A mixed-methods published in the journal Psychiatry Research surveyed individuals who had attempted, at least once, to discontinue taking antipsychotic medications. Fifty-five percent of participants reported successfully stopping, and 50% reported no current use. In the findings, a gradual approach to withdrawal was positively associated with successful discontinuation and was negatively associated with relapse, suggesting that gradual withdrawal (more than one month) is a more effective method of discontinuation.
The authors write that, “When considered in conjunction with the longitudinal research and studies exploring psychiatric medication withdrawal in general . . . discontinuation is a legitimate choice that requires and justifies appropriate support.”
Persons prescribed antipsychotics often make adjustments to their medications independent of their prescriber or attempt to discontinue the medication on their own. As the authors point out, 60-80% of individuals with schizophrenia spectrum diagnoses report discontinuation.
Additionally, in other studies, as much as 55% of patients who were on APs stopped taking their medication without consulting their prescriber, and 41% withdrew abruptly. Of those patients that discontinued the drug, 78% experienced withdrawal effects, and 21% completely stopped taking APs. Studies of AP use have found that those who discontinued AP treatment had better long-term functional outcomes and lower rates of relapse than those with continuous use. While discontinuation can result in better long-term outcomes, the process of discontinuation can come with numerous withdrawal effects including, somatic, emotional, and cognitive effects as well as psychotic or manic relapse.
The authors of this study sought to elucidate the association between gradual withdrawal methods, withdrawal effects, and successful outcomes across different diagnoses. The authors also aimed to explore how people manage discontinuation. To do this, a mixed-methods (qualitative and quantitative) study was conducted via an online survey of adults (n=105) who were taking or had taken antipsychotics for at least three months and had at least one attempt to stop taking antipsychotics.
Among other demographic data, participants were asked to identify the primary symptoms they were experiencing when they began taking antipsychotics, medication history, treatment history, and the number of attempts to discontinue and age at those attempts. Participants were asked: “What was the outcome of your most recent attempt to stop taking antipsychotics?” and “are you still taking oral antipsychotic medication?” Participants were also asked about their method of discontinuation and (slow reduction over time or abruptly stopping) and the withdrawal effects they experienced.
Thirty-five percent of the participants had received a bipolar diagnosis, 18% schizophrenia, 28% other (unipolar depression, anxiety, obsessive-compulsive disorder, post-traumatic stress disorder, personality disorder). Only 48% of participants reported speaking with a doctor about their most recent attempt to discontinue, 55% successfully stopped taking APs, and 50% reported no current use.
Participants who identified as successfully stopping described experiences of improved psychosocial well-being, as captured in the quotes below:
“I experience no psychosis and only occasional anxiety […] I am (reasonably) physically healthy, extremely mentally healthy, working and enjoying life”
“I manage my mental health well. I have occasionally visited [a] counselor since stopping the medication, but mostly use my support network for help now.”
Continued difficulties after successfully stopping were also reported such as ongoing mental health problems and unresolved adverse effects of antipsychotic medication. For those the participants who resumed the drug, they described hospitalization or a compulsory treatment order (CTO) or described returning to prevent hospitalization and mandatory treatment.
Others described changes to dosage, medication, or clinician, e.g. “changed psychiatrist, correct diagnosis and prescribed different drugs.” Additionally, some participants who resumed taking antipsychotic medication described accepting having to take antipsychotics, saying, “I have to stay on it for life I can’t cope without it.” Lastly, a subset of participants described having adverse events that affected their mental health, including losing a job, a relationship ending, or a growing sense of failure.
Half of the participants reported gradual withdrawal, while the other half reduced their medication abruptly (one month or less). Those who gradually withdrew did not report relapse, described successfully stopping, and were not currently using antipsychotics.
Gradual withdrawal over one month was positively associated with successful discontinuation and no current use. There was also a significant positive association between following a gradual withdrawal method and consulting a doctor. However, 47% of those who asked a doctor withdrew abruptly, while 52% withdrew gradually. Unsurprisingly, relapse was negatively associated with discontinuation and no current use.
Two-thirds reported unwanted withdrawal effects, 18% reported no withdrawal effects, and 13% reported positive effects. Some of the adverse emotional withdrawal effects included: anxiety and fear, low mood, sadness and depression, irritability and agitation, suicidality, and mood swings. On the physical side, withdrawal effects included: nausea, diarrhea, vomiting, headaches, unpleasant bodily sensations, appetite, and rapid weight loss, insomnia or disturbed sleep, shaking, sweating, and one person reported seizures.
Twenty-seven percent of the sample reported relapse of psychosis or mania during withdrawal. Thirteen percent of those who discontinued gradually reported relapse while 34% of those who stopped abruptly reported relapse.
The authors conclude that “it is possible to successfully discontinue antipsychotic medication, relapse during withdrawal presents a major obstacle to successfully stopping an antipsychotic medication, and people who withdraw gradually across more than one month may be more likely to stop and to avoid relapse during withdrawal.”
Larsen-Barr, M., Seymour, F., Read, J., & Gibson, K. (2018). Attempting to discontinue antipsychotic medication: withdrawal methods, relapse, and success. Psychiatry research. (Link)