Blind Tapering Vs. Informed Consent | The Gaslit Truth Podcast with Dr. Teralyn Sell & Therapist Jenn Schmitz

The Gaslit Truth Podcast is hosted by Dr. Teralyn Sell and Therapist Jenn Schmitz, where they examine mental health myths, psychiatric medication harm, and informed consent.

In this episode, Dr. Teralyn Sell and Therapist Jenn Schmitz explain blind tapering, the psychology of psychiatric medication withdrawal, and the role of therapy in tapering safely.

What if knowing your dose cut is coming makes you feel worse? We dig into blind tapering—masking dose reductions during psychiatric medication withdrawal—to explore how anticipation, nocebo, and hypervigilance can drive symptoms. Drawing on research from benzodiazepines, hypnotics, and even methadone programs, we unpack why combining taper protocols with behavioral therapy often improves short‑term discontinuation and reduces withdrawal complaints. More importantly, we translate those findings into practical strategies for antidepressants and antipsychotics, where data are thinner but psychology still matters.

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Chapters

• 0:00 Setting The Stage: Blind Tapering
• 0:26 Community Shoutouts And Milestone News
• 1:40 What Blind Tapering Is And Isn’t
• 2:45 Charlie Sheen’s Blind Taper Story
• 5:55 The Nocebo Effect And Withdrawal
• 9:20 Why Therapy Belongs In Taper Plans
• 12:00 What The Research Actually Shows
• 16:28 Real-World Logistics And Ethics
• 20:30 Risks: Trust, Control, And Oversight
• 25:20 Hypervigilance, Tracking, And Timing
• 29:42 Microtapering Vs Larger Cuts
• 32:17 Agency, Boundaries, And Stop Rules
• 34:47 Benefits: Reducing Nocebo And Burden
• 39:45 Relationship Dynamics And Support
• 43:30 Alternatives And Transparency Levels
• 47:50 Flexibility, Personalization, And Next Steps
• 56:20 Closing Thanks And 100th Episode Tease

Transcript

Dr Teralyn Sell: 0:02

Is blind tapering a tool? A risk? A therapeutic experiment? Or simply evidence that the psychology of withdrawal might matter as much as the pharmacology? Whoa.

Jenn Schmitz: 0:18

All right, everyone. We are your whistleblowing shrinks, Dr. Taryl and Therapist Jen, and we are here to talk about blind tapering today off a psychiatric medication. That's what's up. However, before we do that, make sure you guys hit like, smash subscribe, get on YouTube, ring the bell, and listen to us. Just all you gotta do is click one button because the more subscribers we have, like we keep going then, people. And something that's kind of exciting to get to talk about real quick is Terry, we have our hundredth episode coming up in two weeks. Woohoo! 100.

Dr Teralyn Sell: 0:47

I have I cannot believe that we have produced a hundred episodes by ourselves. By the way, everybody by ourselves. This is Jen and I. We don't have a a crew, a team, an estate. Not yet.

Jenn Schmitz: 1:01

Not yet. Not yet. Not yet. But I think it's gonna have to come here pretty soon because we keep growing because of you guys. So thank you for listening and for commenting. We have we have such a great fan base.

Dr Teralyn Sell: 1:15

Yes.

Jenn Schmitz: 1:16

We couldn't do it without you.

Dr Teralyn Sell: 1:17

We get emails all the time and we love it. We love every single comment that we get. So keep them coming. Keep them coming.

Jenn Schmitz: 1:23

Yeah. Yeah. All right. So let's, we're gonna, we're gonna dive into this, guys, and talk a little bit about this. Because yeah, blind tapering off of psychiatric medication has got some risks and benefits to it. So we're gonna give you a big ass dose of informed consent today.

Dr Teralyn Sell: 1:39

All right. The first thing I want to tell people though is there really, there's there is a lot of research on blind tapering out there for one or two particular medications. There is really none out there for your SSRIs or antipsychotics. So that is a real big gap in research. But I I think in some respects we can, you know, glean information from the research that's out there in, you know, to help people with informed consent.

Jenn Schmitz: 2:09

Absolutely. And as Dr. Mark Horowitz said when he was on the show, right? Like information was coming from homemakers, truck drivers, right? Like, because sometimes it's not out there, but it doesn't mean that we can't start to figure it out. Right. Um, and as deep drivers, we do this with our we do this with our clients. It's a very subjective process. Yeah, I can talk about it too here and and the risks and benefits that I had to mull through my head and why I chose to not blind taper. Okay. So let's jump into this. You want to talk a little bit about some of the research you found in just like on the benzo tapering part of this?

Dr Teralyn Sell: 2:45

But hold on, let's backtrack because one of the biggest uh news stories that came out was about Charlie Sheen. Right. So Charlie Sheen. And and I it was funny because I happened to catch this on an interview because he's got that new Netflix series that's coming out. And so I happened to catch it in the interview. He was talking about how his uh drug dealer blind tapered him off of crack. Yes.

Jenn Schmitz: 3:11

And in cahoots, in cahoots with his therapist, which, okay, let's we're not even gonna get into ethical stuff, guys, here, but I think this is so progressive.

Dr Teralyn Sell: 3:24

That there was uh signed consent and it was probably a bunch of forms, but I love it.

Jenn Schmitz: 3:28

I seriously, I I thought that this was so incredibly progressive and fascinating and like all the things. I actually loved it coming from a space of a of knowing a lot, you know. I mean, you follow Charlie Sheen, the man has probably done every single type of intervention ever that has ever existed. And then some when it comes to trying to battle his addiction. Um so I was like, this is this is fantastic.

Dr Teralyn Sell: 3:56

So he had he had a legitimate taper team, right? So he had his therapist and he had his prescriber. He had his prescriber, which was dealer, who by the way, this is this is the funniest part to us, is that his drug dealer was way more invested in helping him than most prescribers are when we talk to them.

Jenn Schmitz: 4:22

So I thought that was that's exactly where my mind went when I saw this. I kept thinking, here's my prescriber who wouldn't even give me the time a day to try to get me the liquid that I'm needing to get go down on my Lexapro. And it took a fight, right? Took two appointments, took a fight, took me tapping on the damn mousely manual, like a mother, like, no, you sit down and read this, right? Like, and that was this like, oh my gosh. And then here you have that, and and there's no vestment either, by the way. Like it's not like every two months or something, like my prescriber reaches out and is like, who's going? No.

Dr Teralyn Sell: 4:56

Then you have a drug dealer who's only dealing to a celebrity, getting tons of money, making shit tons of cash.

Jenn Schmitz: 5:03

And it's like, nope, I'm gonna invest in tape helping him taper off of this because I can see what it's doing to him. And that man is in the background doing the math. He's got the science dialed in to figure out how to do it.

Dr Teralyn Sell: 5:17

Yeah, so he's actually cutting it with uh more baking soda, like he's cutting it down with more and more baking soda just for Charlie.

Jenn Schmitz: 5:24

And let's not hear, like, oh, that's so bad for Charlie. Ladies, I can't even believe you would even be on like okay. Listen, the man is like a cat. He's like a whole herd of of like wild cats because he's had that many lives. Not nine. There's nine thousand. So, I mean, let's let's get real with this for a second. So they got super creative, and the person who was his dealer was so incredibly invested in helping him, and it worked.

Dr Teralyn Sell: 5:52

And you know, here's the thing though, and this is the controversial part is that the the dealer and the therapist were in cahoots without Charlie knowing, without him knowing. So he did not know that knowledge. So he he did not have knowledge, so he didn't really have informed consent either, unless he did. Who knows? I mean, I don't know if there was a discussion about maybe one day we should try this, and he was all about it, and he's like, just don't tell me when. I don't know. Who knows?

Jenn Schmitz: 6:15

It didn't and we're we're getting, you know, we're not getting full truth, right? This is what we read online, this is what we can see, even what we're seeing in a Netflix series, guys. Like, there's still things behind doors that are are not being discussed. So there's an appeal to this too, from like a marketing, like like big TV standpoint, right? Like, right, he didn't know about this, right?

Dr Teralyn Sell: 6:36

Right, but the conversation though needs to come into these rooms as well. So, because I think right now, from what I'm seeing, the conversation is to shut it down altogether, to shut down the conversation, it's not an option, do not do it. And Jen and I believe that that is not full informed consent because everybody is different and everybody's needs are different. And to me, this talks more to the psychology behind things than anything else. And of course, you know, that's what Jen and I do. So, you know, there's a thing called uh before we get into the research, called the nocebo effect instead of the placebo, it's the nocebo effect. Yeah, and I think the nocebo effect is the important piece in this conversation. So I do have a little definition here. Oh, for no SIBO? For no SIBO. So no SIBO is expecting a negative outcome creates a negative outcome. So so when you are tapering, the fear of withdrawal can sometimes trigger symptoms even before the dose changes. Masking the dose reductions may protect some patients from no SIBO-driven symptoms, especially those who brace in an anticipation of a cut, or after it, yeah, or after it, like you expect so exactly. Yes, you get it. Yeah, you brace for the worst, right? You do, you and then the worst happens, or or you have, and this isn't meant to be minimizing to anybody, or after you cut something, you expect a certain thing to happen to you, and then you're you're actually like that certain thing happens to you because it's like you you've kind of willed it into existence. It sounds crazy to say that. Like, but this is how the psychology of the mind is so profound, even though you know the placebo effect is kind of the opposite. It's like the ex expectation something good is gonna happen, right? So placebo means if I take this, I it will help me, which is why so many psychiatric medications, the placebo outperforms the med.

Jenn Schmitz: 8:43

That's what I think and that guys, that's all the psychology behind it. That's psychology, all it is all the power of the mind. That's all it is. That is the most like the power of cognition and what it can do.

Dr Teralyn Sell: 8:54

So the nocebo is the is the opposite of placebo, the expectation that something bad is gonna happen when you do this thing.

Jenn Schmitz: 9:02

And that's a real oh, is that real for the real taping tapering? Oh my god. You just said that. I thought I'm like, oh god.

Dr Teralyn Sell: 9:11

Yeah, visceral response.

Jenn Schmitz: 9:12

If you're not gonna be able to do that, I can I can feel it because you, your, your, your whole life every single day is about cutting, weighing beads, yeah, dosing down a liquid, and getting ready and being hyper-vigilant. It almost creates this level of hyper-vigilance among the nervous system, especially when you've had multiple times where you did have pretty significant withdrawal. Okay. So it's almost like this is this is like it's almost like a trauma in the process. If you're, I don't want to say not careful, but if you don't consider all of these different things, which is one of one of the reasons why I talked with you year ago, year and a half ago about Jen, maybe we should start a blind taper for you. Yeah. Because your head is getting the best of you.

Dr Teralyn Sell: 9:57

And that's exactly the that was exactly the discussion. Yes. And I think we said that, like Jen, your your mind is fucking you over right now.

Jenn Schmitz: 10:06

It is like it is. I know, and I'm sorry, Anders, you call it really nice things, and I call mindfuckery because as a patient, that's what I feel like I was going through.

Dr Teralyn Sell: 10:16

When we had when we had Anders on the show, he talked so much, and this is the belief about the psychology of all of this, right? And I think because I've been thinking a lot about this, like when we get into the research, you're gonna understand why. But but axing out a mental health professional is the wrong move for most people. Now, it needs to be the right mental health professional who understands all of this, you know, but I feel like in many respects, like the therapist has been axed out of the entire conversation. Whereas you're gonna see in the research that the therapist needs to be a part of it. And so you think about Charlie Sheen. His therapist was part of this crucial conversation and this crucial plan. And, you know, but again, we go back into yes, but a lot of therapists say you need more, just like the, just like a prescriber. Are you sure you want to do like they they bring in the wishy-washy, right? So it obviously would have to be a therapist practicing that understands tapering and understands all these things, which, you know, so I I have felt so much that the role of a therapist, a good quality mental health therapist in tapering has been like silenced, like ax them out. They're, you know, they're they do more harm than good, blah, blah, blah. And I just don't think that that's accurate, you know. I mean, it can be accurate for sure, but I I don't think that doing that is the right move. As evidenced by Anders talking about it, his whole book is about the psychology of taper.

Jenn Schmitz: 11:48

Right. I mean, like a 16. The taper plan is this thing, like and everything else is about the not even if you have it. Yeah. All right. So, what do you got here uh on the other side that we can talk about there being research about this? Because there have been several uh people out there that have podcasts and shows and on bigger social media presence that are in our field. And I'm sure a lot of our listeners here follow some of those people. And one of the things that I kept hearing throughout some of it is that there isn't a lot of like science to back this, which is also kind of a bunch of bullshit, because there is a little bit there.

Dr Teralyn Sell: 12:19

Well, there's not that it's not there for SSRIs, like I said, your typical antidepressants, but blind tapering off of medications that are super difficult, like benzodiazepines, are certainly out there. There was actually, I found a methadone detox clinic, which it's very difficult to get off methadone, that they do blind tapering in this clinic, right? So I was like, okay, so to say there isn't research out there is really not true. There is quite a bit of research out there, and I found some of it, like a fraction of it. There's research out there for blind tapering on other types of medications too, of course. But the ones that had the are most heavily researched is benzodazbeans. Yep. And I I was surprised by that.

Jenn Schmitz: 13:02

Does it mat I I'm thinking about this from a if we stop siloing things from a bird's eye view, does it matter if it's a benzo, if it's an SSRI, an SNRI, as you know, we're talking about a Z drug, like any typical antipsychotic, like whatever it is, we're not talking specifically about the like it's about the psych because this is all about the psychology behind a taper. Exactly. It's not so much about the the the drug that we're tapering, but more about how to work this through with somebody and when to figure out whether or not it can be effective for them. So I I look less at the drug right now, and maybe some of the researchers out there would go, Jen, that's that's that's a naive like standpoint to take.

Dr Teralyn Sell: 13:44

But I mean, it could, but I think it's a curious standpoint, actually, because you know, with every research article that there is, there's going to be, you know, a downfall of the article, you know. And so most of the most of the negative pieces of this research would obviously be length of time, right? And follow-up, follow through. There was an article that did a follow-up, which was good. But so, of course, like they're not gonna be doing a blind taper according to, and this would be a great rich research article, a blind taper according to hyperbolic tapering, right? Like they're they're not gonna do that. They're not gonna do a blind taper that lasts four years, right? Um, you're not gonna see that in the research. But you're going to see it in the research in a shorter term, which we know, I mean, the the criticism is going to be, but what happens with in protracted, right?

Jenn Schmitz: 14:33

Like so all those are things that you have to consider, right? Listen, I blind taper my kids all the time off of sugar. They have no idea that the like the syrup that I put on their pancakes very slowly over time switching from the shit stuff to like natural syrup. They have no idea. They're gonna be all right. I think it's gonna be okay. Yeah, yeah. Sugar is an addiction.

Dr Teralyn Sell: 14:55

It's it's very, very true. Okay, so here's some of the research. It is I'll just give you the studies. I have one, two, three, I just have four studies up here. So the first study that pops up when you type in it was from 2019. There was only five participants in the study. So this was the smallest study, okay. But all five successfully discontinued uh hypnotics when mass taper was combined with behavioral support. So this this was a group of people with insomnia and they're using hypnotics for insomnia. So I think the key, the key there is with behavioral support, like with therapeutic support. Okay. So again, they trained the therapists in, I think it was CBTI. So CBT cognitive behavioral therapy for insomnia. And they used those protocols with these people. The next one was a blinded hypnotic tapering strategy with 78 participants. So we're getting a little bit bigger after CBTI. Again, they use CBTI, participants randomized to mask taper had higher discontinuation success and fewer withdrawal-like complaints than an open label taper. I mean, these things are interesting to me because it's really the combination of CBT, this obviously CBTI, but a CBT type program with a blind tapering protocol is looking like it has value, right? The next one was another one, and that was a 2021 study. The next one was in 2004. It was CBT to facilitate benzodiazepine discontinuation. 76 participants, 85% discontinuation, which was versus a lower success taper with only CBT. Okay, so they did CBT, blind taper, and just CBT. And then the next one was a meta-analysis that had they looked at 20 different studies and they had over 2,000 total participants. So combining a taper with behavioral therapy improved short-term discontinuation rates versus a taper alone. You know, uh long-term evidence showed that it was promising but inconsistent, right? And so we're gonna see that over time, but I was just like, wow. And then when I saw this methadone detox that was doing a blind taper thing too, I thought that was really fascinating. So I don't know. I mean, I think this is a conversation worth having. Yeah, so the five-person one had 100% discontinuation when tapering was masked. The 78% randomized trial suggested masked tapering reduces withdrawal complaints and improves proves success. The 76 participation, the next one showed combining tapering with therapy improves outcomes dramatically. I don't know if that was a masked taper, maybe. Maybe it wasn't. It just says tapering. But anyway, so it's basically saying that combining a blind taper or any taper really with behavioral health support.

unknown: 17:59

Yeah.

Dr Teralyn Sell: 18:00

Now, what does that sound like, Jen? It sounds like the gold standard of using medication with behavioral health support. I'm like, it does.

Jenn Schmitz: 18:06

There's there's the gold standard. There's the marriage. There it is. And also, we've talked about this too. Why do they only use CBT? Like, I know it drives me insane, right? I as you're talking in the back of my brain, all I can see is this word like nutrition, amino acids, neurotransmitter optimization. This is all I could see popping, right? Like, and imagine if we add that in. Like, let's add that in. Let's, you know, let's bring a whole whole nother piece of this to help people. Yeah, because I lost a whole bunch of mind.

Dr Teralyn Sell: 18:36

I almost thought that EMDR might be a valuable asset when it comes to any type of tapering. I do not disagree with that. Yes.

Jenn Schmitz: 18:44

Do not disagree with that. I just use the word tapering can be traumatic. I I think it absolutely 100% can be. And I think a lot of people have residual trauma from tapering, tapering too fast. I mean, this is a the this is this is what happens because the psychology of the taper, yes. The process itself, yes. And you are so fearful to keep going after what has occurred to you and the scariness that happens, and you become very hyper-vigilant around that and you don't sleep around that, and it becomes irritable. And it it's an intrusive thought that is there that changes your entire nervous system. Yeah, that's trauma. Okay. Yeah. So let's call it, let's call it that, right? Doesn't mean we have PTSD, right? Some things are traumatic, they don't have to be labeled as that. But this can be very traumatic for people. We've a lot of people on the show that would absolutely 100% say yes. So 100%. So I think we have to we have to talk a little bit about in light of this research, then let's talk about, let's categorize this for people and let's let's do our informed consent thing, which we which we eat, eat, breathe, love, and shit. Okay, informed consent. Let's talk about some risks. Can we start with it?

Dr Teralyn Sell: 19:48

Because there are risks for sure. Okay. So I I want to wait. I want to start off by saying, and I think this will bring the picture completely. When in these in these research studies, all the blind tapering uh protocols. were compounded. So they're compounded by a pharmacist, right? So, so the the medication itself was outsourced to somebody else to to make who was trusted, right? Like it was a trusted person. But I think I need to make that clear is that they were basically prescribed in this blind taper by a compounding protocol. Okay. Right. So it was very scientifically measured and done. Okay.

Jenn Schmitz: 20:25

So anyway, which can which is that leads us right into our risk category. Yes. Because if you are choosing to do a blind taper, that means that there is somebody else in your life that you have to put enough trust in that is going to be pulling your syringe, weighing your beads, cutting your pills um every single day for you or you know whatever that looks like for you. So so I think we got to talk about that as a risk. Because that person really holds a little bit of the golden ticket, so to say, for you. And you've got to have a pretty heightened level of trust for that person. I think about people who have spouses that have their own issues with alcohol or drugs. Okay. Yeah. And and let's say it's an evening thing for you and every evening, you know, you're taking or twice a day. If you're tapering off an SNRI, fuck, you're you're doing twice a day, right? Yeah. You've got to have that person available. They need to be accessible to have it laid out for you. Okay. I think about someone who works a lot. Let's say you've got a spouse who is over the road truck driver or somebody who does does late work because of the type of job that they have. And when they come home can very much be variable, right? We know that for some of these some of these drugs, specifically like an SNRI, even some of the SRIs, the stability of them let's say you're doing a water taper, for example, okay? The stability of that you can't draw two weeks worth of syringes and pull the labels off and go here's Monday AM, Monday PM, Tuesday AM you cannot. They are not they are not stable that long. So you've got to have somebody that can be there to do this. Does that make sense?

Dr Teralyn Sell: 22:14

Like present they have to be present and they also have to be willing to follow a plan. And it and the plan still is the person who's tapering is still in charge of the plan. Like just because you're blind tapering doesn't mean you're giving up all control.

Jenn Schmitz: 22:33

Well that's okay and that's on my risk list. That's actually one of the things that I when I was going through some of these risks even for to prep for the show but when I went through this in my brain a year and a half ago and I was considering blind tapering. That to me is a risk that I put in that category because part of you has to remain in charge. Like that's a huge piece to the empowerment of tapering. At the same time though, part of you doesn't have control over all of this and we're going to talk about like when that plan to stop might be there because you've got to have a a fail safe to go nope, we're, we're, I'm going to be done with this. But you do give away a bit of your power within the tapering process to someone that you trust no different than you gave your power away when you started taking a psychiatric medication to someone that you trusted. Okay. For me that's a risk. That went in my risk category because that was a lot of the impairment we all know Jen's a control freak so that's probably her biggest risk in the thing I was like what's going on my risk list because for me that that mattered.

Dr Teralyn Sell: 23:37

So I'm a control freak too.

Jenn Schmitz: 23:39

I think it would be tough to give that up you know yes yeah so so I I think that matters you've got to be able to trust that person and you've got to have somebody that's willing to like plan this out with you. Like it doesn't mean that you don't get to see what your taper's going to look like. The part of this is that you don't get to know when the dose is happening and switching for you. Right.

Dr Teralyn Sell: 24:01

That's well I think that that other person too needs to have their own agendas flushed on the toilet. So like if if it's your partner and they're wanting so much for you to be back right as the person because they want to have sex with you and they want you to have a libido back and they want all these things. And so their agenda needs to be quelled away and it's just your partner's agenda that that's the whole thing. And I think sometimes that can maybe get mixed up too because like you want so desperately for the person to be done for many reasons. I want my spouse back I want the intimacy back I want all these things back that you have to be able to set all of your feelings aside and just continue to do what's right for your partner. Or if your partner says I'm done with this blind taper you need to be done with the blind taper like that that's it. Like that's where your control actually is still exists like you have the ability to say stop you can have a safe word.

Jenn Schmitz: 25:02

Yes as you should right and that's a that's a risk to this is not only your partner's like agenda also another risk is your partner's willingness or whoever's doing the taper I keep saying partner but whoever's doing a taper partner taper partner. Yeah the TP also they also have to understand some of the science tapering okay and they also have to understand withdrawal and this to me is a risk. Okay. This is a very big risk because if your partner's agenda is to kind of ignore some of those signs of withdrawal because they want you to keep going okay that's a big piece to this if your symptoms are dismissed when you are tapering okay that is a huge piece to taper uh like tapering failing because you're going too fast. Too fast. Your symptoms are there and you're doing the taper because you're the mindfuckery is already there first. Like you're choosing to do a blind taper because that's already exists for you. Like I think that's one of the reasons why many people it's going to be a benefit when we get to benefits. That's why they choose to do it. But if your person that's doing the the tapering with you doesn't understand okay that's a sign of withdrawal like she's been sick for three days right sitting in the bathroom on the toilet and is complaining about like you know GI issues. She usually doesn't have GI issues right if they don't if they don't have that knowledge that the person doing the tapering does as well I think that's a huge risk.

Dr Teralyn Sell: 27:20

That person has to kind of be an extension of your arm like as if you were the one going through it. Like what would you do for yourself? Huge responsibility on somebody else. Alternatively there's you know you have to pick somebody that also believes in your taper. Yes. Right? Because you could have someone that doesn't believe you should be tapering doing a blind taper because you want it and then they're like see I told you you should just be on this like this or someone also I think somebody who is this sounds weird like okay with watching you be in pain right I think for my husband that would be the hardest part because he because he would knowingly be the one providing me with the pain and he is not one to sit with me in pain very easily he wants to take it away right like he's yeah he wants to fix it. And so for him I think I don't know maybe psychologically for him he'd be like I'm not so sure like if if I got into a a space I think he would start feeling guilty. Yes that he put me in that space essentially through the taper.

Jenn Schmitz: 28:23

So partner when you say extension of the arm exactly what it has to be the person helping you has to know as much about tapering and withdrawal as you do. As you do and you might not know much by the way so yes yes but they they've got to they've got to know that they've got it they've got to have that antidepressant check sheet somewhere right like for those I know there's a lot of people out there that use that from Glenn Mullen's work right that lists out these common symptoms you fill in you add more I've got mine hanging in my bathroom I look at it every single day that person has kind of like an observational thing like they need to be observing. Here's here's the deal if you're doing a hyperbolic taper for those of you that are out there you know that the safest way within that taper, okay and I'm air quoting this guys if you're not on YouTube watching this, because yes, this is so a subjective however there's research out there that is going to show us that the safest way to taper is to go two to four weeks between dosing down depending on what you're doing. If you're micro tapering you're dosing down every single day. Okay. If you're not you're going two to four weeks symptom free without major withdrawal symptoms. So the person on the other side has to know what all of that is right they have to be they have to be willing to see it and like be mindful of it and aware of it because guess what? They're in charge of your of your dose down. So the clock restarts when you have these major symptoms of withdrawal yeah so they need to restart the clock you have to trust they understand that there's a I'm just as you're talking I want to ask you a question.

Dr Teralyn Sell: 29:51

So when you get to a certain you don't have to answer it if you don't want to if you get when you get to like let's say you're at four okay you're at four milligrams and you get down to like 3.2 how does that feel for you or a three how does that feel for you after you've gotten down there like you're like I'm at I finally hit the three threshold or 3.9 for me personally it didn't feel psychologically.

Jenn Schmitz: 30:15

Yeah psychologically it didn't feel that great because guess what I knew what was going to happen about 12 days after I dosed down no SIBO. Correct. And many times it did and that's where some suicidal thoughts came in that's where like the wind being too windy outside I can't handle sensations was coming in all of that for me that's where withdrawal landed protracted withdrawal was not within like the half life of the med going down it wasn't 48 hours for the lexicon no it was day 12 between day 12 and day 15 and that is when it would hit so I never actually feel great whenever there's a dose down now that I'm microtapering it's a little different because I'm dosing down every single day. Yeah. And it has greatly removed some of those risks because that is a risk of tapering guys is the psychology behind this and the mindfuckery behind this. Microtaering removed that for me because I'm doing it every single day now and I'm not having as much withdrawal. But a risk is the psych the psychological piece of this.

Dr Teralyn Sell: 31:15

So no it didn't feel good because I knew okay here we go count down 12 to 15 here's the question if you're micro tapering down from I'm just going to make shit up here. If you're microtapering down from four milligrams to 3.9 so we micro tapered down to get to the 3.9 how does it feel when you finally get to the 3.9 it's it's I'm neutral.

Jenn Schmitz: 31:34

Okay. I'm very neutral. I'm not worse I'm not worse but I'm not worse. It's not like I'm anticipating the withdrawal now I'm just I went down again. It's like it's Tuesday the sun came out put my underwear on and my pants aren't backwards just another day.

Dr Teralyn Sell: 31:47

Well because I see what I'm saying is I'm I see on social media like when people hit a certain mark and they're like I finally got to this and there's some level of like excitement and exuberance that you finally got to the I don't know if yet I can't the worst I should have been talking earlier I know I know I'm very not trying to be negative in it.

Jenn Schmitz: 32:09

However we're talking about risks right like this this this for me like it it there's the psychology behind this and that falls under the risk list. Right. Because for me I I weighed those benefits and I still was like nope I'm going to be in charge of pulling my syringes and drawing myself down every day. That to me was that was the benefit of me doing that was outweighing the the cost of what it would be for me to not know along with a bunch of other other things and the benefit of the return to agency I think was probably it for you I am so about the empowerment part of this I mean like oh my gosh it's like I'm I I have to be in charge of this now. Like I didn't let I let someone else fucking dictate this for 25 years for me. So again risks and benefits guys so you would outweigh this and there's a ton of psychology behind it.

Dr Teralyn Sell: 33:02

And I yes I I uh but I want but I think like so when I'm on this this website that's doing the methadone blind tapering I think this is an important thing. Blind tapers are voluntary you still remain ultimate control after all it's your body and your money is what they said. Two points here that they make and I think these are valid. With a blind taper you should retain control to the end the blind at any time to find out your current dose dose should schedule an estimated tapering completion date.

Jenn Schmitz: 33:32

Like you can still you can ask even like okay right so you've got the agency to go where am I at you where am I at?

Dr Teralyn Sell: 33:39

Yep. You and what's my goal right you should never forfeit your right to learn your current dose or schedule this is unsafe. You could need this information for a medical reason and unethical you have the right to know what you put in your body so I I think I mean that's kind of the informed consent and I think when when we hear people say don't blind taper it's too risky it's too whatever I'm like but if you can maintain those ethical boundaries for yourself and still that sense of agency and you can also maintain the sense to say I'm done with this I don't want to do this anymore.

Jenn Schmitz: 34:15

That's ex it's exactly what it is. I I've I've got a couple clients that are are doing this and their spouses are extremely involved in the process. And one of the things that was very concerning was it's it's a risk for for them for the person that's doing this because they kept saying they were very worried about you know if I experience withdrawal and I'm still in my head because for them it was all about the psychology behind this and it was taking them down. So that for them the decision was to do this. Well what happens if I start having these symptoms and is it in my head is it not in my head does my spouse notice it does it not you write this shit down. So you find alternatives to do this if you're going to taper you keep yourself a journal and you educate the person helping you on looking at that journal and looking at the symptoms that you have keep a tracker do a checker whatever the hell you got to do. And the person doing your tapering can look at that and go, huh, pretty interesting how every time we taper down about four days after that, these symptoms start to pop. Yeah. Okay. So that what does this mean for for my person that I'm doing this with okay so there is a little bit of maybe more acute or protracted depending on what the what the medicine is that they're taking, right? That means something. That means I might need to resource my person in a different way when we start to go to up to like day three, day four like they can be part of of that. If you're tracking stuff, you track it together.

Dr Teralyn Sell: 36:14

Well that's the thing I think together I think when you know people talk about blind taper they're doing it from a complete fear-based perspective instead of like collaborative perspective it doesn't mean that you give up everything and you have zero control and zero knowledge and zero that it's not you're not in a in a double blind placebo controlled study. Exactly this is still your life this is still your life and I think for some people to you know take that away as an option because people are afraid to talk about it in the way that it needs to be talked about I think is a disservice for some people especially people who are seriously in that nocebo effect piece of it right so I because there there are people that are in that and you know if if I were in that space I would like to have an option. Now here's the deal if if I because I mentioned this to Jen a year and a half ago or whatever it was. Right.

Jenn Schmitz: 37:16

And but prior to that did you even think of it as being an option no no no I would have never thought to have would have been my my spouse right someone right there convenient in my home I would have never thought to have them do this for me in a million years. It wouldn't have even crossed my mind yes with me yes and and that that to me was that was yeah again we raise we were risking risk and benefit we went through risks we did a ton of risks here is there anything we're missing otherwise we should move to benefit for time's sake here. What else are we missing for risks that we didn't cover? I I I think I mean I exhausted my whole nice little list that I wrote about all the shit that went through Jen's head.

Dr Teralyn Sell: 37:56

I think that's probably it I mean if we're missing something I would love for people to comment like what is it that we might be missing as far as our risk goes you know because we like having a knowledge for medical stuff would be a risk. So making sure that you know where you're at like you can still ask those questions.

Jenn Schmitz: 38:14

It doesn't have to be that so yeah I think it's about having a really good great plan because if you don't have a really good trade plan in partnership with your TP, then you're the you know what it's like EMDR where's the stop signal what is it and how do I know when I can pause like that's all stuff that you plan for and you spend some time working through what that looks like.

Dr Teralyn Sell: 38:34

Well maybe the last risk that I could think of is if and it's kind of a not really a risk but it might not be for you if you don't have a trusted person. Right. So that you know and that that feels bad. So the risk of like feeling bad because you don't have a trusted person to do that with you might be a risk, right? Right. So yeah because now you've got one option that is gone. Yeah. Correct.

Jenn Schmitz: 38:57

Yep. No I I think that's a good I think that's a good coverage of of some of the risks that that you could experience. Okay. All right let's go to let's go and talk about benefits of doing a blind taper off of psych meds well I think the first benefit would be like get it off of me.

Dr Teralyn Sell: 39:14

I don't want the you know that res that's a huge responsibility if you've been doing it for a while. I think blind tapering in anyways in my opinion I think a blind taper would probably come after somebody has just feels so exhausted or out of control or just is can't move themselves forward on their own. I think then the conversation I don't I don't know that I would ever have it as an introductory conversation of well you can do it this way or you can have a blind taper.

Jenn Schmitz: 39:43

Like I I'm not sure that I would have I guess that that's again person dependent right like yeah I I think it probably comes it comes up more so when I mean at least in in our consulting that we do with people it's usually not the first like first conversation that you that you have it's one I will introduce when talking with people and recognizing just based off what they're sharing that there is a whole level of hypervigilance that is now occurring around you can tell you know I mean I think as narratives we can really see it easily more so than maybe somebody who doesn't have the training that we do.

Dr Teralyn Sell: 40:19

But yeah I think that's that's part of it. So I would say that a pro would be maybe the relief of not having that responsibility on yourself. I think that would be a could be a pro. Yeah.

Jenn Schmitz: 40:33

Yeah no it's a it's a heavy it's a heavy weight that that's there. And you kind of do feel a little alone in it as you're doing it. And I'm not saying that your partner or your taper partner out there isn't isn't there with you during the process and trying to understand things but you're you're kind of alone yeah you know you're you're alone more robust team than like you know it's more of a team approach. It is it's much more of a team approach and it's somebody that's investing a lot of their interest in trying to help you through this. So you don't feel quite as much like an island doing it because they got to put their hand they have to get their hands dirty. So I don't disagree. It it there's a weight probably a weight a little bit that can be lifted off of people that leads us to the next like Really, more obvious kind of benefit to doing this is the psychology behind the tapering and what happens when this becomes or elimination of nocebo. Yes, when this becomes so incredibly stressful, overwhelming. And for some of us, we create, for example, I was doing this. Just because I have withdrawal at day 12 does not mean a protracted withdrawal, does not mean that I'm gonna have that on day 12 every single time I dose down. And in my head, the question you asked me earlier, right, is like, well, what did that feel like? It didn't feel great at all to go down from say four to 3.84, because I'm like, well, here we go. Let's just count down till day 12 when shit hits the fan for me. Um that's that's very real.

Dr Teralyn Sell: 42:10

Yeah. Like there'd be no countdowns. Yes. But I want to introduce something right now because I I think placebo would be a pro. Because if you're going into a plan like this and you're believing that this is gonna work and this is gonna be the helpful plan, and this is gonna take away some of those other psychological pieces of the nocebo effect, right? So I'm gonna say the placebo could be a benefit. Like 100, I believe this is gonna work. Yep.

Jenn Schmitz: 42:40

And so then we and we and that's real. We were just talking about that in research, right? That's that's very real in research. Why placebo can outperform? Placebo is real than right, yeah. Because this is all the cognitive part of what happens and how I mean, we know we can convince ourselves of almost anything if we try real hard, and this is what's happening. So if this is the thing, right, that's gonna be helpful. I I'm gonna do it. I'm gonna do it. I'm gonna try it.

Speaker 2: 43:06

Yeah.

Jenn Schmitz: 43:06

And and let that part go, which that's very, that's very fascinating. And I think that's a huge possible benefit to doing this. Yeah. Um, sometimes we have to let go of control. I think that depending on our personalities, like that's where that's where risk benefit comes in. Because for some of us, we we need to reach out to other people and fucking ask for help.

Dr Teralyn Sell: 43:30

You know me, I don't do that very well.

Jenn Schmitz: 43:31

Same zy, I suck at it. I I suck at it. And so, of course, here's Jen choosing to not do the blind taper. Shocker, right? Like, if I just shocked.

Dr Teralyn Sell: 43:40

I remember mentioning it to you, Jen, and you were like, oh, blasphemy. Like, are you shitting me? I am not gonna do that.

Jenn Schmitz: 43:46

My environmental circumstances are not gonna allow for that. Okay, screw that. My personality is not gonna allow for that. But if you think about this, right, we talk about this a lot with our even our deprescribing clients or even in therapy. You need to stop being neutral, you need to stop being Switzerland, you need to ask for help and let people that's what a taper team is. So if you're somebody who cannot relinquish that control and actually in areas of life when you start to ask for help and allow someone else to fucking take some of your heaviness away from you, that's super powerful. Huge risk benefit, sorry, of of blind tapering. Yeah.

Dr Teralyn Sell: 44:23

Yeah, yeah. I mean, like I said, this is that this is a risk benefit analysis.

Jenn Schmitz: 44:28

Put trust in somebody, all of us that cannot put trust in people because all the like here's you.

Dr Teralyn Sell: 44:33

All the untrust things that have happened to you to get you to this far. And now we're saying, well, in a blind taper, you have to regain trust in somebody. You have to, right? You have to.

Jenn Schmitz: 44:45

And for some people, you need to do that. Like it's imperative now that I start to trust somebody. I mean, yeah, all the psychology behind this is really it's it's profound.

Dr Teralyn Sell: 44:56

And it is profound. I think that's the hard part is because people have been told so many times that their symptoms are in their head and it's not real, and all these things. And symptoms are very real, but psychology is also very real. Like the power of the mind in all of this is so profound that I think we need to tap back into it instead of like abandoning the idea that there's power in the mind. And I think we need to tap right back into there is power in my mind, right? And so I think that's that's important as far as blind tapering or tapering in general goes and rebuilding trust, like, and also trust in self. I have the ability to stop this taper. I have the ability to know where I'm at in the taper. I would probably suggest you don't ask every day where you're at, but like you don't even have a plan for that. Like every couple of weeks, I'm gonna ask you where I'm at in the taper, and you're gonna tell me where I'm at in the taper. And I'm gonna be like, okay, all right, sounds good. This is where I'm at in my taper. Every few weeks I can do that. And then you feel like you still have some control, you know, over the blind taper.

Jenn Schmitz: 46:06

So you had another benefit. Yep. Another benefit to it. Yeah. Yeah.

Dr Teralyn Sell: 46:11

So, you know, I I don't know. Like, I like again, I think there's a lot of fear in this in this area of blind tapering because there hasn't been robust conversation around it. It's just been, don't do it. Like, you know, how dare you suggest a blind taper? Yes. I don't know that it's that easy. I don't know that it's that simple.

Jenn Schmitz: 46:30

No, and I I think you I think you have to talk through this with yourself. Like this is where having somebody that you can work with who understands this, like a therapist, I think is going to be extremely beneficial because part of part of the decision on whether or not to do this is also gonna lie around the type of personality that that you have. Yeah. And if there are limitations or things that you know that you really greatly struggle with, if you're somebody who taper aside, okay, let's pull the tape, the blind taper aside for a second. If you are somebody who really, really struggles with trusting people, if you're somebody who, I mean, I think here's where my brain goes, it goes way too far. I think about how much this process can assist in actually growing a relationship with whoever that person is that you're doing the good relationship.

Dr Teralyn Sell: 47:18

I'm just gonna caveat a good, healthy relationship that has foundational pieces to like I I keep thinking about this too.

Jenn Schmitz: 47:24

And I'm watching I watch this happen in the deprescribing world when spouses come in or significant others come in and they are so in tune with that other person, and that other person has spent so much of their life not being able to just kind of let go and bring bring that significant other in, and all of a sudden the game changes with this. These ripple effects that happen. For some, this is a is a benefit. Like, I'm not saying go choose a blind taper because you want your marriage to not fail and you're really looking for another skill to bring it all back together. I know I'm gonna save this marriage, a blind taper, like that'll do it. Like okay, but I these are some of the ripple effects that happen over time when if you have a personality that still really struggles with that and you know deep down, I gotta let go of it. I I gotta let somebody else help me.

Dr Teralyn Sell: 48:15

Man, it the the relationship, you know, again though, I just want to make the caveat that not every person is going to be trustworthy. When we say you have to learn to trust someone, you have to learn to retrust a trustworthy person, right? Like I feel like that's the conversation. But evaluating if they are trustworthy is the is the key, which is also a heavy load to of evaluation when you're in these spaces that you're you know, your head is not even connected to your body, and now I have to figure this part out, right? So yeah, so I I don't know. There's a much larger conversation around this than just don't do it, or you know, how dare you say to somebody to maybe think about it, right? Like there's a bigger conversation because again, as in the tapering world, every person is different. Yes, every taper is different. If we are looking for a boxed in approach to any of that, we're not gonna have it.

Jenn Schmitz: 49:12

Like you're that yes, that's what got you in this fucking mess in the first place. First place, yes, was the boxed-in approach, right?

Dr Teralyn Sell: 49:18

Even the hyperbolic tapering, you know, is is a guide, they call it the guideline. It's not a boxed-in approach. Like that's not at all. That's the key, is that yes, you can read the charts, you can look at the percentages, you can do all these things, but then there's you, like you, what do you want to do within that and how do you want to accomplish it, right? So you can do it on your own, you can do a blind taper, you can do all kinds of things. So if you don't want to box yourself in, keep your eyes and ears open and your curiosity open for alternatives, especially if it's if it's not working.

Jenn Schmitz: 49:55

That's I think that's part of the alternative conversation. So informed consent, we have risk, risk enough alternative. I think part of the alternative, and we've touched on this, we didn't just call it that, is there are ways to do this taper allowing higher levels of transparency within how it's occurring, more conversation. I mean, you can be somebody who watches your taper team person, whoever it is, weighing all the beads. Shit, you can help them, like especially if you're doing capsules. I'm thinking about this, right? Why couldn't you have it already? You make yourself a month's worth of capsules and you do it with them. You may not know exactly what day is what you're getting, but here's your chart. I'm going from 3.75 down to 3.72, and you're weighing your beads, putting it in your in your capsules, and you can see it. Like that's a heightened level of transparency that can exist.

Dr Teralyn Sell: 50:44

That's kind of what they did with the the compounding, is they would compound it all out and they would give them a week or two's worth in little boxes, and then you know, so yeah, it's it's the same thing situation.

Jenn Schmitz: 50:56

Yes, so I think part of the alternative is finding strategies to be as transparent as you would like to with the blind at the same time, like right?

Dr Teralyn Sell: 51:05

Like there's a line here, there's a there's a line, but also I think that is person dependent too. Do you want to know? Do you want you right? Like, how blind do you want this, right?

Jenn Schmitz: 51:15

Yes, do you want it completely blind? Like and it goes back to your personality. What do you know you need if you're somebody who has got so much anxiety over this, and this has just been ruining you to even start to be pulling, drawing these syringes every night and looking at these charts and worrying about the protracted withdrawal. Right, maybe you're the person who has to remove this part of it. Right. And let your let your nervousness.

Dr Teralyn Sell: 51:37

And I'm gonna say this too. Like you can change that. Like maybe in the early stages you say, I want to be completely blind. The only way I'm gonna get through this is for the next month is complete blindness. And then after a month, you're like, you know what? Now I want to know some things. You can change it. Change it, right? Change it up. But yes, I'm telling you, I'm trying to think about this for me. Like if I were like in a blind taper, I'd be like, because I'm a freaking control freak of control freaks. Like I have to be, I'm either all in control or I have no control. Like, so I'm like, I would either have to have all the control and do it myself or zero control and have my husband do it. Be like, nope, just take it from me. Like, I don't want it, you know? So I'm either all in or get it off of my plate.

Jenn Schmitz: 52:15

And it can alter and change. And and it really should. In fact, alternatives would be making sure that there is a check-in time frame. I mean, guys, when you're tapering, that's not like this is gonna take you a month and you're done. You're gonna be doing this for a while. So, where do the check-ins lie? Every 60 days, I'm gonna sit down, or if sooner I need to and go, you know, I just went from knowing everything to or more to now I need to know less because it's still taking over. And it again, that's where the psychology of it comes in. So it's so subjective. And people have such a hard time, even when they like come and talk with me about this, because they they want, like, I want the plan. And I will spend multiple coaching sessions talking like two ways from Sunday about the 96 alternatives of how you could do this. Because exactly you need to have that information because you're not stuck. There's multiple ways to do this, right? You know, you might start doing a taper and decide you got a micro taper, like like I did, because it was like, nope, this isn't going to the work.

Dr Teralyn Sell: 53:16

The beauty of it though is that it is in the tapering process is not a boxed-in approach, like like being prescribed. The deprescribing is a very different approach than the prescribing. And this is where the problem is, is because in typical de-prescribing, like if you go to your doctor, they do it the exact same way as they prescribe a five, 10, 20, you know what I mean? And then they go down the same way like that.

Jenn Schmitz: 53:40

And same drop-down, linear amounts. Yes.

Dr Teralyn Sell: 53:43

We have to have like this open mind and be the ability to change and the ability to offer different ideas to people and collaborate on new ideas so they can regain a sense of agency, right? Again, I when I work with people, it's never what I want. It's never what I want. It's always this collaboration. What do you want? Like, here are some options that I know. What do you think? You know, what is it that you feel like you want to do in this process? And, you know, by just saying no blind tapers, like that's you telling somebody what they can and cannot do. And that is exactly how they got here in the first place. Yeah. So don't do that, people. Don't.

Jenn Schmitz: 54:25

Yeah, stop. I mean, but I think for most people, once we get to a spot where we're ready to start tapering, we have already opened some of those other doors of curiosity, which I think is pretty cool, right? I mean, I think that for I can speak for anybody when they get to a space where they're ready to start tapering, it's because they've learned some things they didn't know before, which is a great space to be in in terms of agency, because then now you know I, you know what, I have all of the information and now I can make a decision for myself. But you might be the person who is like, listen, don't tell me when the pharmacy switches the company that they were using to get me my liquid. Don't tell me. I don't want to know. Because can that create all kinds of mindfuckery? 100%. And some of it is very real. As like you switch comp you switch companies, absolutely. That happens to so many people because of how it's produced is a hair off. And guess what? That impacts you. If you're somebody who's overly sensitive, you might say, Don't tell me. Yeah. You might say that. I don't want to know. I don't want to know. But you might want to know later. So I think this was a great discussion.

Dr Teralyn Sell: 55:27

And by the way, even saying I don't want to know, like I don't want to know in the pharmacy, that's somewhat blind. Like, even if you're doing your own taper on yourself and the pharmacy switches over, like a manufacturer would have to be. So again, even in the blind taper, there's opportunities to be blind or to be insightful. I don't know. Yes, exactly. So yeah, anyway. Right. What do you guys think? So, how do you think this discussion went on blind tapering? And is it something that you would ever consider, right? Knowing now that you have full informed consent, risk, benefit alternatives. So, yeah. So we'd love to hear your thoughts on the blind taper. Yeah. Yeah. Let us know. Yeah. Thanks for hanging out.

Jenn Schmitz: 56:15

We're we're at the end, guys, here. So please make sure that you go on YouTube and subscribe if you have not. Please give us all the stars, all the things. And once again, in a couple weeks, we will be having our hundredth episode that's going to come out. So make sure that you are listening because we hit the hundred, and I don't think we're even getting close to stopping. Because guess what? There's way too much shit that we got to talk about that we're being gas lit on, guys. So we are going to keep it going. But thank you for listening thus far. And I don't know. Heidi Ho, Terry. Here we go.

Dr Teralyn Sell: 56:47

Peace out.