Informed consent should be the strongest protection a patient has. Before any psychiatric medication is started, the prescriber should explain what the drug can do, what it can cost, how long it will be used, and how it will eventually be stopped. The patient then decides. That is the role informed consent should play in psychiatric medication treatment.
Many patients never got that conversation. They were prescribed benzodiazepines or other psychiatric medications years ago, often in a short appointment, with no mention of physical dependence, tolerance, or withdrawal. Dr. Leeds is an osteopathic physician and deprescribing specialist in Fort Lauderdale who helps patients taper off benzodiazepines and other psychiatric medications. He sees what happens when those conversations never took place.
This article explains what genuine informed consent looks like, why it so often fails patients, and why it matters just as much during tapering as it does when a medication is first prescribed.
What Informed Consent Really Means
Informed consent is not a form or a signature. It is an ongoing conversation between a patient and a physician, and it has specific parts:
- Risks: physical dependence, tolerance, and withdrawal, explained before the medication is started
- Benefits: what the medication may realistically help with, described honestly
- Alternatives: other options, including the option of no medication at all
- An exit plan: how long the medication is expected to be used and how the patient will come off it
- The right to decline: patients may refuse treatment, and may withdraw consent at any time, without penalty
If any of these parts is missing, the patient is not giving informed consent. They are agreeing to a recommendation they were never fully told about.
Risks Come First
Consent begins with risks. For benzodiazepines, the central risk is physical dependence. The body adapts to the medication, often within weeks of regular use at a prescribed dose. Once that happens, stopping suddenly or cutting the dose too quickly can cause serious withdrawal symptoms. Some patients develop benzodiazepine-induced neurological dysfunction (BIND), a set of neurological symptoms that can persist during and long after discontinuation.
None of this is controversial. In 2020, the U.S. Food and Drug Administration (FDA) updated the labeling on all benzodiazepines to formally recognize physical dependence, withdrawal reactions, and the need for gradual dose reduction. A risk serious enough to change the label of an entire drug class is serious enough to discuss before the first prescription is written.
The same principle applies to other psychiatric medications. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs), antipsychotics, and gabapentinoids can all produce withdrawal symptoms when stopped too quickly. Patients deserve to know this at the start, not after dependence has already developed.
One warning stands above everything else: never stop a benzodiazepine suddenly, and never let a taper turn into an abrupt stop. Sudden discontinuation can trigger seizures and can be life-threatening. However a taper is shaped, it should be gradual and medically supervised.
Benefits, Alternatives, and the Option of No Medication
An honest consent conversation also covers what a medication may realistically do to help, stated plainly and without exaggeration.
Then come the alternatives, and one of them is always no medication at all. Non-drug approaches, watchful waiting, and addressing the underlying situation are all legitimate choices. A patient who hears only about benefits is not making an informed decision, and a patient may reasonably choose differently once the full picture of risks is on the table.
Every Prescription Needs an Exit Plan
One of Dr. Leeds’ central criticisms of modern prescribing is that psychiatric medications are often started without any plan for stopping them. A prescription meant to help through a difficult period quietly becomes a prescription for years, sometimes decades.
A genuine consent conversation answers two questions from day one: how long is this medication expected to be used, and how will it be stopped? Coming off safely means tapering, a gradual and medically supervised dose reduction. Established references exist for exactly this purpose, including the Ashton Manual for benzodiazepines and the Maudsley Deprescribing Guidelines for benzodiazepines and other psychiatric medications. A deprescribing strategy is not something to improvise at the end. It belongs in the consent conversation before the first dose.
The reasons a gradual taper matters so much are covered in a separate article on the importance of psychiatric drug tapering.
The Right to Say No
Consent protects the patient’s right to refuse. Patients may decline a recommended medication, and they may withdraw consent at any time, without being penalized and without losing the care relationship.
This is where much of what passes for informed consent falls short. When education about a medication is used mainly to make a patient comfortable accepting it, that is persuasion, not consent. The purpose of the conversation is not to secure agreement. It is to give the patient real control over what happens to their own nervous system, including the choice to say no.
Dependence Is Not Addiction
Patients who took their medication exactly as prescribed and developed physical dependence have not done anything wrong, and they are not addicts. Physical dependence is a medical condition caused by the medication itself. This distinction matters for consent in two ways.
First, dependence is a foreseeable risk, which is exactly why it must be disclosed up front. It can happen to anyone taking a prescribed dose. Second, when dependence does develop, patients are too often dismissed. Many are told their withdrawal symptoms are just their old anxiety coming back. This experience, sometimes called medical invalidation, compounds the original failure of consent: first the risk was never disclosed, then the harm was denied.
Dr. Leeds serves on the medical advisory board of the Benzodiazepine Information Coalition (BIC), an organization that advocates for patients harmed by prescribed benzodiazepines. He treats iatrogenic dependence (dependence caused by medical treatment) as what it is: a medical injury that deserves respectful medical care, not an addiction label.
Why Did So Many Patients Never Get This Conversation?
Patients who have been through several psychiatrists over the years often describe the same thing. No one explained the short-term or long-term risks of the medication before it was prescribed, and no one brought them up at the visits that followed.
In Dr. Leeds’ experience, that is the usual history of a patient injured by a prescribed benzodiazepine. While a form may have been signed somewhere along the way, the conversation never happened, and it did not happen prescriber after prescriber.
How does that happen? A fifteen-minute medication check leaves no time for it, and a drug prescribed this widely is assumed to be safe. Until September 2020, the boxed warning on the label said nothing about physical dependence or withdrawal reactions at all. Unfortunately, the patient pays for all three.
So, a doctor who wants to help must first understand the injury the medication caused. A doctor who does not understand the injury cannot describe it, and a doctor who cannot describe it cannot obtain consent for treating it.
Consent is owed at every visit where a treatment is discussed, including the visit where a patient finally asks for help coming off. Many never got it once.
Informed Consent During a Taper
Consent does not end when a patient decides to come off a medication. In Dr. Leeds’ practice, it becomes the working method of care.
Tapering plans are built with the patient, not handed to them. The patient sets the pace, and the plan adapts to how their body responds. If symptoms flare after a reduction, holding at the current dose is a respected clinical decision, not a failure. Weekly telemedicine appointments, often up to an hour long, leave room for the unhurried conversations that real consent requires, and patients can reach Dr. Leeds directly by text with urgent questions between visits.
Education is part of this. Patients who understand the process can give meaningful consent at every step. Those preparing to reduce a benzodiazepine can review what to expect during a benzo taper before deciding how to begin. And because withdrawal affects households, not just individuals, patients who want loved ones involved can share resources on family support during benzodiazepine tapering. Who participates in these conversations is always the patient’s choice.
Who Sets the Pace of a Taper?
The patient does. The doctor’s job is to be a guide, not a director, and the difference matters more in benzodiazepine tapering than almost anywhere else in medicine.
A guide knows the terrain: the Ashton Manual and the Maudsley Deprescribing Guidelines, interdose withdrawal, or the symptoms that surface between doses, how a crossover taper to a longer-acting benzodiazepine works, and when a hold is likely to help. Yet, the patient is the one walking it, and the patient is the only one who can feel the ground.
An analogy that might help is the driving school car with a second brake pedal on the passenger side. The instructor can slow the car when the road demands it, but the instructor does not steer and does not decide where the trip goes.
While this is not a perfect analogy, it is close to how a taper should work. If the pace is too fast, the doctor must advise a slower one. If the pace is too slow, patient and doctor may agree to go a bit faster, as tolerated.
Forced changes rarely lead to good outcomes. A reduction imposed on a schedule the nervous system cannot tolerate produces symptoms, the symptoms produce a crisis, and the crisis too often ends with the patient back at the full dose and blamed for it.
Unfortunately, that is the ordinary result when a timeline set by an insurance policy replaces a pace set by the patient. The nervous system does not read the policy.
Fortunately, a taper directed by the patient tends to be a taper the patient can finish. Choosing a doctor who is willing to work this way is a separate question, covered in how to choose a doctor for a benzodiazepine taper.
What Does Agency Mean?
Informed consent protects something Dr. Leeds calls agency, and he did not coin the word. He borrowed it from a podcast interview with Matt Mullenweg, the founder of WordPress, who spoke at length about agency as a kind of freedom: giving people a platform they control and own for themselves.
While the word came from the world of software, it maps neatly onto medication decisions. Ownership, in Dr. Leeds’ view, means removing as many gatekeepers as possible, and every patient has them: the prescriber who decides what is offered, the insurer who decides what is covered, and the program that decides how long a taper will take.
Agency means owning the decision to start a medication, to continue it, and to come off of it. As few of those gatekeepers as possible should stand between the patient and the choice.
Ownership is one side of the coin. The other side is service, the plain work of helping other people solve their problems and find their own footing.
In Dr. Leeds’ view, that pairing is where durable happiness comes from, not instant gratification and not money. It is why coaching toward meaningful activity is part of the care he provides during a taper.
It is also why patients who come off of a medication so often describe wanting more than the absence of a symptom. They want their own days back, and something worth doing with them.
Informed consent is where that starts. You may accept a medication, decline it, or decide after years of taking it that it is time to come off of it, and the decision is yours at every step. A doctor can give you the risks, the alternatives, and an honest opinion. The rest belongs to you.
Final Thoughts
What role does informed consent play in psychiatric medication treatment? It is the patient’s protection. It begins with risks, includes honest benefits and real alternatives, requires an exit plan, and preserves the right to say no at every stage. Anything less is not informed consent.
Many patients were started on a benzodiazepine or another psychiatric medication without that conversation. It is not too late to have it. Dr. Leeds’ practice provides medically supervised tapering through secure telemedicine throughout Florida, based in Fort Lauderdale, with plans built around each patient’s own decisions and pace. Contact Dr. Leeds today.
This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
