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A Note From James Harper, Founder, The Road Back

Table of Contents

Part One

Chapter

1. The Road Back Basics

2. The Four Simple Steps

3. Suggested Nutritionals for The Road Back Program

4. Things You Need to Know

5. Things to Be Aware Of

6. General Pre-Tapering and Tapering Instructions

7. Daily Journal

8. Graph Your Success

9. Pre-Taper For: Benzodiazepines, Anti-Convulsants, Anti-Anxiety & Sleep Medication

10. Pre-Taper For Antidepressants, Antipsychotics, and ADHD Medication

11. How to Taper Off Benzodiazepines, Anti-Convulsants, Anti-Anxiety and Sleep Medication

12. How to Taper Off Antidepressants, Anti-Psychotics and ADHD Medication

13. Once Off All Medication

14. What to Do If You Have Already Started to Taper Off Your Medication or Quit Cold Turkey

15. How to Taper Off Multiple Drugs

16. What You Can Do If You Have Never Taken Psychiatric Drugs

17. Science Behind The Road Back Program

18. Additional Taper Reduction Schedules

References

Additional Testimonials

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Chapter Seventeen

THE SCIENCE BEHIND THE ROAD BACK

INTRODUCTION

The Road Back Program and the Development of the Program:

1. There are basic common denominators of psychotropic drug side effects.
    
2. How our individual DNA affects drug metabolism.
   
3. The effect of psychotropic medication within the Hypothalamus-Pituitary-Adrenal Axis.
    
4. Utilizing DNA clinical trials, test subject trials and psychotropic drug clinical trials to formulate specific nutritional products to eliminate, reduce or avert withdrawal side effects, while not creating drug/supplement interactions.

This research and development complexity has been transformed into an easy to understand, systematic program, which allows an individual to taper off their medication while alleviating a vast percentage of the debilitating side effects of withdrawal.

The sequence of this program and the application of each step is the key to success. Your patient will not even begin to reduce a medication until all or nearly all-existing medication-induced side effects are eliminated. This gives the physician, as well as the patient, prediction, as well as a structured step-by-step standard approach for tapering off psychoactive medication.

Statements of fact: All psychoactive medications metabolize through specific pathways. All psychoactive medications alter the Hypothalamus Pituitary-Adrenal Axis to some degree. To some extent, you can predict the duration before drug-adverse reactions begin with most psychoactive drugs, if the patients’ P450 (CYP) enzymes have been screened.

A poor metabolizer as well as an extensive metabolizer, will eventually reach the same saturation point; the poor metabolizer much faster, of course.

If one were to look at the basic structure of the human body, the chemical structure of psychiatric drugs, and include with this how psychiatric drugs are metabolized, how foods, vitamins, minerals, DNA, amino acids, hormones, glands, proteins, fatty acids, and enzymes work, in relation to psychiatric drugs, you have The Road Back Science.

DNA and Prediction of Drug Adverse Reactions

 
The following charts detail the P450 enzymes used to metabolize the most common antidepressants, anti-psychotics, benzodiazepines, and ADHD stimulant medications. An X in the row denotes that the medication utilizes that specific pathway. Below each chart, you will find other routes of metabolism if applicable.

These medications inhibit metabolism via listed CYP pathways.

These marked medications (*) will also use other routes for metabolism:

Elavil – UGT1A4, UGT1A3, P-gp
Luvox – 2B6, P-gp, intestinal 3A
Paxil – 2B6, P-gp
Prozac – 2B6, P-gp
Tofranil – UGT1A4, UGT1A3, P-gp
Wellbutrin – 2E1, 2A6, 2B6
Zoloft – UGT2B7, UGT1A4, P-gp, 2B6

These marked medications (*) will also use other routes for metabolism:

Clozaril – FMO, UGT1A4, UGT1A3
Geodon – Aldehyde oxidase substrate
Haldol – Glucuronidation, P-gp
Risperdal – P-gp, renal extraction
Seroquel – Glucuronidation, P-gp, intestinal 3A, epoxide by quetiapine
Zyprexa – Glucuronidation, FMO, UGT1A4.

These marked medications (*) will also use other routes for metabolism:

BuSpar – Intestinal 3A
Depakote – UGT2B7, UGT1A6, UGT1A9, UGT2B15, UGT1A4, UGT1A3
Valium – 2B6, UGT2B7, intestinal 3A
Xanax – Hepatic 3A.

These marked medications (*) will also use other routes for metabolism:

Concerta – Glucuronidation.
Ritalin – Glucuronidation.

How to Use Charts to Decide Sequence of Medication Reduction

If you have two or more medications sharing the same CYP pathway to metabolize, reduce the medication that uses the fewest shared pathways first.

Example: Ambien being used concurrently with Luvox, Paxil, Prozac, Wellbutrin or Zoloft. You should reduce the Ambien first.

If you were to reduce any of the antidepressants listed first, the Ambien would be reduced and the patient would experience Ambien withdrawal without the current Ambien dosage being reduced. Ambien would be reduced by as much as 43% if the antidepressant were reduced first. (See Ambien product insert)

If your patient is taking two antidepressants concurrently, or taking an antidepressant and an antipsychotic, selecting which one to reduce first would also follow the format outlined earlier in this section. The drug using fewer common CYP pathways should be reduced first.

If your patient is taking two antidepressants or one antidepressant and one antipsychotic, and the CYP pathways match, evaluate the patient’s current side effects, when each side effect started, when each medication was introduced, and determine from those side effects which taper schedule to follow.

From time to time, you will have a patient also taking a drug as an inducer of the CYP pathways.

Determine if this “inducer” was prescribed to help offset the inhibitor drugs effect or is the inducer drug prescribed for other health reasons not related.

You will generally find that your patients who are also taking the inducer medication will be suffering from a wide variety of adverse side effects. When reducing any medication attached to the same pathway as an inducer medication, reduce the normal taper speed by one-half for at least the first 2 months.

You may need to alternate reduction of the inducer drug and the inhibitor drug every other reduction in order to maintain a balance.

Other medications a patient is taking must be closely evaluated. Lipitor, as an example, is an inhibitor of the CYP 2C19, 2D6, and 3A, along with inhibiting the UGT1A3, UGT1A1, P-gp, and intestinal 3A.

Use drug product insert to determine metabolism route or the Physicians’ Desk Reference.

Example 1: If your patient is taking multiple medications and each medication uses the same metabolism route, each of the medications is competing for clearance. If you reduce