Keys to Successful Discontinuation of Antipsychotic Medication

Qualitative study finds that both internal resources and systemic factors play a role in antipsychotic discontinuation outcomes.

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Discontinuing antipsychotic medication can be extremely difficult for service-users and comes with risks related to withdrawal and relapse. In a new study, psychologists Miriam Larsen-Barr and Fred Seymour from the University of Auckland in New Zealand take a close look at seven women’s experiences to shed light on the methods they used to taper these medications.

“This sample shows it is possible for people who experience mania and psychosis to successfully discontinue antipsychotics and safely manage the impact of any symptoms that emerge as a result of the withdrawal process or other life stressors that arise afterward,” the authors write.

A wide body of research suggests that individuals taking antipsychotic medications find these drugs hard to quit, given the array of difficult withdrawal symptoms. Perhaps the worst symptom of these is akathisia, described as a horrific type of pain and agitation that is poorly understood and seldom taken seriously by doctors.

To make matters worse, many mental health service users receive low levels of support for medication discontinuation from their providers. While there is some agreement that antipsychotic medications are best discontinued by extremely gradual tapering methods, withdrawal effects may still be quite severe.

Larsen-Barr and Seymour investigated a convenience sample of women in New Zealand who had experienced mania and psychosis and then successfully stopped taking antipsychotic medication for more than a year.

A series of semi-structured interviews of seven women, six of whom reported bipolar disorder diagnoses and one of whom reported a diagnosis of obsessive-compulsive disorder and depression, yielded insights into how they maintained their mental health throughout the withdrawal process.

Six participants followed a gradual withdrawal method, and these same six reported some level of support from prescribing clinicians (e.g., assistance with planning, tapering, receiving psychotherapy). Only one of the seven participants’ prescribers initially suggested she discontinue her antipsychotic regimen. For the study, successful discontinuation was defined as the cessation of regular, daily antipsychotic use for over a year, even if other psychiatric medications were used.

Participants defined wellbeing in terms of their ability to manage the impact of any difficulties faced rather than their ability to prevent them entirely and saw this as something that evolved. They described managing the process and maintaining their wellbeing afterward by ‘understanding myself and my needs,’ ‘finding what works for me,’ and ‘connecting with support.’

These themes gave rise to particulars. For example, ‘finding what works for me’ involved many flexible strategies, like making strides to create more positive life experiences, drawing upon inner resources, like persistence, and practicing acceptance.

The interview findings gelled with existing qualitative research highlighting the importance of a web of information, strategies, and supports in successful withdrawal. Likewise, it supported longitudinal research showing that outcomes improve over time as coping skills and beneficial support utilization are learned.

Withdrawal periods were varied, as their plans were defined flexibly in accordance with their current needs in life and capacities to cope with emergent vicissitudes. While gradual withdrawal moderated and delayed relapse, it did not eliminate it entirely. Given the participants’ definition of wellbeing as a process, however, it was possible for the 5 people who did experience relapse to curtail these symptoms and safely move through them.

Unsurprisingly, those who described having knowledge, skills, and social or familial help had a much less disruptive withdrawal experience than the single patient who lacked these structural supports. The process was described as one of “learning and self-reflection, flexible coping and relation support” that fostered identification of and beneficial responses to a full range of bio-psycho-social needs.

Acceptance of occasional distress in themselves and from others was defined as a key coping skill, as has been found in similar studies of antipsychotic withdrawal in men and women diagnosed with schizophrenia, major depression, bipolar disorder, and obsessive-compulsive disorder. Preparation for and response to relapse was described as more important than avoiding relapse altogether.

Supportive figures like therapists, prescribers, family, and other survivors played an enormous role in participants’ efforts to understand and meet their own needs. The modulation of these relationships and determining whose support to elicit at various times was essential to their efforts to manage wellbeing.

The authors note that these elements are consistent with descriptions of recovery from mania and psychosis in general and “emphasize the critical role that modifiable psycho-social processes play” in the withdrawal process and its outcomes:

“Participants appeared to benefit from access to information specific to antipsychotic withdrawal, special tools to enable finer control of the reduction process, and prescriber follow-up during and after the withdrawal period. Improving antipsychotic withdrawal outcomes calls on improved access to information and support.”

While this exploratory study’s results should be interpreted cautiously, the sample demonstrates the possibility that people who have experienced mania and psychosis are capable of managing symptoms resulting from withdrawal from antipsychotic medications and related life stressors.

 

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Larsen-Barr, M., & Seymour, F. (2021). Service-user efforts to maintain their wellbeing during and after successful withdrawal from antipsychotic medication. Therapeutic Advances in Psychopharmacology. https://doi.org/10.1177/2045125321989133 (Link)

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Emaline Friedman, PhD
MIA Research News Team: Emaline Friedman received her doctorate in Psychology from the University of West Georgia in 2019. Her forthcoming book Internet Addiction: A Critical Psychology of Users argues that we are all implicated in Internet excesses as a function of social power under capitalism. Against pathologizing this, her work advocates for data ethics in tech. She is currently pursuing a Master's degree in Counseling.

6 COMMENTS

  1. I think we need to talk more about akathisia as a result of withdrawing from psych meds. I see it as being mistaken for a relapse if one doesn’t understand how it can manifest in so many ways. Having a support system is very important but the physical and psychological aspects of akathisia derail even those systems.

  2. Call me skeptical but this study reminds me John Ioannadis’ famous tract ‘Why Most Research Findings are False” :

    https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124

    “Participants appeared to benefit from access to information specific to antipsychotic withdrawal, special tools to enable finer control of the reduction process, and prescriber follow-up during and after the withdrawal period. Improving antipsychotic withdrawal outcomes calls on improved access to information and support.”

    Ah, yeah, because the white coated set or psy-professionals interest of accruing their fee is perfectly inline or in tune with my own health interests ? If you believe that I have a bridge in Brooklyn to sell you.

    There are two kinds of health research, but only one of them is currently recognized by medical science, namely, what I call group study, i.e., studies of groups of people who are subjected to some form of procedure, diet, supplementation, etc… Group studies have obvious value, at least when competently done, although there are certain important problems inherent in these studies which I will not discuss here for the sake of brevity, including proper choice of variables and the need to replace double-blind with multiple-blind studies .However, the fact that group studies are not — or not consciously — combined with the second form of research is perhaps the most important flaw in allopathic medicine, and one which is actually leading to its collapse in the face of competition with naturopathy. This second form of research what I call self study, by which I mean the process in which an individual subjects his own body to some form of procedure, diet, supplementation, etc, to see if it works for him. This procedure, of course, is different from that of various medical heroes, who subjected themselves to such things as yellow fever, AIDS and other dread diseases in order to prove something for others: Rather, self study is merely the way an individual can find out if the result of some group study — or his grandma’s advice, or his own intuition — has any relevance for his own personal well-being. Self study is important not merely for the obvious reason that group studies are irrelevant to what works for some particular individual, but also because the individual is the one person with the greatest interest in promoting his own health — unlike his doctor, whose interest inclines to collecting his fee — and because the individual has access to “research data” (his own feelings and reactions) not accessible to the white-coated set.

    For instance, I had my genetics tested and I know which vitamins and minerals I have a tendency to be deficient in (one of them is Magnesium which can exert similar affects to that of lithium) and I also know that while tapering off of antipsychotics I should throw in COQ10, vitamin B2, melatonin and (optionally) maganese because these drugs tend to zap these things out of your system etc… it is also known that a mediterreanean or low carb diet may be helpful; there is really much more to say but I’d have to write an entire article to possibly have it published here or somewhere else.

  3. Self-Study is something each one of should be doing to the best of our ability. It is that old adage “Know Thyself” made alive. However, from my experience, very few doctors, it seems, especially psychiatrists, are interested in what you know about yourself, as it undercuts their “authority.” This is also can be true for other professionals, too. This is a shame, I think, because who knows better about you, than you. Thank you.

  4. “….A series of semi-structured interviews of seven women, six of whom reported bipolar disorder diagnoses …”

    A doctor friend of mine told me that people came to see him sometimes reporting their Bipolar to be “up” or “down”.

    When he looks into it he finds that they’ve never been diagnosed as “Bipolar” or anything else; and there’s nothing wrong with them.

    Some famous movie stars claim to be “BiPolar”, and some people “Self Diagnose” themselves as “BiPolar”.

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