What Happens When Your Doctor Lowers Your Psychiatric Med?Why the pace matters more than almost anyone realizes
Most prescribers taper medication in good faith, using the doses their patients can actually buy. But commercially available tablets often step down far too steeply near the end — and the person left holding those symptoms is frequently sitting in a therapist’s office, not a physician’s.
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Never change your dose on your own
Do not stop, skip, split, or reduce any psychiatric medication without talking to your prescriber first. Stopping some medications suddenly is not merely uncomfortable — it can cause seizures, severe psychiatric symptoms, and other medical emergencies. This page exists to help you have a better conversation with your prescriber and pharmacist. It is education, not a tapering plan, and it is not a substitute for medical care.
If you are having thoughts of harming yourself, call or text 988 (Suicide & Crisis Lifeline) or go to your nearest emergency room. Thoughts of self-harm can emerge during medication changes even in people who have never had them before.
A note on my role: I do not prescribe, and nothing here is a medication recommendation
I am a Licensed Professional Counselor. I do not prescribe medication, and I do not make recommendations about whether, when, or how any person should change a dose. Those decisions belong entirely to your prescribing provider.
I share this information from my role as a clinical mental health provider who supports clients as they navigate medication changes that their prescribers have implemented. My work is to help you notice what is happening, describe it accurately to the people who do prescribe, and stay steady while your system adjusts.
I also encourage every client to recruit the wisdom and insight of a pharmacist as part of an integrated care team. Pharmacists hold detailed knowledge about formulations, dosage forms, and compounding options that is often the missing piece in these conversations, and they are consulted far less often than they should be.
What I see in my office
A client is doing well. Their prescriber agrees it may be time to come off a medication. The taper is described as gradual — cut the dose in half, then in half again, then stop. On paper it looks careful.
Three weeks later that client is in my office describing electrical sensations in their head, waves of dread that arrive without cause, sleep that has fallen apart, and a sense that something is fundamentally wrong that they cannot put into words. They have often already been told this is their original condition returning.
Sometimes it is. Frequently it is not.
Therapists occupy a particular vantage point here. We see clients weekly, often for an hour, and we know their baseline in fine detail — how they normally speak, sleep, think, and regulate. When something shifts, we notice it early, and we hear about it in far more detail than a fifteen-minute medication check allows. That is not a criticism of prescribers. It is a description of two different sightlines onto the same person, and it is exactly why the two need to be connected.
Two terms worth knowing
Having accurate language changes what you can ask for. These are the terms your prescriber and pharmacist will recognize.
Hyperbolic tapering
Also called the Horowitz–Taylor method, after the two researchers who described it. Rather than removing the same number of milligrams at each step, each reduction is a percentage of the current dose — so the steps get progressively smaller as the dose gets lower (Horowitz & Taylor, 2019).
The related umbrella terms are deprescribing (the planned, supervised reduction or discontinuation of a medication) and gradual dose reduction. Two refinements you may hear are microtapering (very small daily reductions) and cut-and-hold (reduce, then stay at that dose until symptoms settle before the next step).
This is now more than a fringe position. Britain’s National Institute for Health and Care Excellence revised its guidance to recommend proportional rather than linear reductions (NICE, 2022a, 2022b).
Abrupt discontinuation and over-rapid tapering
Abrupt discontinuation is stopping outright. Over-rapid tapering is reducing faster than the nervous system can adapt — which is far more common, and much easier to miss, because it looks like a taper.
What follows is called a withdrawal syndrome or, for antidepressants specifically, antidepressant discontinuation syndrome — a label many researchers now consider misleadingly gentle. Chouinard and Chouinard (2015) separate three distinct patterns:
- New withdrawal symptoms — symptoms the person never had before, caused by the dose change itself.
- Rebound — the original symptoms returning rapidly and more intensely than before treatment.
- Persistent post-withdrawal disorder — symptoms lasting well beyond the expected window.
When symptoms continue for months or longer, you may hear protracted withdrawal syndrome. Drug-specific forms have their own names: supersensitivity psychosis and withdrawal dyskinesia after antipsychotics, cholinergic rebound syndrome after certain antipsychotics and tricyclics, and rebound mania after mood stabilizers.
Why “just cut it in half” stops working near the end
This is the part that most often surprises people, including clinicians.
The relationship between the dose of a medication and its effect at the brain’s receptors is not a straight line. It is a curve. At higher doses, receptors are already close to fully occupied — so a large reduction in milligrams produces only a small change in what the brain actually experiences. At low doses, the curve turns sharply, and the same small reduction in milligrams produces a very large change (Sørensen et al., 2022).
This is why so many people sail through the first several reductions and then fall apart on the final step. That last step, which looks like the smallest one on paper, is often the biggest one the brain has been asked to absorb.
It also explains a pattern I hear constantly: “I did fine going from 40 to 20 to 10, so I don’t understand why 10 to zero destroyed me.” Nothing went wrong with the person. The arithmetic was wrong.
Hyperbolic — steps shrink
- Each reduction is a percentage of the current dose, so steps get smaller as the dose falls.
- Keeps each step roughly equivalent in what the brain experiences.
- Pace is set by how the person responds, not by the calendar.
- The taper can pause, or step back up, when symptoms appear.
- Often takes many months. Sometimes longer.
Linear — steps stay the same
- The same number of milligrams comes off at every step.
- Feels easy early, then becomes disproportionately hard.
- Pace is set by available tablet sizes and appointment schedules.
- Symptoms near the end are frequently read as relapse.
- Often compressed into a few weeks.
When the available doses are too far apart
Here is the bind prescribers are in. A medication may be manufactured only as a 20 mg and a 10 mg tablet. If a person needs to step down by small increments below 10 mg, the pharmacy simply does not stock what they need. The prescriber is not being careless — the dosage forms do not exist.
Ways to create the steps that aren’t on the shelf
These are options to raise with your prescriber and pharmacist — never to arrange on your own. Which ones are appropriate depends entirely on the specific medication.
- Compounded formulations. A compounding pharmacy can prepare doses between commercial strengths — sometimes for just the few weeks needed to bridge a difficult gap.
- Liquid preparations. Some medications come in a manufactured liquid, which allows precise small reductions. Some liquids can be further diluted; a pharmacist must advise on this.
- Tapering strips. Daily pouches, each holding the same or a slightly lower dose than the last, developed specifically for gradual reduction (Groot & van Os, 2020).
- Tablet splitting. Useful early on, but only for medications that can be safely split, and it loses precision at very small doses.
Your pharmacist is the most underused person on your care team. They know which formulations exist, which tablets can be split, which have coatings that must not be broken, whether a compounding pharmacy nearby can help, and what your insurance will cover. Many are glad to be asked and rarely are.
Skipping doses is not the same as lowering the dose
Taking a medication every other day to “average it out” seems logical, but for medications that clear the body within about a day, it produces sharp peaks and troughs in blood level rather than a steady lower level. For some people, this is considerably worse than the taper it was meant to soften (Horowitz & Taylor, 2024). If someone suggests alternate-day dosing, it is a reasonable thing to ask your prescriber and pharmacist about specifically.
Symptoms by medication class
Withdrawal looks different depending on what is being reduced. Expand each class below. This is not a complete list, and any new or worsening symptom during a dose change is worth reporting to your prescriber promptly.
Antidepressants — SSRIs, SNRIs, tricyclics
Withdrawal is common and frequently underestimated. A systematic review found that roughly half of people report withdrawal effects when coming off antidepressants, and among those, nearly half describe the experience as severe (Davies & Read, 2019). Shorter-acting medications such as paroxetine and venlafaxine tend to produce more intense effects.
The sensory symptoms are distinctive. “Brain zaps” — brief electrical-shock sensations in the head, often triggered by eye movement — are so characteristic that they are one of the clearest signals distinguishing withdrawal from a returning mood episode.
Benzodiazepines & Z-drugs — highest medical risk
Stopping a benzodiazepine abruptly can cause seizures, which can be fatal. The U.S. Food and Drug Administration (2020) requires a boxed warning stating that stopping suddenly or reducing too quickly can produce life-threatening withdrawal reactions, including seizures. Physical dependence can develop within days to weeks of regular use, even exactly as prescribed. Never stop a benzodiazepine on your own.
The FDA’s own case review found the median duration of withdrawal symptoms was around nine and a half months, with the longest documented case still ongoing after eight years. Withdrawal seizures have been reported even after short courses at ordinary therapeutic doses.
Benzodiazepine tapers are typically measured in many months, and complete discontinuation after long-term use often takes a year or more.
Antipsychotics — including for non-psychotic uses
Long-term blockade of dopamine receptors leads the brain to compensate by increasing receptor sensitivity. When the medication is removed suddenly, ordinary levels of dopamine can overstimulate those sensitized receptors — producing supersensitivity psychosis, a rapid-onset psychotic reaction that can occur even in people with no history of psychosis (Chouinard et al., 2017; Moncrieff, 2006).
Abrupt withdrawal has also been associated with movement disorders that resemble the ones antipsychotics are meant to treat — withdrawal dyskinesias, parkinsonian symptoms, and dystonias (Howland, 2010). Gradual, hyperbolic reduction is now the recommended approach (Horowitz et al., 2021).
This matters for a wider group than people often assume, since antipsychotics are frequently prescribed at low doses for sleep, anxiety, or mood — and those patients are often told the medication is minor enough to simply stop.
Mood stabilizers — lithium, anticonvulsants
Lithium was long assumed to carry no withdrawal risk. That assumption did not survive study. Rapid discontinuation is associated with rebound mania occurring sooner and more often than the natural course of the illness would predict, and relapse has been documented after stopping for only a few days (Baldessarini et al., 1996).
Discontinuing lithium — particularly abruptly — has been associated with increased suicidal behavior (Baldessarini et al., 2019). Any change to lithium warrants close coordination among prescriber, therapist, and family, and gradual reduction whenever it is possible.
Stimulants — ADHD medications
Stopping stimulants tends to produce a crash — a period of pronounced fatigue, low mood, and increased appetite as the nervous system readjusts. This is generally less medically dangerous than benzodiazepine or antipsychotic withdrawal, but it can be mistaken for a depressive episode and can be genuinely destabilizing, particularly for someone whose daily functioning has been organized around the medication.
Gabapentinoids — gabapentin, pregabalin
Often described to patients as carrying little withdrawal risk, these medications are now included in deprescribing guidance alongside antidepressants and benzodiazepines (Horowitz & Taylor, 2024). Abrupt cessation after sustained use can produce a withdrawal syndrome that overlaps considerably with benzodiazepine withdrawal.
Two symptoms that need urgent attention
Emerging thoughts of suicide or death. These can appear during a medication change even in someone with no prior history of them. This is not a sign of weakness or of the taper being “worth pushing through.” It is a signal to contact your prescriber immediately.
Akathisia — an intense inner restlessness, an inability to sit still, a feeling of being driven from the inside. It is frequently misread as anxiety or agitated depression, and it is deeply distressing. It warrants prompt medical attention rather than watchful waiting.
Withdrawal or relapse?
This is the question that determines what happens next, and getting it wrong has real consequences in both directions. Withdrawal mistaken for relapse leads to medication being restarted or increased unnecessarily — and to a person concluding they will need medication for life. Relapse mistaken for withdrawal leads to a genuine episode going untreated.
Neither error is trivial. Horowitz and Taylor (2022) identify several features that help distinguish them, and this is precisely where a therapist who knows the client well can contribute something a chart review cannot.
Points toward withdrawal
- Onset within days of a dose change
- Physical symptoms — dizziness, brain zaps, nausea, flu-like aching — that were not part of the original condition
- Symptoms the person has never experienced before
- Rapid improvement if the dose is restored
- Symptoms that fluctuate through the day in waves
Points toward relapse
- Onset weeks to months after the change, not days
- Symptoms that match the person’s own previous episodes
- Gradual build rather than sudden arrival
- Absence of the distinctive physical symptoms
- A course that follows the person’s known illness pattern
Your prescriber knows the pharmacology. You know how this feels. Your therapist knows what you looked and sounded like six weeks ago, and can often say with real precision whether this resembles your previous episodes or is something categorically different. That third data point frequently settles the question — but only if someone thinks to ask for it.
People have been saying this for years
These accounts are not unusual, and the volume of them is part of what shifted clinical guidance.
In April 2018, The New York Times published an investigation into people who found themselves unable to stop taking antidepressants, and invited readers to write in about their own experiences. More than 8,800 people responded — teenagers, students, new mothers, people in retirement. Some wrote to say the medications had saved their lives and objected to the framing. Many others described symptoms lasting far longer than anyone had prepared them for.
Carey & Gebeloff, 2018; The New York Times, 2018
The peer support community Surviving Antidepressants was founded by a woman who spent roughly seven years working her way through withdrawal largely without informed medical guidance. The site now hosts thousands of people comparing notes on tapering — and in interviews, researchers have noted that patients were arriving at hyperbolic tapering on their own, out of necessity, before the pharmacological explanation for why it worked was published.
Reported in MindSite News, 2025
In its 2020 review of benzodiazepine safety, the FDA examined 104 reported cases. Physical dependence had developed after a median of about two weeks of use. The median duration of withdrawal symptoms was approximately nine and a half months. In the longest case in the series, symptoms had persisted for eight years and were still ongoing at the time of the report.
U.S. Food and Drug Administration, 2020
The other side of this
Some psychiatrists have raised legitimate concern that coverage of withdrawal may frighten people away from treatment that would genuinely help them, or lead someone to stop a medication that is holding them steady. That concern deserves respect.
Nothing on this page argues that psychiatric medication is bad, or that you should come off yours. Many people are alive and well because of these medications, and staying on one is a completely legitimate choice. The argument here is narrower and, I think, uncontroversial: if and when someone does come off, the pace should be set by their nervous system rather than by the tablet sizes the manufacturer happened to produce.
Three people, one plan
Medication changes go best when the people involved are talking to each other rather than each holding one piece.
Your prescriber
Decides whether, when, and how fast. Ask directly:
- What size steps, and how long at each?
- Can we use proportional rather than equal reductions?
- What do we do if symptoms appear — pause, or step back up?
- How will we tell withdrawal from relapse?
Your pharmacist
Knows what is physically obtainable. Ask:
- What strengths does this come in?
- Is there a liquid form?
- Can this tablet be safely split?
- Is there a compounding pharmacy that could make intermediate doses?
- What will insurance cover?
Your therapist
Watches the week-to-week picture. Contributes:
- Detailed observation of your baseline
- Early detection of change
- Withdrawal-versus-relapse perspective
- Support through the hard stretches
- Communication back to your prescriber, with your consent
Sign a release before you start
A signed release of information allows your therapist and prescriber to speak directly. It takes five minutes and it is the single most useful thing you can do to make a medication change go smoothly. Without it, each of us is working from a partial picture and relying on you to carry information between us during precisely the period when you may be least able to.
A letter to take to your prescriber
Many people find it hard to raise this in a fifteen-minute appointment. Writing it down ahead of time helps — it gives your prescriber something concrete to respond to, it keeps you from forgetting your questions under pressure, and it becomes part of your medical record.
Download the letter below, fill in the highlighted blanks, and bring or send it to your prescriber. It is written to open a conversation, not to tell your doctor what to do. Please change anything in it that does not sound like you.
From: your full name · Date of birth:
To: your prescriber’s name and credentials
Re: Request to discuss a gradual, proportional tapering plan
Dear Dr. ,
Thank you for the care you have provided. I am writing because I would like to talk with you about beginning / continuing / adjusting a reduction of medication name and current dose , which I have been taking since approximately month and year .
I want to be clear at the outset: I am not asking to stop this medication on my own, and I will not change my dose without your direction. I am asking for a conversation about the pace and the method, so that we can plan it together.
What prompted this letter. I have been reading about tapering approaches, and I learned that the relationship between dose and effect at the brain’s receptors is not linear. At higher doses, a large reduction in milligrams produces a relatively small change in receptor occupancy; at lower doses, the same small reduction produces a much larger change. This is described in the pharmacology literature as a hyperbolic relationship, and it is the reasoning behind proportional or hyperbolic tapering — reducing by a percentage of the current dose rather than by a fixed number of milligrams, so that the steps become smaller as the dose gets lower.
My own experience so far. Describe here what has happened for you — any previous attempt to reduce or stop, what symptoms appeared, how long they lasted, and how they compared with your original condition. If this is your first attempt, say so and describe what you are hoping for and what worries you.
Questions I would like to discuss with you:
- Would a proportional (hyperbolic) reduction be appropriate in my case, rather than reductions of a fixed number of milligrams?
- What size steps would you recommend, and how long would we hold at each dose before the next reduction?
- If withdrawal symptoms appear, what is our plan — pause at the current dose, return to the previous dose, or slow the pace?
- How will we distinguish withdrawal symptoms from a return of my original condition, and what would each one lead us to do differently?
- Are there specific symptoms you want me to report immediately rather than waiting for the next appointment?
About the available dose sizes. I understand that the commercially manufactured tablet strengths may not allow the small steps needed at the lower end of a taper. If that becomes a limitation, I would like to ask whether any of the following might be options in my case, and whether it would be helpful to consult a pharmacist about them:
- A compounded formulation providing doses between the commercial strengths, even temporarily
- A manufactured liquid preparation, if one exists for this medication
- Tapering strips or another packaging approach designed for gradual reduction
- Whether this particular tablet can be safely split, and down to what size
I recognize that some of these may not be appropriate or available for this medication, and I am relying on your judgment and a pharmacist’s guidance on that.
Coordination with my therapist. I am currently working with therapist name and credentials , who sees me weekly / every other week and knows my baseline well. I have signed — or am willing to sign — a release of information so that the two of you can communicate directly during this period. My therapist can offer week-to-week observation of any changes, which may be useful to you in deciding how to proceed. My therapist does not prescribe and does not advise on dosing; the role is observation, tracking, and support.
My commitment. I will follow the plan we agree on. I will not skip doses, split tablets, or adjust anything on my own. I will report new or worsening symptoms promptly — including any thoughts of self-harm, severe restlessness or inability to sit still, or anything that feels medically alarming — and I understand that I should seek emergency care if symptoms become severe.
Thank you for considering this. I appreciate the chance to plan this carefully with you rather than rushing it.
Sincerely,
signature
printed name
phone / email
References, should you wish to review them:
Horowitz, M. A., & Taylor, D. (2019). Tapering of SSRI treatment to mitigate withdrawal symptoms. The Lancet Psychiatry, 6(6), 538–546.
Horowitz, M. A., & Taylor, D. (2024). The Maudsley deprescribing guidelines: Antidepressants, benzodiazepines, gabapentinoids and Z-drugs. Wiley.
National Institute for Health and Care Excellence. (2022). Medicines associated with dependence or withdrawal symptoms: Safe prescribing and withdrawal management (NG215).
Sørensen, A., Ruhé, H. G., & Munkholm, K. (2022). The relationship between dose and serotonin transporter occupancy of antidepressants — A systematic review. Molecular Psychiatry, 27, 192–201.
Downloads as a Word-compatible document you can edit, fill in, and print. Scroll the letter above to read it in full.
- Send it ahead of your appointment if your office has a patient portal. It gives your prescriber time to think rather than reacting on the spot.
- Bring a printed copy too, and keep one for yourself.
- Edit it freely. Cut anything that does not apply. A letter that sounds like you will land better than one that sounds like a form.
- Take the pharmacist question seriously. If your prescriber is open to it but unsure about formulations, a call to the pharmacy often resolves it in minutes.
- If your prescriber disagrees, that is worth hearing out. There may be reasons specific to your medication or history. Ask what they are.
Planned elevated support during a taper
When a client is reducing a medication that has been holding them steady, ordinary therapy spacing is often not enough. The difficult stretches do not schedule themselves conveniently, and the periods just after each reduction are when close observation matters most.
For clients coming off stabilizing medication, I offer a deliberately intensified level of support arranged in advance rather than assembled in a crisis. That has included increased session frequency around each dose reduction, structured tracking so that changes are documented rather than remembered, and direct coordination with the prescriber where the client has consented to it.
Two things I want to be clear about. I do not prescribe, and I do not advise anyone on dosing — that is your physician’s role and I will not step into it. What I can do is help you notice what is happening early, help you describe it accurately to the people who do prescribe, and stay close while your nervous system does something genuinely difficult.
- A plan made before the first reduction — what we watch for, how we’ll track it, and what triggers a call to your prescriber.
- Closer contact around each step down, tapering back as things stabilize.
- Symptom tracking that distinguishes new symptoms from familiar ones, so the withdrawal-versus-relapse question has actual data behind it.
- Coordination with your prescriber and pharmacist, with your written consent.
- Support for the people around you, who often notice changes first and rarely know what to do with what they see.
If you are planning a change — or already struggling with one
Whether you are considering coming off a medication, are partway through a taper that has become harder than expected, or are trying to work out whether what you’re feeling is withdrawal or something else, you do not have to sort it out alone.
Request a consultationIf you are in crisis, call or text 988 or go to your nearest emergency room. If you are having a medical emergency, call 911.
References
- Baldessarini, R. J., Tondo, L., Faedda, G. L., Suppes, T. R., Floris, G., & Rudas, N. (1996). Effects of the rate of discontinuing lithium maintenance treatment in bipolar disorders. Journal of Clinical Psychiatry, 57(10), 441–448.
- Baldessarini, R. J., Tondo, L., & Vázquez, G. H. (2019). Effects of treatment discontinuation in clinical psychopharmacology. Psychotherapy and Psychosomatics, 88(2), 65–70.
- Carey, B., & Gebeloff, R. (2018, April 7). Many people taking antidepressants discover they cannot quit. The New York Times.
- Chouinard, G., & Chouinard, V.-A. (2015). New classification of selective serotonin reuptake inhibitor withdrawal. Psychotherapy and Psychosomatics, 84(2), 63–71.
- Chouinard, G., Samaha, A.-N., Chouinard, V.-A., Peretti, C.-S., Kanahara, N., Takase, M., & Iyo, M. (2017). Antipsychotic-induced dopamine supersensitivity psychosis: Pharmacology, criteria, and therapy. Psychotherapy and Psychosomatics, 86(4), 189–219.
- Davies, J., & Read, J. (2019). A systematic review into the incidence, severity and duration of antidepressant withdrawal effects. Addictive Behaviors, 97, 111–121.
- Groot, P. C., & van Os, J. (2020). Outcome of antidepressant drug discontinuation with tapering strips after 1–5 years. Therapeutic Advances in Psychopharmacology, 10, 1–9.
- Horowitz, M. A., Jauhar, S., Natesan, S., Murray, R. M., & Taylor, D. (2021). A method for tapering antipsychotic treatment that may minimize the risk of relapse. Schizophrenia Bulletin, 47(4), 1116–1129.
- Horowitz, M. A., & Taylor, D. (2019). Tapering of SSRI treatment to mitigate withdrawal symptoms. The Lancet Psychiatry, 6(6), 538–546. https://doi.org/10.1016/S2215-0366(19)30032-X
- Horowitz, M. A., & Taylor, D. (2022). Distinguishing relapse from antidepressant withdrawal: Clinical practice and antidepressant discontinuation studies. BJPsych Advances, 28(5), 297–311.
- Horowitz, M. A., & Taylor, D. (2024). The Maudsley deprescribing guidelines: Antidepressants, benzodiazepines, gabapentinoids and Z-drugs. Wiley.
- Howland, R. H. (2010). Potential adverse effects of discontinuing psychotropic drugs. Part 3: Antipsychotic, dopaminergic, and mood-stabilizing drugs. Journal of Psychosocial Nursing and Mental Health Services, 48(8), 11–14.
- Moncrieff, J. (2006). Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse. Acta Psychiatrica Scandinavica, 114(1), 3–13.
- National Institute for Health and Care Excellence. (2022a). Depression in adults: Treatment and management (NICE Guideline NG222).
- National Institute for Health and Care Excellence. (2022b). Medicines associated with dependence or withdrawal symptoms: Safe prescribing and withdrawal management (NICE Guideline NG215).
- Sørensen, A., Ruhé, H. G., & Munkholm, K. (2022). The relationship between dose and serotonin transporter occupancy of antidepressants — A systematic review. Molecular Psychiatry, 27, 192–201.
- The New York Times. (2018, April 20). Antidepressants and withdrawal: Readers tell their stories.
- U.S. Food and Drug Administration. (2020, September 23). FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. FDA Drug Safety Communication.
Dr. Darleen Claire Wodzenski, MS ESE, MA CMHC, PhD, LPC, ACS · Orchard Human Services, Inc.
This page is educational and does not constitute medical advice, diagnosis, or treatment for any individual. It is not a tapering protocol. Licensed professional counselors do not prescribe or advise on medication dosing. Always consult your prescribing physician and pharmacist before making any change to a psychiatric medication.
If you are in crisis, call or text 988. For a medical emergency, call 911.