Do psychiatric medications create permanent brain changes after discontinuing?

Some do!: There is a class of medication called "neuroleptics" used for severe conditions that do. These are associated with neurological problems that are usually irreversible. Therefore they should only be used when the benefits outweigh the cost. But most psych meds are very different and are not known to cause irreversible changes.

Some do: The only example of permanent change that I am aware of is when the antipsychotic medications cause a permanent condition called tardive dyskinesia, not all of which are actually permanent. Tardive dystonia is another example from the same class of drugs. Permanent diabetes is a change in the pancreas. Perhaps some of my colleagues can think of some other examples, but generally most are safe.

Brain changes: The intent of prescribing psychiatric medications is to affect the brain improving its function and performance. It is beneficial to produce long term effects on a diseased brain, and to reverse the mechanisms of disease if possible. Most of current treatments produce those changes only if administered every day, and the effects last shortly after discontinuation. One exception is psychotherapy.