What the RADAR Trial Tells Us About Antipsychotic Reduction and Discontinuation

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The RADAR trial is complete. Disappointingly it showed that people who gradually reduce their antipsychotic medication are more likely to relapse than people who continue it. At 2-year follow-up there were no differences in social functioning, symptoms, side effects or quality of life. Yet relapse was far from inevitable and the qualitative analysis showed that some people felt empowered by the opportunity to reduce their medication with official support, regardless of the outcome.

Running the RADAR study is by far the most difficult thing I have done in my professional career, and I would like to take the opportunity provided by the publication of its results (Moncrieff et al, 2023) to reflect on what I have learnt from the process of doing it, as well as the results.

Data filter vector illustration. Flat tiny information selection persons concept. Technological artificial intelligence cloud storage content analysis management for digital file collection system.The RADAR study involved a randomised trial comparing a gradual strategy of antipsychotic reduction (with discontinuation where possible) with maintenance treatment in people who had experienced recurrent psychotic episodes or been diagnosed with schizophrenia.

From the beginning I was supported by a strong team of experienced psychiatrists and academics who helped me with the practicalities but also gave the study credibility. They included people who have worked with drug companies in the past, but everyone acknowledged that antipsychotic drugs are unpleasant and potentially harmful, and that we need to research alternatives to life-long treatment. The trial was also supported by a team of people with lived experience of psychosis and the use of antipsychotics, who gave their time generously and provided constant encouragement.

I learnt how difficult it is to do a randomised trial, especially when the options are radically different from each other. Most trials struggle to recruit enough participants, partly because many people don’t like the idea of having their treatment decided for them by the role of a dice (or a computerised randomisation programme). But the RADAR trial was not offering people an additional treatment, like many trials, it was offering people the possibility of receiving two quite different treatment strategies—continuing their antipsychotic or reducing it with a view to stopping it if the reduction proceeded smoothly.

Understandably, people who are already on antipsychotics often have strong views about whether they want to stay on them or not. So despite our best efforts, we did not recruit as many patients as we had originally intended. Still, we managed to recruit 253 people, and this was down to an incredible effort by my hard working and devoted local research team and to an amazing network of NHS research sites around the UK. The people recruited had a long history of contact with the mental health services on average, including numerous admissions, and were comparable to the general population of people under the care of community mental health services in the UK with the same profile of problems (diagnoses) (Freudenthal et al, 2021).

We ended up enrolling people from 19 different areas and organisations and in each one there was a team of people supporting the project. I was also reminded of how many good psychiatrists there are in the UK. Each area required a psychiatrist to support the study and this was a job that required commitment and nerve—some of these psychiatrists had to face down colleagues who thought the study shouldn’t have been done. They did it because they believed it would provide patients with better evidence about their treatment and improve their lot in the long run.

What about the results (see Moncrieff et al, 2023)? Most previous trials have taken people off their antipsychotics over a few days or weeks, and relapse was often defined in such a way that it could have consisted of symptoms like agitation or insomnia, symptoms that may be due to a withdrawal effect. When we planned the RADAR study, we hoped that reducing antipsychotics slowly would prevent serious relapses (which we defined as hospitalisation to ensure it reflected a significant deterioration). It didn’t. People randomised to the reduction strategy were more likely to be hospitalised with a relapse compared with people randomised to maintenance treatment (25% vs 13%). Relapses were full-blown psychotic relapses, not minor deteriorations, and people who reduced their antipsychotics did not show any improvement in their social functioning that might have compensated for this.

On the other hand, people in the reduction arm didn’t show any deterioration in their social functioning by the end of the study either, and psychosis symptoms were also the same in both groups at this point. There were no differences in any of the outcome measures at the two-year follow-up, including quality of life and side-effect scales. It will be interesting to look at the data in more detail (which we will do in the future), but it looks as if having a relapse, even one that requires hospitalisation, did not lead to long-term decline, as is sometimes suggested.

The results are not surprising and they are similar to the initial results of the Wunderink study conducted in the Netherlands which involved people with a first episode of psychosis. Wunderink and colleagues also found an increased rate of psychotic relapse at their 18 month follow-up and no difference in social functioning (Wunderink et al, 2007). It was only at the 7-year follow-up that social functioning was better in people who had originally been randomised to reduction, and that relapses had evened out (Wunderink et al, 2013).

The RADAR results show how difficult it is for people to stop antipsychotics once they have been taking them for a while. The RADAR trial did not provide any specific additional support to people who were randomised to reduce their antipsychotic medication except for more frequent monitoring by their psychiatrists (because we did not have the resources to do this). Participants in either arm could be referred for psychological therapy or general social support as provided by their local service and we also gave people information about local support groups. However, more specific support may have been beneficial and if I were to do this sort of study again, I would certainly want to provide something of this sort.

I wrote about the possible ways of explaining an adverse outcome after stopping a drug almost two decades ago now (Moncrieff, 2006a; Moncrieff 2006b), and other eminent researchers have echoed my analysis (Tondo & Balessarini, 2020). One possibility is that the drug was suppressing an underling pattern of problematic behaviour that surges back when the drug is removed. I think this is the case for some people. Another possibility is that the process of drug withdrawal induces psychotic symptoms, as has been shown to occur in some people who have no history of psychosis or even mental illness. A gradual withdrawal process should make this possibility less likely, but it is difficult to say whether the reduction in the RADAR trial was gradual enough to eliminate it entirely. We know that most people who withdraw gradually from benzodiazepines or antidepressants still experience withdrawal symptoms, after all. A related possibility is that the experience of drug withdrawal precipitates a relapse of the underlying problem. Again, gradual withdrawal would be expected to reduce this possibility but not necessarily to exclude it. The qualitative results (which are just published too), which highlight the emotional rebound that can occur after antipsychotic reduction or discontinuation, suggest it can metamorphose into psychosis and psychotic relapse and support this possibility (Morant et al, 2023).

I don’t want to underplay the effects of having a full-blown relapse, but the qualitative results show that for some people, the process of reducing their antipsychotics was empowering regardless of the outcome. For some, the RADAR trial was the first time they had been offered anything other than continuous drug treatment and the first time they had been really involved in making decisions about their own future. Some went back onto their medication but felt better able to accept it, and some looked forward to getting off it eventually, even if they had not succeeded so far.

Some members of the group of people with lived experience of psychosis who supported the study were also empowered to ask for different approaches to their personal treatment.

Although the trial showed that you are more likely to relapse if you stop or significantly reduce your antipsychotic medication, it did not show that relapse is inevitable. In fact, 72% of the people who discontinued their antipsychotics across both groups (47 people) did not have a serious relapse, and 71% of the 109 who reduced their antipsychotic by at least 50% did not. Thirteen people in the reduction arm and 8 in the maintenance arm were off antipsychotics by the end of the trial.

The data from the RADAR trial enables people to make more informed decisions about their antipsychotic treatment. We can say that if you come off reasonably slowly over 1-2 years you will be more likely to relapse than if you stay on your medication. Not everyone will relapse, however. The majority will manage to avoid a relapse—whether that is by increasing their medication again or through other means. Around 10% might manage to stop their medication completely.

And above all else, the fact that the RADAR trial was funded, completed and supported by so many patients and professionals underlines that antipsychotic treatment is far from ideal, and that we need to explore alternative ways of supporting people who experience psychotic states.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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53 COMMENTS

  1. Congratulations on the Radar trial. I am pleased at all you & your team have achieved.
    There are probably many of us who are delighted with your findings which will give hope, agency & conviction to many.
    I hope that people will see past making a merely initial interpretation for their own purposes. I have already read a one line summary by one psychiatrist today. I should have wanted a more nuanced reading by a professional.

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  2. I’m not sure that I fully grasp the make-up of of these two groups. I understand that there were 2 arms –reduction and maintenance, but it is unclear to me how the two groups were selected. The article suggest that people with schizophrenia were included in the second (maintenance) group, but it’s unclear who was in the reduction arm. How is that some people in a maintenance group were off antipsychotics at the end of the study if they were in the maintenance group?
    “In fact, 72% of the people who discontinued their antipsychotics across both groups (47 people) did not have a serious relapse, and 71% of the 109 who reduced their antipsychotic by at least 50% did not. Thirteen people in the reduction arm and 8 in the maintenance arm were off antipsychotics by the end of the trial.”
    The results of this trial don’t surprise most long haulers in the reduction game. You try to reduce antipsychotics, you fail to stay off them, you try again. Like Dr. Moncrieff, I’d like to see what the outcomes might be if future studies were conducted that involved broader non-drug interventions. My list would include the ketogenic diet (Dr. Chris Palmer), deliberate cold exposure (Dr. Andrew Huberman), and breathing techniques (Huberman). Always overlooked in these studies is the importance of developing good communication strategies on the part of family members.

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  3. Thank you Dr Moncrieff for demonstrating credible thought leadership in this domain.

    I know research studies sometimes must isolate a parameter and leave other stuff ‘as usual’. Yet it seems so obvious to me that if you decide to taper… ‘relapse’, specifically in the form ‘returning to the hospital’ or emergency room is a predictable event that can readily be mitigated.

    I manage voices routinely with simple mind strategies. In that tool box is an ’emergency plan’ that plays this role. It is as simple as having two friends I have primed to respond in a particular way, should I call. I have asked them to say, “Sure (just agree with any silliness, it doesn’t matter), remember this has all happened before and everything worked out just fine (minimize the problem, a little crisis is unimportant). We know what to do (get two days of a tranquilizer), do you need me to organize them? And.. Is there anything in your diary that must be taken care of? (remove immediate worries). Then.. Go to bed and I will check in on you later.”

    Literally the answer is sleep it off for up to two days in your own space. Crisis over and nobody cares what happened.

    Knowing you have a plan is usually enough to ensure you don’t need it… because a solution fires up in the brain, instead of an unchecked escalation of the perceived problem. If instead you keep telling people ‘there is a problem with your brain’ then you negate the ability to simply train it to respond differently.

    To be pro-active about it… you can also have a ‘what’s the worst that can happen’ conversation with voices… and mitigate any perceived risk before it happens (a day in bed is the worst… really, the answer is yes!). We are just working with a representation of a threat voices have made – which is malleable and can be made safe preemptively.

    It would be interesting to see a similar trial where tapering is combined with the addition of tools for relating to voices differently that also include working with social relationships, such as Relating Therapy developed by Mark Hayward Sussex University in the UK, which seems like a great pairing. https://understandingvoices.com/working-with-voices/therapies/emerging-therapies/relating-therapy/

    I came off meds twice and did it cold turkey (I had not been taking them for years on end)… I think even this is doable if you identify the risks and mitigate them. I was in determined mode and had no fears… so I think building confidence in the process, the idea that I ‘can’ ‘make’ this work even if there are a couple of adverse events along the way… is an essential component.

    The real world conditions can be organized for success in ways that were not part of this protocol. So great, now we know we need something else – and there are existing options out there…

    You may be feeling a bit disappointed. Many of us on the other hand see it as a step towards better outcomes.

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  4. I invite the principal author to expand more on this study, I have so many questions:

    1.- What could have been the role of additional medications?. Like increase use of benzos or sleep inducing medications might have a negative effect making hospitalization more likely. Same as antidepressants, etc.

    2.- The high number of “natural causes” of death in relative young persons, around 50yrs, 12 out of 253 sounds to me several fold the normal population rate. And it’s typical of psychiatric hospitalization. Typical also to say they are natural…

    3.- What’s the cumulative dose of the paticipants in both groups?. I remember some reduction studies ended up using more of the medication to be reduced!.

    4.- It seems there is from a quarter to a third of patients who do have some difficulty to shake off “something” with medication. And similar percentage who might have diffculty to shave off medication. Thirds, quarters, eights, one way or another. And the recurring figure of two thirds that apparently on big outcomes could go either way.

    5.- Management. It seems although praised by the authors, the clinical management of psychosis is in itself deadly. For much care that can be shown in words, 4 natural death causes in the attempted discotinuing group seems too high. And knowing a person is discontinuing makes to me more likely to jump the gun on hospitalization, even if it was done with more “stringent” criteria than in other studies. The criteria are not blood glucose bigger than 600mg per dL.

    6.- There does not appear to be a dose response
    in severe relapse. Which suggests lack of causality between the dose reduction and the severe relapse. It’s one of the Hill criteria for causality, apparently not well observed here. Another third that appear in those 4, four, groups.

    7.- That suggests to me the presence of several confounding factors, explaining the results. I know the regular speech is that it is ludicrous, that I don’t know what I’m talking about. But still, very little dose response I observe, but the study might be underpowered to claculate that, I suspect.

    8.- Metabolic effects are notoriously sensitive to small doses of neuroleptics. So, no surprise there. I bet even a reduction to a tenth of the starting dose might leave someone with 10-20% overweight/obesity.

    9.- If only one third goes one way, the other third another way, it seems that along the way precisely the confounding factors, the diagnosis and clinical situation itself might explain a lot of the findings. But I admit the study did not try to address that and it probably would be underpowered to do so.

    10.- But social functioning might respond and illustrate that. Same as cognitive imparment, etc. It might be impervious to dose reduction in the medium term, there being social, familial, legal, etc. And there seems to be suggestions that the non-medication support is heterogeneous. Which might be a more powerfull confounding factor.

    11.- The implications for youngsters without psychosis is appauling, to say the least, they seem to be sentenced to more than 2yrs of psychosis lability and liability without any psychosis to begin with. Not directly shown in this study of course, but by correlation from the previous work narrated in the study.

    12.- The heterogeneity of the medications used. In the discussion it seems some drugs like quetiapine might be more difficult to shave off, not surprising given it affects many neurotransmiter “systems”. But I guess the study is underpowered to determine that.

    13.- From lived experience, yeah, 1 to 2 yrs in a non psychotic individual might lead to no withdrawal psychosis.

    But unfortunately, family, criminal one even (long dating I might add, like for decades), could land someone without psychosis as psychotic in a hospital. I know that, I’ve suffered that, it’s documented, and that at least from MY experience is a more important confounding and deadly factor than medication.

    With the colusion of criminal professionals, both psychologists and psychiatrists, policepeople, public oficials, human rights personel, district attorneys, etc.

    Such is life for some of us imputed mental illnesses when we demonstrably never had one. Calumny, infamy, etc. is a more predictive factor of hospitalization in my personal experience than symptoms. And of covert diagnosis and treatment. For which I have proof.

    But such individuals in the comunity will try again and again, and a study is not gonna pick that up. That requires exposure, not research…

    And to land that on relevance, the mortality is a well known indicator often reported as “natural causes”. It’s been published several times.

    “… it is notable that there were no differences between the groups at 24 months on any measures except for relapse.” except for fatalities, which were double in the reduction attempt group. In line with the mortality rate for psychiatric hospitalization. Supported by the finding that 25%, 2 out of 8 were in females, which if I remember correctly are more likely to die due to more severe management during hospitalizations. You know, mysogyni, particularly when intersectional with skin color…

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  5. Thanks for sharing this information.

    Here are two things to consider when evaluating the disappointing (for those of us critical of psychiatry and their oppressive medical model) results regarding success at tapering off of anti-psychotic drugs:

    1) It is quite common for people withdrawing off of ALL different kinds of psych drugs to make MORE than one attempt at a complete successful tapering. Many are forced to stop at some point and increase their dose again, and/or, even go back on the drug for a period of time before starting a final successful taper to zero.

    2) The design of the study left those people in the actual tapering group somewhat “in the dark,” AND without all the necessary preparation to know exactly how to maximize positive strategies to ensure favorable odds for a successful tapering.
    For example, many people (with correct counseling regarding the start of their ordeal) might increase consults with a guide or counselor, increase exercise and meditative activities, improve their diet, and more carefully guard their sleep patterns etc. etc. In other words, the psychological “gearing up” process may be a VERY necessary and important part of a successful outcome.

    Richard

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  6. Many thanks Joanna for all the hard work by yourself and your colleagues on this study, and thanks also for writing about it here. These are tricky issues to study and doing a 2 year study sounds really hard, but maybe we really need to be looking at 5 or more years to see clear advantages to getting off drugs. Still, this study showed that supporting people in attempting to discontinue is not the “certain to fail” prospect that people are often led to believe is the case.

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  7. I was on olanzapine (generic for Zyprexa) for 3 years after an out of the blue psychotic break in 12/2014 triggered by a high fever of unknown cause, possibly exacerbated by exposure to toxic levels of chimney smoke courtesy of my selfish neighbors. tapered off slowly and totally stopped 8/2017. no mental issues since, 6 years clean. I was 48 when the break occurred with no prior mental issues or meds. never take your sanity or reality for granted.

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  8. “the fact that the RADAR trial was funded, completed and supported by so many patients and professionals underlines that antipsychotic treatment is far from ideal, and that we need to explore alternative ways of supporting people who experience psychotic states.”

    I couldn’t agree more, as one whose family just had a loved one who was put on an antipsychotic in a hospital, who was abruptly withdrawn from it, who subsequently suffered from three days of non-sleep drug withdrawal induced super sensitivity mania, resulting in psychosis, and is now back in the hospital.

    Thankfully, the hospital has been largely respectful so far, except I was unable to keep my loved one off an antipsychotic. My loved one was, I think, properly finally diagnosed with alcohol encephalitis, which is a neurologic disease that can be healed from, but there is no cure, except time, abstinence, and love, likely. So, an antipsychotic was NOT a cure.

    But I do have a possible suggested alternative to at least a part of psychiatry’s systemic violence and force. My loved one had a non-medically trained companion sitting with him at his last hospitalization (since there were concerns he’d be dangerous, despite the fact he has never been a danger to anyone, but himself), as opposed to force and constraints (albeit he was forced onto an antipsychotic). And the companion was a much better option, and infinitely more respectful option, for my loved one, than psychiatric violence.

    My loved one has been detoxed from the alcohol, and does understand he may never drink again. He stayed at my mom’s for two days, which was all she could take. He and I had a nice couple walks around a local lake yesterday, and he seemed somewhat okay, until about 8 or 9 at night.

    Initially, I had him trying to stay in the present, by reading the subtitles on a movie he was enjoying. But then I witnessed his inability to process all of what we’d done that day. He started talking, nonsensically, about all we’d seen and done – but he wasn’t able to process it in a normal manner.

    Then he proceeded into discussing a bunch of mathematical concepts (and I am a former mosaic designer, which does involve a lot of mathematics) and medical stuff one of my children is studying, that I know little about, and I’d never discussed with him. But I am one more open to the belief system of the Jungian psychologists’ “collective unconscious” theology, than the scientifically “invalid” DSM “bible” believing psychologists’ theology.

    I personally got a few hours of sleep, but my loved one never did, albeit he was respectfully quiet for my neighbors for a while, and did seem to find some privacy in my guest bedroom. But things got harder when I woke up a few hours later.

    Finally, this afternoon, I called the hospital, in the hopes of getting a nice young critical psychiatrist’s (who we’d dealt with at my loved one’s last hospitalization) number, so I could try to get something to help my loved one sleep. But my loved one non-violently took my phone to talk to the hospital nurse, then threw my phone out the door. I went out the front door to try to find my phone, and my loved one wanted to beat me to it, so he decided to gently wean himself off my balcony, to beat me to it.

    Thankfully, I was able to get my phone back from my loved one, but an emergency call was already made, during the struggle to get my phone back. So I felt calling 911 was my only option at that point.

    Thankfully, the ambulance and police came without sirens blaring, and in a very peaceful manner took him back to the hospital. He’s now on haldol, and a benzo, which he needs to be properly withdrawn from. But he did need to sleep.

    Please pray for my family, people of MiA. Most definitely “we need to explore alternative ways of supporting people who experience psychotic states,” without initially putting people on the antipsychotics. The antipsychotics should be a last course of action treatment, rather than a first course of action treatment, as most American psychiatrists and ER doctors seemingly currently believe.

    Especially given the sad fact, “When we planned the RADAR study, we hoped that reducing antipsychotics slowly would prevent serious relapses (which we defined as hospitalisation to ensure it reflected a significant deterioration). It didn’t.”

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  9. l said to psychiatry ‘l hear a voice’. this was lie. l was not hearing a voice.psychiatry diagnosed schizophrenia. psychiatry was saying me ‘ you is ill’. the psychiatry was make a drink clozopine me by force.one of the side effects of clozopine is sudden unexplained death. this was writing clearly. now l have to live with family. family and social and state are exploiting me and people like me. my father is requests to commit violence me. l am sure he was saying himself ‘it was diagnosed schizophrenia so one does not believe him’.my mother requests to work me for take my money. psychiatry and state in turkey continuos are requesting to appoint a guardian

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  10. A very important study – and we look forward to the longer term results.

    Needless to say, it is already being hailed by defenders of the status quo as ‘showing that antipsychotics work’. This is rubbish – the study is about withdrawal, not about whether the drugs ‘work’ (whatever that means). It shows that withdrawal is difficult, for all kinds of reasons that are still somewhat unclear (withdrawal effects? artificially-induced dopamine sensitivity? sudden exposure to all the emotions that the drugs had suppressed? lack of support and knowledge about tapering?) and may take longer than 2 years. Given the known downsides of ‘antipsychotics’, this is an extra reason to be cautious about encouraging people into long term use – they may well find they are stuck with the drugs, whether they want to be or not. We’ve seen this with other types of psychiatric drug, of course, so it is hardly a surprise to see it here too.

    If those who did succeed in discontinuing (and it would be useful to partial out the data relating to this small group, including those in the ‘maintenance’ group who discontinued) were, as seems to be the case, no worse off at the end of the trial than those still on the drugs, then given the significant health risks of ‘antipsychotics’, there would be a strong argument for discontinuation being the preferred option. Of course, this is not what the status quo defenders are concluding.

    What the study didn’t ask, and therefore can’t tell us, is whether people would have been better off not taking the drugs in the first place. There is ample reason to think that this might be the case (‘Anatomy of an Epidemic’ etc). This, of course, is the bigger and most important question…. If it was accepted that the risks, especially in longer term use, outweighed the benefits, then the question of withdrawal would arise much less often, and the process of withdrawal would probably be much less challenging anyway.

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    • “This is rubbish – the study is about withdrawal, not about whether the drugs ‘work’ (whatever that means). ”

      I kind of disagree, finding that several metrics are statistically no different, assuming, in fact, the accumulated doses are in fact different, which I could not find in the paper, suggests to me that continuing medication will not improve any metric other than fatalities and relapses. And severe relapses don’t seem to be dose dependent.

      So, continuing medication might not improve social functioning, employment, etc.

      So, as stated before, patients CARE more about things, sometimes, other that hallucinations and delusions. Not everyone of course.

      And this study, if the amount of medication over the 2 yrs was actually different, then it would suggests that what is MORE important to some patients, might actually not be that different with or without medication.

      And that would prove, once again, neuroleptics have no impact in what matters most to the sufferer, as in continued therapy.

      With the caveats of relapses and fatalities.

      So, to me, it does suggest the neuroleptics are innefective, assuming my caveats, for certain outcomes.

      That in the real world are also VERY important: health insurance, having a home, having a family, avoiding violence, making retirement, etc., do depend of social functioning and employability. Therefore are very important social outcomes for patients, families and societies at large.

      After all, without that, the old rhetoric that people with psychosis are a burden for society is going to be difficult to fight. And neuroleptics are, as suggested by this study, not going to help “fix” that when continued.

      So to me it does prove continued treatment is ineffective for socially, familiar and patient centered values, sometimes more valued than hallucinations and delusions.

      ****And it does suggest, indirectly a very positive finding: people labeled with schizophrenia WITHOUT HALLUCINATIONS AND DELUSIONS PROBABLY WILL NOT BENEFIT FROM NEUROLEPTICS!.***

      At least they are not prone to psychotic breaks….before medication, that is. And it won’t help them achieve good-better outcomes…

      And in fact, are MADE PRONE TO PSYCHOSIS IF EXPOSED TO NEUROLEPTICS. And yeah, some people are labeled and diagnosed with schizophrenia without having delusions AND/OR hallucinations. That is a fact, not opinion nor speculation, it is in the diagnostic criteria!.

      And on a more depressing comment. One old rethoric to intervene early to avoid relapses, over 30yrs old, is that each episode of “acute” psychosis left the patient in a worse “functional” capacity. Hence the need to maintain stability without relapses, good social outcomes depended on “functioning”. Otherwise, as happened to many, many, patients ended up institutionalized, in prision, dead or on the street.

      Nowadays one can suspect acute, big doses of parenteral neuroleptics might be the culprit. Not the disease. There is published evidence for that.

      And I imagine there being not much difference to some patients, if in fact the accumulated dose was different, the acute relapses, it’s medication and/or hospitalization made patients take two, 2, steps back for every step forward when reducing the dose.

      So, kind of a back and forth, precisely because acute “high” doses of neuroleptics and/por hospitaliation are used whenever there is “relapse”. No way to get down that carrusel with current “care”. Even if such care is praised by Ms. Montcrieff.

      That’s why I point out at the fatalities. They migh occur with the same frequency as anywhere in the world, and being truthfull praise it still suggests strongly to me that:

      BEST PSYCHIATRIC CARE IS DEADLY.

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  11. I deeply appreciate this research and hope that instead of feeling discouraged by its results, it motivates further similar research to identify the problematic factors of withdrawal and why improvements in social functioning were not observed.

    I can confidently say that while focusing on symptoms and social functioning may be an accepted approach in scientific research, it is not the best way to understand what is happening. There’s a substantial difference between two cases of seemingly similar social dysfunctionality.

    During antipsychotic medication, social dysfunctionality mainly results from the medication itself. After withdrawal to well below an effective therapeutic dose, the seemingly same social dysfunctionality mainly arises from the learning process. When the medicine is entirely gone or reduced to less than 25%-50% of the minimal therapeutic dose, one should easily differentiate between these two cases by observation, even if they have the similar Social Functioning Scale scores, by comparing these individuals or video of their earlier behavior with the current them side by side.

    One should also observe a noticeable cycle where, when medication is reduced, there’s repeatedly a moment of increase in actions and abilities followed by a higher occurrence of symptoms and a need for rest. This cycle is absent while using antipsychotics because they prevent these actions.

    The phase of prolonged social dysfunctioning, resulting from years of learning, is likely the reason why short-term and long-term results of antipsychotic withdrawal differ. This might explain the results of the RADAR trial, where no improvement in social functioning was observed. If this is the case, the presence of this action-rest cycle and the observable difference between two forms of social dysfunction could serve as indicators.

    It’s unfortunate that the RADAR trial only had a 2-year follow-up. In the future, it would be intriguing to find a more comprehensive answer to why some trials don’t show better outcomes for unmedicated individuals while others demonstrate the opposite. I would have appreciated it if the trial had been able to answer this question, but I highly respect the kind of honest science where trial results are not altered or softened, even when they yield unwanted outcomes for the researcher and their peer group.

    Currently, discontinuing antipsychotics is exceptionally challenging because it would necessitate suffering, behavioral changes, and the right decisions not only from the patient but also from those around the patient. It would also require a society free from threats, which is impossible while society actively hunts people with mental illnesses and attributes diseases as explanations for unwanted and threatening behavior.

    It’s possible that only by understanding the situation and its challenges can we plan a safe, repeatable method for reducing medication. However, this would likely require the development and adoption of a different descriptive language that considers all parties involved, instead of relying on medical language and tests focused on describing and reducing harm in a patient and only in a patient.

    Alternative and possibly more accurate description of psychosis is a conflict between an individual person and a bigger group of people. When a psychiatrist or a researcher does his job, he takes a side in that conflict just by using the vocabulary of his field.

    If someone can invent a secure method for withdrawal and demonstrate its benefits, that achievement would merit the Nobel Prize more than lobotomy. It would be extremely challenging because it would require securing all the basic needs of the patient and eliminating threats. This, in turn, would require a change in behavior from people surrounding the patient in something less pleasant to them, but more pleasant to the patient.

    It would not usually occur naturally without some form of motivation: punishment for opposing patients’ will and rewards for compliance. The need for rest and mutual attention and consequences of ignoring them are particularly challenging for third-party observers to recognize and respond to correctly.

    However, aside from relapses, this aspect doesn’t significantly affect the RADAR results, as even in ideal conditions, it may take time for social functioning to return.

    Lastly, a final question: How does the 25% relapse rate compare to other withdrawal trials? Is it higher or lower?

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    • “I deeply appreciate this research and hope that instead of feeling discouraged by its results, it motivates further similar research to identify the problematic factors of withdrawal and why improvements in social functioning were not observed.”

      I do not appreciate it, Ms. Montcrieff made no strong remark of the FACT that fatalities were HIGHER when attempting to discontinue.

      And that kind of omission is a strong indicator of bad science.

      It is a very important outcome, if I were a Freudian I could suggest why it was omited, like it is not important!, haha!. Most likely though, it’s a “coded” omission, a dogwhistle to practitioners, that apparently other MIA commenters didn’t pick up.

      Dogwhistleing works, coding things so patients don’t get the “pict”, as Chicolini would have said, that’s why I do not appreciate Ms. Montcrieff and colleagues published work.

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  12. Nothing special. It was a 2 year study. Previous long-term studies had the same results. Differences in favor of the withdrawal group begin to show after 2 years. Will this study continue till 7, 15, 20 years like Harrow or Wunderink or will it stop now, at 2 years?

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  13. This article is very helpful. I sent a link to it to Dr Neff at Mindstream. https://mindstreamintegrative.com/
    At the moment I’m on 3mg of Invega by mouth daily. Me and Dr Neff are in the process of lowering and hopefully eliminating the antipsychotic. It helps for me, my family and the doctor to expect a higher risk of relapse in the first year or two of reduction but that there is light at the end of the tunnel after two years. It also tells me that the rate of reduction may not matter as much. I have wanted to get off this stuff for a long time. It’s nice to know what I’m up against.

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  14. It is wonderful to see researchers publishing and openly discussing even ‘disappointing’ outcomes like this one. I am very hopeful that Dr. Moncrieff will be able to follow up with these participants again 7 years out to see if the longer-term results line up with the ones from Wunderink 2013, which would provide a more encouraging picture.

    I also appreciate the author pointing out that, while a 25% relapse rate is obviously worse than 13%, it still means that 72% of people who would have otherwise been prescribed antipsychotics all their lives WERE able to taper off with NO relapses or worsening functioning whatsoever. I can think of many psychiatrists and other mental health professionals I’ve worked with over the years, and unfortunately MANY patients who have internalized the stigma of their diagnoses, who would be completely astonished by that last number. I am so happy that it’s published in black and white with all the trappings of scientific respectability, which means I can start strategically waving it in people’s faces and have a greater chance of being taken seriously.

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  15. “ and relapse was often defined in such a way that it could have consisted of symptoms like agitation or insomnia, symptoms that may be due to a withdrawal effect”

    Or due to Stress (see Mayo Clinic symptoms of stress).

    “Factor analysis of these items revealed three main effects of antipsychotic medication related to doubt and self-doubt, cognitive and emotional numbing, and social withdrawal”
    https://pubmed.ncbi.nlm.nih.gov/23643756/

    My personal experience with discontinuation of psychoactive drugs is that it takes more than 2 years to regain “normal – ordinary human functioning”.

    I’m not sure how to explain this for the scientific community to understand …

    The introduction of these mind numbing drugs requires an individual to adapt. The groceries still need to be acquired, the car filled with gas, and cash acquired from the bank. Yet – you find that you can’t even get off the sofa.

    Take this chemical straight jacket away and a person must adapt, again. The dishwasher is broken, the apartment complex was sold to a different landlord, and the “Goodwill” pickup is expected the next day. It takes “a while” to regain the skills to cope with normal everyday “stressors”.

    It takes more than 2 years.
    Now 7 years later, I am totally surprised. I have friends. I am a valuable contributing member of my community. No one knows, or thinks I am “odd”.

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  16. The most obvious explanation, in my opinion, is that the structural changes in the brain caused by neuroleptics result in psychosis when the neuroleptics are discontinued. The drugs manufacture the “illness.” Instead of asking whether patients should be permitted to discontinue these cruel brain-damaging drugs, ask why they’re used at all.

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    • One not so obvious complement to that is that the “care”, diagnosis and the label might not let anyone improve by much.

      Many stories at MIA of improvement, dramatic and so cherished for me are from persons who extricated themselves from psychiatrc “care”.

      That is a big confounding factor, like studying the outcomes of respecting human rights for those that remained in concentration camps, without noticing the “improvement” for those that escaped away.

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        • Confidence Scam, courage to tell lies with a straight face. And courage to break the law again and again.

          Confindence in one’s ability to lie, cheat, and deceive with a straight face and charging for it anyone who can pay, whatever amount they can pay.

          Etc. Full of courage and confidence in the MHI.

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  17. I think the results are interesting and you are interpreting their significance too negatively!

    “At 2-year follow-up there were no differences in social functioning, symptoms, side effects or quality of life.” That shows that the drugs are not providing overall relief.

    For most folks who experience psychosis, having an occasional altered state is *not* the worst outcome. It’s the longterm impairments / restrictions that cause intense suffering. Clinicians are fixated on altered states and treat them like a disease. This is not how patients regard the experiences. There should be safe respite houses for folks to receive acute care, we deserve accommodation.

    Also, 2 years is a short time. I hope you can follow a subset of those trial participants for 10+ years to see the trajectory of their lives. The iatrogenic harms take time to compound.

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  18. I don’t think studies testing withdrawal reactions from antipsychotics or any other psychiatric drug can or will ever be conclusive because there’s so much variability people in the way each person reacts to each drug, even from the same class. I stopped Haldol without tapering but was immediately placed on Librium which may have masked withdrawal symptoms. But when I suddenly stopped Thorazine, all hell broke loose that got increasingly worse over the next two and a half years. During this time, I was gradually tapered off Norpramin to a dose so low the psychiatrist didn’t think I would have any withdrawal if I stopped taking that. Well, getting off that last bit of Norpramin not only made the Tardive Dykenesia I was suffering go into exponential overdrive, but also brought on hours-long crying jags and an acute mania that I HAD NEVER EXPERIENCED BEFORE BUT INSTINCTIVELY KNEW was caused by stopping the Norpramin. The doctor then put me back on Norpramin which did ease the Tardive to a degree and stopped the crying jags but guess what he told me! He said that the crying jags and mania were a “relapse” of my “illness”, which I also instinctively knew was NOT the truth. So, the conclusion I’ve come is this: the way each person reacts to stopping each type and quantity psychiatric drug (whether sudden or gradual) is entirely unpredictable, and since the way these drugs work in the brain isn’t fully known and probably can never BE known, prescribing them is playing with fire.

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    • “I don’t think studies testing withdrawal reactions from antipsychotics or any other psychiatric drug can or will ever be conclusive because there’s so much variability people in the way each person reacts to each drug, even from the same class. ”

      Not if a person is labeled with schizohphrenia without delusions and hallucinations. Other outcomes will be no different with continued medication.

      Other than that they might die more frequently and now, attempting to withdrawn, they might actually develop an emergent psychotic withdrawal.

      So, I disagree, this study suggests that for people without hallucinations AND delusions, is best to not start treatment, the medication makes no difference in outcomes other than, I assume, PSYCHOTIC relapses and FATALITIES.

      So, persons labeled with schizophrenia without psychosis won’t benefit from neuroleptics.

      And it will a hell of a ride trying to come off them. They might die you know, or, as Hermione would have said, “worse, expelled”… from society…into the dungeons of psychiatric hospitalization and its praised “care”…even by Ms. Montcrieff.

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        • I was following the rhetoric that they may be usefull. To put a “spin” on the reviewed artcile.

          Worst case scenario of “fighting” for their use, the article suggest to me people diagnosed with schizophrenia without delusions and/or hallucinations won’t benefit.

          That’s all, I am not saying they should be used, just in that limited sense this article shows IMO who definitively won’t benefit.

          🙂

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    • Clarification: I miscounted: the TD got progressively worse for about two and a half to three and a half years, at which point it seemed to stay the same for another couple of years. By the fifth year it began subsiding slightly, then in the sixth year it started to abate meaningfully to the point of being gone, which I believe had something to do with my having moved to a less-pollenated region.

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  19. CLARIFICATION: I realize this blog is about stopping antipsychotics for people who experienced psychosis. But this was not the reason I was prescribed antipsychotics. I was prescribed antipsychotics for chronic anxiety which years later I found out was unnecessary and therefore inappropriate. But the reason I commented here is because it points to how unpredictable the results of these so-called “medications” can be and how indiscriminately these drugs are prescribed. It’s also worth mentioning that when I was nine years old my father gave me a small dose of Stelazine for a bout of anxiety and within a few hours my face and tongue began twisting uncontrollably. My father was so alarmed he took me to the ER where the doctors said that since it was a one-off dose it would probably wear off overnight which thankfully it did. Little did I know that this experience was a harbinger of things to come…

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  20. I WARMLY commend Joanna and her team for this gruelling paper. Anyone who has even hinted at the possibility that there might be something tainted about today’s orthodox psychiatry, will know just how virulent are the forces that one must contend with. And it’s sad to see that Jonna herself is disappointed with the outcome – all that hard work, with so little to show for it. The hoped for knock-out blow, did not arrive.

    BUT the medical truth of the matter is rather starker. Anyone who takes on board Harrow’s astonishing 20 year study, must conclude that these psychiatric drugs are not neutral players here. The drugs which doctors actively promote, not only fail to help, they actually prolong psychosis. And there’s the living truth – it should be enough for those brave enough to see and act upon it.

    There is perfectly sound medical reasoning to account for this, which I expound in my Substack pages. We are a social species – our minds are there to mingle with other minds – so when they go wrong, which they do most dramatically with psychotic symptoms – then re-training, re-establishing healthier social contacts and communications, are vital. Joanna calls for more social support “next time”. I would insist on it now.

    The fact of the matter is that our minds can float all over the place – for any mental stability at all, we all need trustworthy emotional human support and contact. No one is exempt. Not easy to achieve – we are a cantankerous species and when we are socially isolated, for whatever reason, we all, every one of us, suffer mental distress, mental symptoms, even mental agonies – which is precisely what psychotic symptoms are.

    And the ultimate remedy, the one which is difficult to deliver, but which alone hits the spot, is solid reliable friendly socialising – reaching out in a generous honest manner is not the easiest thing to do, especially when an entire profession talks ‘brain’ not ‘mind’. But if you can go against the prevailing psychiatric pessimism, then minds can blossom, as Robert Whitaker never tires of pointing out.

    Emotions and getting them right can be most confusing – indeed some of the theories about mental health are too complex for words – so try something much simpler, something everyone can understand – such as “a smile a day keeps the doctor away”. From which it follows that you can then learn to say “if I meet someone without a smile, I give them one of mine”. And, when you’re really good at this –“a smile shared is a smile doubled”. All much less complicated and more fruitful, than it might seem at first.

    More power to all who labour to re-humanise us – not the easiest of tasks, as Joanna and too many others have found – but by far the healthiest. Rock on, and never despair.

    ~~~o0o~~~

    Professor Bob Johnson, DSc(hon), MRCPsych, MRCGP, PhD(med computing), MA (Psychol), MBCS, DPM, MRCS, School of Psychology, University of Bolton, BL3 5AB, UK. GMC num. 0400150 https://drbobjohnson.substack.com/

    Harrow’s paper is at — https://pubmed.ncbi.nlm.nih.gov/25066792/#:~:text=Results%3A%20At%20each%20follow%2Dup,antipsychotics%20longitudinally%20had%20psychotic%20activity.

    My sub stack page is at — https://open.substack.com/pub/drbobjohnson/p/why-the-medical-label-schizophrenia?r=dveyu&utm_campaign=post&utm_medium=web

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    • Sad truth is that delusions are also learned, just small doses of delusion inducing drugs in a world with mk/ultra mind controlling satellites, angels and demons possessing people, reptilians eating something, etc., might make any unlearning or relearning difficult if not impossible.

      It’s the “augmented” travel into the rabbit whole of radicalization. Seems to me the same dynamic.

      So, to me, it is more serious than medication just inducing psychosis. In rats hallucinations can be induced without medication, just exposing them to anticipate a bell tone does that. Saddly for humans, happily for rats, there is no rat society to amplify any whim of delusional thinking.

      I imagine a rat society where bell tones mean a message from the divine, or a nefarious three letter agency doing the nasty. Maybe involving cats…

      One decades old rethoric was that people who “developed” schizophrenia came from violent, neglectfull and otherwise “disfunctional” families. Values explanation for “psychosis”.

      Within societies without strong comunal ties. Selfish societies, some called them liberal or libertarian. Individualists, western or westernized.

      Socializing with “friends” not when “friends” are gonna call the mental enforcers on you, seriously. Not only stigma, but missinformation and availability of coercion will make that impossible for many sufferers. Running to another state, even another country will not help either.

      “Acoso moral”, mobbing, moral harrassement, is going to make difficult any social integration of a person who already fell pray to that and went into psychosis.

      Unless, legal protections are in place.

      Education, even training against sexual harrassement, me ignorant I admit, has had no effect on the number of sexual harrasement complaints. They seem to have exploded and not just from the past. From the present!.

      ‘“a smile a day keeps the doctor away”’ I have an alternate to that one: Gratitude. Gratitude to all non-human beings. Without you know, running a rescue kennel in your house.

      More gratitude, less compasion, particularly of the not so usefull one.

      Animals are not gonna judge anyone for “psychosis”, particularly when they are not put in a situation to live within a “shared” one. Like one set with unusual beliefs, and the other set with harmfull, wrong beliefs, but shared as “truth” by many, if not the overwhelming majority.

      Without turning into horse therapy or doplhin therapy, just plain simple gratitude to non-human living beings everywhere, everytime possible. Without recurring to useless or counterproductive compassion.

      “re-humanise”, I say not, re-animalize, like old native cultures were humans were not that different from eagles, condors, snakes, spiders and the like. In fact!, some of those other animals embodied virtues hardly accesible to humans.

      From some viewpoints the shrewdness of the coyote, the magnificence of the eagle, the strengh of the bear, were more virtuous than the deceit, cowardice and evilness of humans. Not preaching for mysanthropy though.

      Without of course, falling into “delusion” territory when that already was a problem…

      Aware, that in the “modern” world there are for the most part roaches, spiders, flies, mosquitos, cats, dogs, rats and the ever present sparrow.

      And, for me, that is more than enough, it fills me with gratitude, everytime, almost everywhere….

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  21. Thank you Dr. Moncrieff for your tireless work and analysis of the RADAR study. Dr. Peter Breggin calls all antipsychotics neurotoxins. Is it possible that the brain damage caused by antidepressants, stimulants (for ADHD), etc. can create these psychotic episodes that are presented when the influence of the psychiatric drugs are reduced? While the RADAR study participants in the reduction group tapered over a longer period of time, it may not have been long enough and perhaps stress from knowing they were in the taper group also precipitated some of their symptoms. There are also other factors that may affect their mental state, including vitamin levels, gut health, etc. Thanks again for all you do to support those seeking better solutions.

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  22. Congratulations to all the RADAR Trial researchers on this fantastic research project. It’s heartening to see scientists testing and questioning existing methodologies to open up new avenues for improving mental health treatment.

    The research’s sample group was very small (I believe only 253 participants), so would be hesitant to put too much weight on these early findings as definitively conclusive or representative of the potential experience or outcomes of the hundreds of thousands of people prescribed antipsychotics who might benefit from reducing or stopping these psychiatric drugs.

    This is not meant as a criticism of the study or the researchers. I have a lot of admiration for Dr Moncrieff and her colleagues. I also celebrate their pioneering efforts in this recently published trial.

    But it’s also important to highlight the potential limitations of the trial due to the difficulty of conducting a similar study but with a larger sample size. Cancer or heart disease trials (like for instance testing the efficacy of beta blockers) often involve tens of thousands, or hundreds of thousands – if not even millions – of research participants. When the scale of a study is so small, statistics such as these are more vulnerable to anomalies – so drawing definitive conclusions from such data can be problematic and inaccurate.

    I would be very pleased to see these inspiring researchers continue in their efforts – and urge them not to be disheartened by their early findings.

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  23. I agree with earlier comments, that this belongs in the headline or at least warrants much greater prominence:

    “72% of people who would have otherwise been prescribed antipsychotics all their lives WERE able to taper off with NO relapses or worsening functioning whatsoever”.

    Hats off to the 72% who managed to taper off, it’s not easy.

    Hats off too to Dr. Moncrieff and her team for the humane approach, the huge amount of work, and truth-telling despite the disappointing headline (which really needs to be reframed).

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    • I do not disagree with the reframing, but I think, still, insistently, that it is important to remark the increase in the number of fatalities, 100%, when trying to tapper/withdrawal. From 4 to 8 fatalities, half of them ruled “natural causes”

      That might explain why the reframe title/summary won’t fly:

      It gives the impression that beyond higher relapse rates trying to withdraw/tapper is safe, which is NOT.

      Trying to withdraw/tapper increases fatalities DOUBLY, and the fatality rates for people using neurolpetcis in the RADAR study that did not try to tapper, the control group, was already apparently TOO high for being people around 50yrs of age.

      And in the control group having around 3.2% of them dying, around 50yrs of age, half of them also of “natural causes” is unusual. If I am not misunderstanding.

      According to statista (from 2021):

      https://www.statista.com/statistics/1125118/death-rate-united-kingdom-uk-by-age/

      The death rate of males in the 50-54yrs range is 4.5 per THOUSAND not per hundred, and 2.8 for females. And that was a year of INCREASED fatality rates because of COVID!, so it’s already above the “natural rate” of fatalities in the around 50yrs of age!. And the UK was among the countries with HIGHER mortality rates because of COVID in the WORLD!.

      That means the 3.2% fatality rate in the CONTROL group is around at LEAST 7 fold higher! than the “control population”. And it is AROUND the 6-8 fold death rate “reported” increase of fatality by “schizophrenia”, which DOES NOT take into account fatalities by treatment, not disease.

      Having a fatality rate of 6.3% is at least 14 FOLD higher than the “control population” fatality rate and it is TWICE the rate of “control” schizophrenia patients, which already is considered a DEADLY disease…

      So in its effects, the RADAR study EFFECTIVELY will close the option to withdraw/tapper BECAUSE it’s results can be weaponized to label people trying to withdraw win LACK of INSIGHT and VERY POOR JUDGEMENT, since trying it will LEAD to a big incrase in FATALITY risk.

      “Only a ‘crazy’ person would try it, since treatment is SUPPOSED to prevent such fatalities by the DISEASE”. Being hyperbolic, not trying to offend, but that seems they way of some practitioners to “express” themselves…

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  24. And for an explainer of the increase fatality rate in the RADAR study in the “control” group:

    1.- Obesity DOUBLY increases fatality rates.

    2.- Hypertension increases TWO to THREE fold mortality rates.

    3.- Diabetes increases TWO fold the fatality rates.

    4.- Assuming they are independent, which they are not, that gives anywhere from 4 to 12 FOLD increase in moratility rate in the “control” group, just on the metabolic SIDE EFFECTS of the medication. Taking into account how frequent obesity and hypertension are in that group. Without considering dyslipedemia: high cholesterol, low “good” cholesterol and high triglicerides.

    5.- Around 50yrs of age, the mortality rate of non-coronay sudden death for males is around 10 fold higher when using neuroleptics. Considering that such deaths accour around 1 in 2,000 people in the US, regardless of age, gives a death rate of around 1 in 200, just on SUDDEN NON-CORONARY DEATHS around that age when using neuroleptics, at least, see quotes below…

    And NONE of that explains the DOUBLE increase in fatalities when trying to tapper, except, in my opinion, for the TREATMENT FOR RELAPSE. Which according to RADAR might be way WORSE than having the disease…

    “Many autopsy-based studies have documented unexplained cases among sudden deaths of schizophrenia, with rates ranging from 2.8%[58] to 52%[73].” In the RADAR half fatalities are “natural”, apparently, IIANMR…

    “An autopsy report also confirmed antipsychotic-induced myocarditis, which showed that in 24 sudden death cases, 11 (45.8%) died from myocarditis, and 7 (29.2%) were on clozapine medication[49].” BUT four, 4, were not on clozapine, or around a third…

    “Current users of FGAs and SGAs had higher rates of SCD than nonusers of antipsychotic drugs, with adjusted incidence-rate ratios of 1.99 [95% confidence interval (CI): 1.68 to 2.34] and 2.26 (95%CI: 1.88 to 2.72), respectively[6]. Autopsy-based evidence also confirmed that approximately 3.5% of schizophrenia patients under antipsychotic use died from cardiac causes[7]. ” That does not take into accout the exponential increase in SCD, sudden cardiac death with AGE…

    “The incidence of antipsychotic-induced SCD is also dose-related. The incidence-rate ratios of FGA users increased from 1.31 (95%CI: 0.97 to 1.77) for those taking low doses to 2.42 (95%CI: 1.91 to 3.06) for those taking high doses (P < 0.001). Among users of SGAs, the incidence-rate ratios increased from 1.59 (95%CI: 1.03 to 2.46) for those taking low doses to 2.86 (95%CI: 2.25 to 3.65) for those taking high doses (P = 0.01)[6]." See, higher doses lead to DOUBLING that fatality rate.

    And high doses is what I imagine is used when "addressing" relapse…

    From:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8546771/

    " Only 22% of the patients had coronary artery disease as an underlying structural cardiac disease in the study of Wu et al from Taiwan. " on SCD and psychotropics…

    From:

    https://www.ahajournals.org/doi/full/10.1161/JAHA.115.001894

    Reviewing/commenting on:

    https://www.ahajournals.org/doi/10.1161/JAHA.114.001568

    And the risk mitigation treatment for obesity, hypertension, diabetes, dyslipidemia, when using neuroleptics DOES NOT return patients to baseline risk, it reduces the several FOLD increase in fatality risk by at most 10-20-30%, which for a 30 FOLD increase in fatality, at BEST, brings it down to just 21 FOLD, to illustrate a hypothetical case, around 50yrs of age…

    And that means not that there was “excellent” “competent” care in the RADAR study, it means that there are probably several demises in BOTH attrition groups, that were not reported when doing and publishing the results of the RADAR study.

    Just the cardiac death rate reported in the quotes is 3.5% which is ABOVE the 3.2% fatalities in the RADAR control group.

    Of course RADAR lasted 2 yrs, and that might change the calculations…

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  25. As a corollary:

    Using neuroleptics in persons above 40-50yrs of age is a very bad idea, the increase in sudden cardian death is exponential with age…

    And it does already occur in general in around 3.5% of the people labeled “schizo” and treated with neuroleptics.

    Using them when trying to withdraw kills 6.3% pf people trying it, above the 3.2% fatalities reported in the “control” group.

    So, very bad trying to withdraw when reaching 40-50yrs of age, and very bad keep using them JUST on the sudden cardiac death risk.

    Age catches everyone using neurolpetics, just on sudden cardiac deaths alone, relapse treatment related fatalities, as I guess RADAR proves, or not…

    So it makes the question:

    Isn’t using neuroleptics against anyone a clear attempt to try to kill them when they reach 50yrs of age?. When the sudden deaths spike when using neuroleptics, as does “general” mortalities in the “normal” population. Just several fold higher…

    Withdrawal or continuing using them will increase a lot the risk of dying, just on sudden cardiac deaths ALONE…

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  26. I very much appreciate both your dedication to the scientific model you used, and to your willingness to interpret fairly and with a mind for learning how these data might guide methods for assisting those who can benefit from medication reduction/cessation. It is very difficult to adhere to the null hypothesis rigor and not allow a working hypothesis longing to cloud our fidelity. These data do not represent anything negative in my view. We have more to investigate about how contextual factors for each subject/person desiring a reduction might be adjusted to enhance a likelihood of successful reduction. Many factors to investigate, and as the Social Determinants of Health and the neuroscience data keep suggesting, environmental modifications can produce amazing settling of synaptic restlessness/extremes.

    Thank you so much for your own and your team’s great work.

    Jacek

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