Resources:

• Top Supplements for Brain Health Guide
• Dr. Teralyn Sell’s Website
• The Antidepressant Coalition for Education (ACE) — free de-prescribing support groups
• Alzheimer’s Breakthrough Podcast with Dr. Josh Helman

Connect with Dr. Teralyn Sell:

• Website
• TikTok
• Book
• Podcast

Connect with Dr. Josh Helman, MD:

• Instagram
• LinkedIn
• YouTube
• Substack

READ THE COMPLETE BLOG POST HERE:

The Pill You Take for Sleep May Be Raising Your Dementia Risk

What if the medication you were told was “safer” turns out to be one of the hardest things you’ll ever try to quit? That’s the territory this conversation covers with Dr. Teralyn Sell, a mental health clinician with more than two decades of experience who has become one of the most outspoken voices on de-prescribing psychiatric medication.

Roughly two-thirds of Americans rely on something, prescription or over-the-counter, to fall asleep. Common sleep aids like diphenhydramine (the active ingredient in many over-the-counter options) now carry long-term risk data that most people were never told about when they started. The same is true for benzodiazepines, SSRIs, and SNRIs: medications treated as routine that carry decades of unknown cumulative effects on the brain.

What Full Informed Consent Actually Looks Like

True informed consent covers the risks, the benefits, the alternatives, and the risks and benefits of those alternatives. In practice, most patients never get that full picture before starting a psychiatric medication. Roughly one in five women in the U.S. is currently on an antidepressant, and most were never walked through what long-term use might mean.

The comparison that lands hardest: everyone understands the cumulative harm of smoking a pack a day for twenty years, but almost no one thinks about psychiatric medication the same way, even though the long-term brain research on many of these drugs simply doesn’t exist yet.

Dr. Teralyn’s Story: Prescribed in Pregnancy, Stuck for Six Years

Dr. Teralyn was prescribed an antidepressant during her third trimester, framed as prevention for postpartum depression, a use case she notes isn’t actually supported as “preventative.” She stayed on it for six years, feeling increasingly numb and disconnected from her family. Every time she raised that with her prescriber, the response was to raise her dose or add another medication rather than help her find an exit.

She eventually came off the medication only because a move caused her to lose access to her prescriber, forcing an unsupervised, cold-turkey stop. She’s clear that this is exactly the wrong way to do it. Withdrawal from these medications can be severe, and the story became the starting point for her later specialty in helping people taper safely.

The “Med Stack” Offer and Why Prescribers Reach for the Hammer

Years later, as a perimenopausal patient visiting an endocrinologist for a thyroid concern, she was offered a stimulant, an antidepressant, and a sleep aid in a single visit, before any labs were run. When she declined, the provider asked why she’d even come in.

The underlying pattern: when a prescriber’s main tool is a prescription pad, every complaint starts to look like something a pill can fix. Basic questions about caffeine intake, alcohol before bed, or a snoring partner disrupting sleep rarely come up before a prescription does.

Why De-Prescribing Can’t Follow a One-Size-Fits-All Plan

Current de-prescribing frameworks, including hyperbolic tapering models, offer useful structure, but no single protocol works identically for everyone. Genetics, metabolism, and how long someone has been on a medication all change what a safe taper looks like. Some people come off with minimal disruption; others end up on disability because of how severe their taper turned out to be.

A rough rule of thumb: budget one to three months of tapering for every year spent on a medication, with room built in for life to happen along the way. Genetic testing that looks at how the body metabolizes and uses neurotransmitters like serotonin and dopamine may eventually help personalize this further, but it isn’t mainstream yet.

Manipulation, Marketing, and the “Dirty 30”

Dr. Teralyn co-hosts a podcast built around confronting language she and a colleague were once trained to use to keep patients medication-compliant, including one episode cataloguing manipulative phrases they’d been taught to say. Pharmaceutical marketing plays a role too: she recalls pharma reps regularly visiting her former workplace with food and pitches, an influence that shaped clinical conversations even among staff who weren’t prescribers themselves.

She’s careful to note she isn’t opposed to psychiatric medication across the board, her concern is with overuse, and with people never being told what they might be trading away.

Akathisia, Anhedonia, and the Real Risks of Fast Tapering

A too-fast taper can trigger akathisia, an intense internal restlessness that’s been linked to some of the more severe outcomes people experience while coming off these medications. Long-term use can also produce anhedonia, a flattened emotional state where a person struggles to access feeling at all.

Emerging research connecting SSRIs to increased dementia and Alzheimer’s risk adds another layer to the conversation, alongside black-box warnings tied to suicide risk in younger patients that Dr. Teralyn feels are too often glossed over.

The Five Foundational Pillars Before You Taper

Dr. Teralyn’s book, Your Best Brain, lays out five pillars, nutrition, sleep, movement, meditation and mindset, and stress management, that she recommends building up to roughly 70% before attempting to taper off a psychiatric medication. Her reasoning: medication often masks an underlying issue rather than resolving it, and that issue is usually still there once the medication comes off.

One of the simplest starting points she recommends is stabilizing blood sugar by eating more protein more frequently, including before bed, which she’s seen help with both mood and sleep quality.

Amino Acids, Omega-3s, and What Actually Supports the Brain

Dr. Teralyn’s interest in nutrition-based brain support traces back to a moment early in her career working in a prison mental health setting, where she brought forward research on omega-3 fatty acids reducing aggression in a jail population, only to be told it was outside her professional lane. That experience later became the foundation for additional training in nutrition and functional medicine.

Her caution: quality matters enormously with omega-3 supplements, cheaper versions often require taking a dozen capsules to reach an effective dose, and they should generally be kept refrigerated rather than sitting on a store shelf. Algae-based omega-3s are a lower-mercury option, particularly for vegans and vegetarians. Amino acid therapy, tyrosine for dopamine support in particular, can also help, though it isn’t right for everyone and requires care around interactions with existing medications.

Key Takeaways

• Informed consent is often incomplete – Most patients aren’t told the full risks, benefits, and alternatives before starting psychiatric medication
• De-prescribing is not one-size-fits-all – Genetics, time on medication, and individual physiology all affect how a safe taper should look
• Fast tapers carry real neurological risk – Akathisia and other withdrawal effects are serious reasons to taper slowly and under supervision
• Foundational health work matters before and during tapering – Nutrition, sleep, movement, and stress management build the base a taper depends on
• Quality matters with supplements – Not all omega-3s or amino acids are equal, and getting the wrong dose or product can undercut the benefit

Conclusion:

Psychiatric medication can be genuinely helpful for the right person at the right time, but that only holds up when the person taking it actually understood what they were saying yes to. If you’re on a long-term psychiatric medication and have never had a real conversation about the trade-offs, or you’re thinking about tapering, that conversation with your prescriber, and a plan built around your own physiology and foundational health, is worth having before you make any changes.