witt-Doerring is a board-certified psychiatrist and co-founder of TaperClinic, specializing in psychiatric withdrawal and safe, individualized tapering.