The Ethics of Antipsychotic Dose Reduction and Patient Rights

A new study published in the Psychiatric Rehabilitation Journal explores the ethics around antipsychotic dose reduction and discontinuation.

According to the authors, providing a path for service users to reduce or discontinue antipsychotic drugs aligns with the four core biomedical ethical principles of autonomy, justice, nonmaleficence, and beneficence.

The authors write:

“Clinicians have a responsibility to balance the four core ethical principles to the best of their ability when supporting a person in their recovery journey. Exploring, trialing, and supporting antipsychotic dose reduction may be part of this process if that is the patient’s choice.”

The analysis, headed by Kelly Allott of the University of Melbourne, argues that assisting with antipsychotic reduction and discontinuation falls under the principles of autonomy and justice while sharing up-to-date evidence about dose reduction and discontinuation, promoting shared decision-making, slow tapering, careful monitoring, and providing the necessary psychosocial support fall under nonmaleficence and beneficence.

The study challenges the prevailing focus on relapse prevention in antipsychotic treatment, highlighting the often-overlooked benefits of dose reduction, such as improved cognitive functioning and overall quality of life. With 70% of patients desiring to quit antipsychotics, the authors emphasize the ethical responsibility of clinicians to support informed and patient-driven decisions. They argue that slow tapering and careful monitoring can mitigate risks, ensuring that the principles of nonmaleficence and beneficence are upheld.