Harm Reduction Guide to Coming Off Psychiatric Drugs and Withdrawal

The Icarus Project and Freedom Center’s 52-page illustrated guide gathers the best information we’ve come across and the most valuable lessons we’ve learned about reducing and coming off psychiatric medication. Based in more than 10 years work in the peer support movement, this Guide is used internationally by individuals, families, professionals, and organizations, and is available a growing number of translations. Includes info on mood stabilizers, anti-psychotics, anti-depressants, anti-anxiety drugs, risks, benefits, wellness tools, psychiatric drug withdrawal, information for people staying on their medications, detailed Resource section, and much more. A ‘harm reduction’ approach means not being pro- or anti- medication, but supporting people where they are at to make their own decisions, balancing the risks and benefits involved. Written by Will Hall, with a 55-member health professional Advisory Board providing research assistance and more than 50 collaborators involved in developing and editing. The guide has photographs and art throughout, and a beautiful original cover painting by Jacks McNamara.

Now in a revised and expanded Second Edition.

Note: the guide is Creative Commons copyright and you have advance permission to link, copy, print, and distribute for non-commercial purposes, as long as you don’t
alter it and you credit the source.

Download and read the Guide in English.

Download a printer version, with scrambled pages ready to fold into a booklet (print double sided on legal paper, or send to a shop; booklet assembly instructions here).

Download a European printer version in English, with scrambled pages ready to fold into a booklet (print double sided on A4 paper).

You can also order a bound, color cover edition through bookstores.

Read about the making of the first edition and second edition of the Guide.



The Guide is available in the following languages, some also with printer versions:

Spanish – Castellano/Español (printer version)

German – Verfügbar Deutsch (printer version)

Greek – Ελληνική

Bosnian – Bosanskom

Danish – Dansk

Dutch – Nederlands

Croatian – Hrvatski (printer version)

Japanese – 日本で利用可能 (printer version)

Italian – Italiano (printer version)

Thai – ไทย

Chinese – 減害 手冊 脫離精神科藥物

French – Français (printer version)

Norwegian – Norsk

Czech – Čeština


For more information on coming off psychiatric medication, please see the Icarus coming off forums, www.BeyondMeds.com, the UK website www.ComingOff.com, and Will Hall’s webpage at www.willhall.net/comingoffmeds.

Article by on “Addressing Non-adherence to Antipsychotic Medication: a Harm-Reduction Approach” in the Journal of Psychiatric and Mental Health Nursing

Also check out these videos with Will Hall (and this one translated into Czech): and this audio on “Coming Off Medications” from the 2009 Hearing Voices Congress.



Can you connect me with a psychiatrist to help come off medications?

There are many misunderstandings based on the idea of finding a “good” psychiatrist. While a supportive and understanding medical professional can be vital to any medication process, truly supportive doctors are few and far between, and there is no need to wait on a medication reduction process just because you don’t have the ideal doctor to tell you what to do. I have often seen that psychiatrists who claim to use meds “only when needed,” be “holistic,” or use only a “low dose” will end up misleading patients into a pro-medication bias. ‘Only when needed” ends up meaning “anytime things get hard,” “holistic” ends up meaning being ok with supplements as long as you still take meds, and “low dose” ends up meaning the lowest ‘therapeutic’ dose recommended by drug manufacturers.

Sometimes the search for a “good” psychiatrist reflects our assumption that mental health problems are just  like physical problems – they aren’t. Or the search for a good psychiatrist reflects the fear of the unknown and the hope that an expert knows more about the right way than we ourselves do – they don’t. We also may assume we can’t take the lead about medication reduction, or that support can only come from a doctor. We need to work with our prescriber as an equal partner, seeing their role as limited, and being active in learning and getting support for the life change process involved, which is so much broader than just deciding on dosage. Successful medication reduction usually means taking an active role in the process — and even educating our prescribers.

Psychiatrists are not needed for prescription; a general practitioner, nurse, or even a naturopathic physician in some states can prescribe. People can and frequently do choose dosages and work with pharmacists or compound pharmacies when their prescriber is not being collaborative. Medication issues are not medical procedures; medications are not treating disease like antibiotics treat infection. These are life change processes, and a twenty minute meeting every two months often has little meaning for life change. And even when a psychiatrists presents themselves with confidence and authority, they are still working from guesswork: if you go to several doctors and compare their advice, you will receive very different sets of recommendations. You will quickly realize that when it comes to mental health issues, their authority is more of a stance and role than actual certainty.

While expertise on mending  a broken leg is appropriate for medical authority, mending a broken heart, dealign with emotions, traumas, life problems, and life changes is more than a medical procedure. It is a human process that needs supportive relationships, emotional expression, and listening, not an attitude of fixing a machine. I encourage people to take charge of their own decisions about what psychoactive substances to use and how to use them, relying on experts when needed but realizing that it is you who have to make decisions about your own life. Pills are always wrapped up in relationships and meaning, and doctors have no training in relationships or meaning. Dependence on a medical authority who treats the brain not the person is often a way to create more problems.

When people do want a referral for a prescriber I point them to the resource listings at Mad In America, the website Beyond Meds, and the ISPS-US.