Core Harm Reduction Principles & Ethos 

Pharmharmed.ie is an independent educational and awareness project. The principles below describe the values and editorial position that guide the information presented on this website. They are not intended to represent the policies or positions of any government body, healthcare organisation, professional body or registered charity. 

1. Commitment to Hyperbolic Tapering

We advocate for hyperbolic tapering of antidepressants in accordance with the Maudsley Deprescribing Guidelines.¹ We do not condone rapid linear tapering or abrupt "cold turkey" cessation , which can increase the risk of severe withdrawal symptoms and, for some patients, prolonged withdrawal.²˒³ We believe antidepressant deprescribing should be approached gradually and with appropriate attention to the patient's individual response. 

2. Recognition of Akathisia as a Medical Emergency

We believe akathisia is significantly underrecognised and frequently misdiagnosed as standard psychiatric distress.⁴ ⁵  It must be recognised as a potentially life-threatening adverse drug reaction and clinical emergency, particularly when severe. Failure to identify and appropriately manage akathisia can allow the condition to worsen, and is associated with increased suicidal ideation.⁴ ⁶ 

3. Prioritizing Safe Reinstatement Protocols

We believe that following an abrupt cold turkey cessation, consideration of timely reinstatement should be evaluated carefully and promptly where appropriate, as prolonged delays in a destablised nervous system can severely compromise recovery stability. 

4. Reducing Off-Label Prescribing of Psychiatric Medicine

We believe that the off-label use of psychotropics - such as prescribing antidepressants like mirtazapine for simple sleep or insomnia - carries hidden pharmacological risks, metabolic consequences and difficult discontinuation challenges and that all medications should be carefully weighed against an individual patient risk/benefit assessment. 

5. Embracing Natural and Foundational Approaches First

When patients that are yet to be prescribed medication initially present to their doctor with mild-to-moderate depression or anxiety, we advocate for comprehensive foundational investigations before intitiating habit-forming psychiatric medications. This includes utilising comprehensive blood testing for hidden nutrient deficits (such as B12, folate, iron, and vitamin D), gut testing⁸, examining gene expression and individual metabolic variations, investigating root environmental circumstances (toxin / viral exposure) and life stressors (stress or trauma), engaging in supportive talk therapy or professional trauma therapy, therapeutic lifestyle modifications, and debunking the concept of 'chemical imbalance' by understanding the reality behind the serotonin myth.⁹ These act as primary safeguards before initiating potentially habit-forming psychiatric medications. 

6. Protecting Vulnerable Populations in Addiction Recovery

We believe that for patients with Alcohol Use Disorder who have cleared the immediate post-detox seizure window using benzodiazepines, continuing or restarting benzodiazepines to manage protracted alcohol withdrawal (PAWS) is contraindicated due to high dependency risks, cross-tolerance risk complications, and severe threats to long-term sobriety.¹⁰ Patients with a history of substance abuse issues should be considered high risk when it comes to prescribing psychiatric medication. 

7. Safeguarding Against Psychotropic Harms in Brain Injury

We do not advocate for patients with brain injury - whether traumatic, viral or iatrogenically induced - to be routinely given unnecessary psychiatric medication. Clinical guidelines and neurological research emphasise that a brain-injured central nervous system exhbits heightened sensitivity to pharmacological agents and psychiatric medication (such as routine benzodiazepines and long-term antipsychotics) which can cloud sensorium, impair neurological recovery, negatively impact brain plasticity, and present severe risks of paradoxical reactions, dependency and cognitive decline.¹¹ ¹² Recognising that such patients frequently present with severe emotional lability, irritability and behavioral dysregulation,¹³ we advocate for evidence-informed non-pharmacological gold-standard treatments: in alignment with neuropsychiatric and occupational therapy frameworks, primary management should prioritize environmental modifications, structured daily routines and specialised psychotherapeutic modalities¹¹ ¹⁵ to safely support neurological coping and recovering without introducing hazardous chemicals. 

8. Honouring Human Dignity through Christian Values 

We believe every person has inherent dignity and worth because human life is created in the image of God. Our work is therefore grounded in the Christian principles of compassion, truthfulness, humility, mercy, and care for those who are suffering or vulnerable. We believe every individual should be treated with dignity and without judgement, recognising that behind every diagnosis, medication history, or withdrawal experience is a human being deserving of patience, respect and compassionate care.

We are committed to pursuing truth honestly, including where uncomfortable or difficult questions need to be asked about established medical practices. At the same time, we recognise the importance of humility: personal experience is not the same as clinical evidence, and neither should be dismissed without consideration. Our aim is not to create fear of medicine, condemn those who prescribe it, or encourage people to make unsafe changes to treatment, but to advocate for informed consent, careful consideration of risks and benefits, and compassionate care that respects the whole person - body, mind and spirit.

Our Christian faith also informs our commitment to hope. We believe that people experiencing medication injury, withdrawal, psychiatric distress or neurological suffering should not be reduced to their symptoms or defined by their diagnosis. They deserve to be listened to, supported and reminded of their inherent worth, even when recovery is difficult or uncertain.

“Speak up for those who cannot speak for themselves; ensure justice for those being crushed.” — Proverbs 31:8

References

1. Horowitz, M., & Taylor, D. M. (2024). The Maudsley deprescribing guidelines in psychiatry: Antidepressants, benzodiazepines, gabapentinoids and Z-drugs. Wiley. https://doi.org/10.1002/9781394291052

2. Royal College of Psychiatrists. (2020). Stopping antidepressants. https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/stopping-antidepressants

3. Royal College of Psychiatrists. (2020, September 23). The Royal College of Psychiatrists updates information on stopping antidepressants. https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2020/09/23/new-information-on-stopping-antidepressant

4.  Lohr, J. B., Eidt, C. A., Abdulrazzaq Alfaraj, A., & Soliman, M. A. (2015). The clinical challenges of akathisia. CNS Spectrums, 20(Suppl 1), 1–16. https://doi.org/10.1017/S1092852915000838

5. Pringsheim, T., Gardner, D., Addington, D., Martino, D., Morgante, F., Ricciardi, L., Poole, N., Remington, G., Edwards, M., Carson, A., & Barnes, T. R. E. (2018). The assessment and treatment of antipsychotic-induced akathisia. The Canadian Journal of Psychiatry, 63(11), 719–729. https://doi.org/10.1177/0706743718760288

6. Grover, S., Avasthi, A., & others. (2022). Clinical practice guidelines for management of medical emergencies associated with psychotropic medications. Indian Journal of Psychiatry, 64(Suppl 2), S237–S260. https://pmc.ncbi.nlm.nih.gov/articles/PMC9122152/

7. 7. Hengartner, M. P., Schulthess, L., Sorensen, A., & Framer, A. (2021). Protracted withdrawal syndrome after stopping antidepressants: A descriptive quantitative analysis of consumer narratives from a large Internet forum. Therapeutic Advances in Psychopharmacology, 11, 2045125320980573. https://doi.org/10.1177/2045125320980573

8. Bektaş, A., Erdal, H., Ulusoy, M., & Uzbay, İ. T. (2020). Does serotonin in the intestines make you happy? Turkish Journal of Gastroenterology, 31(10), 721–723. https://doi.org/10.5152/tjg.2020.19554

9. Moncrieff, J., Cooper, R. E., Stockmann, T., Amendola, S., Hengartner, M. P., & Horowitz, M. A. (2023). The serotonin theory of depression: A systematic umbrella review of the evidence. Molecular Psychiatry, 28(8), 3243–3256. 

10. American Society of Addiction Medicine. (2020). The ASAM clinical practice guideline on alcohol withdrawal management. https://www.asam.org/quality-care/clinical-guidelines/alcohol-withdrawal-management-guideline

11. Ponsford, J., Bayley, M., Wiseman-Hakes, C., Togher, L., Velikonja, D., McIntyre, A., Janzen, S., & INCOG Expert Panel. (2014). INCOG recommendations for management of cognition following traumatic brain injury, part I: Posttraumatic amnesia/delirium. Journal of Head Trauma Rehabilitation, 29(4), 307–320. https://doi.org/10.1097/HTR.0000000000000077

12. Clinical practice guidelines on post-traumatic cognitive impairment: Assessment and remedial measures. (2025). [Journal details as published in PMC]. https://pmc.ncbi.nlm.nih.gov/articles/PMC11878456/

13. Bayley, M. T., Tate, R., Douglas, J. M., Turkstra, L. S., Ponsford, J., Stergiou-Kita, M., Kua, A., Welch-West, P., & INCOG Expert Panel. (2024). Updated Canadian clinical practice guideline for the rehabilitation of adults with moderate to severe traumatic brain injury: Behavioral recommendations. Archives of Physical Medicine and Rehabilitation. https://doi.org/10.1016/j.apmr.2024.06.006

14. Ponsford, J., et al. (2014). INCOG recommendations for management of cognition following traumatic brain injury, part I: Posttraumatic amnesia/delirium. Journal of Head Trauma Rehabilitation, 29(4), 307–320. https://doi.org/10.1097/HTR.0000000000000077

15. Encephalitis International. (2026). Rehabilitation after encephalitis. https://www.encephalitis.info/rehabilitation-after-encephalitis/