You probably only see one end of this.
If you prescribe, you write the taper and hand the client off. If you’re the therapist, you’re the one who notices the wobble and has nobody to call. If you’re the guide, you meet the client at intake and say “Come back when you’re off.”
Dr. Raghu Appasani sits at both ends. He writes the prescriptions, he runs the tapers, and he does the psychedelic work, with the same clients, in the same practice. The call most practitioners hand off is the one he makes himself.
On September 23rd, he’s bringing three of those clients into the room.
Three real cases from his practice, walked start to finish, each one turning on a decision most practitioners never get trained to make. You’ll see the case the way he saw it, and the call he made and why.
If you’re thinking the taper belongs to the prescriber, well, it does. The prescriber sees the client for 15 minutes every few weeks and writes a schedule. Everything around that schedule belongs to whoever the client actually talks to.
Someone has to notice the wobble in week three and know whether it’s withdrawal or the depression coming back. Someone has to decide whether a client four weeks off their last dose is steady enough to sit with a full dose. A client who has been medicated for six years is a particular kind of client, and you wouldn’t prepare them for a journey the way you’d prepare someone who has never been.
That’s what these three cases are about.