Why Gradual Reduction of Antipsychotics Could Be Safer for Service Users

A new commentary argues for the slow tapering of antipsychotics to reduce relapse risks and withdrawal symptoms in patients.

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A new commentary published in Current Opinion in Psychiatry presents the case for slow tapering of antipsychotics. According to authors Mark Horowitz and Joanna Moncrieff of University College London, slow tapering of antipsychotics can reduce the chance of relapse by allowing the brain time to adjust to the absence of these drugs.

Stopping antipsychotic medication can be more dangerous than taking it, with withdrawal symptoms so severe they can feel like a return to the original illness – or even worse. For millions of people prescribed these drugs, this is a daunting reality that’s been largely overlooked by the medical community. In this commentary, the authors suggest that slower tapering of antipsychotics may be more prudent and save harm from withdrawal symptoms.

“Research shows more rapid reductions of antipsychotic dose in people on long-term antipsychotics is associated with a higher rate of relapse than more gradual rates of reduction.”

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Kelli Grant
Kelli has two Master’s degrees, in Criminal Justice and Sociology. In 2024, Kelli was awarded an Honorary Doctorate of Humane Letters and a Kentucky Colonel designation for her demonstrated contributions to academia, her community, and professionally. She believes that qualitative research methods can provide a deeper understanding of social systems and experiences. Kelli has her own experiences with the mental health care system as a late-diagnosed autistic woman. Those experiences, as well as her academic training and advocacy work the past 20 years, motivates her to help bring about a fundamental shift in how we approach mental health care, especially for the most vulnerable in our society. She resides in Kansas.

6 COMMENTS

  1. I was first put on antipsychotics in 1980 when I was placed on 800 mg of Mellaril as a teen ager. I was finally able to escape psychiatry completely when my psychiatrist lost her license. I took my last dose of Seroquel on June 4, 2023. It took me a year and seven months to taper the last 50 mg of Seroquel. My brain is slowly waking up. Being drugged and chemically incapacitated at such a young age should be a crime against humanity. Being forcibly drugged is a crime far worse than growing up being sexual assaulted in the home. Antipsychotics should not be used to silence survivors especially in the era of #metoo.

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  2. “A new commentary published in Current Opinion in Psychiatry presents the case for slow tapering of antipsychotics. According to authors Mark Horowitz and Joanna Moncrieff…slow tapering of antipsychotics can reduce the chance of relapse by allowing the brain time to adjust to the absence of these drugs.”

    Erm: how is this news? And what is Johanna Moncrief donating her brain to such a totally insignificant bit of commentary that merely states what has been obvious for decades? She would be putting her brain to better use if she hung it out on the washing line with the clothes, so birds can peck at it at leisure. She’ll then have many new and really quite perfect and beautiful visitors to her undoubtably perfect and beautiful British garden, gardens being like humans – like an artwork trapped in a frame, or like an animal trapped in a cage.

    We’re trapped in glass. We stagnate in picture frames. Smash the artwork. Then we will be free. You have to die completely to know what love is. And it is the whole of existence. When you are there it is not.

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  3. “psychotic symptoms may be withdrawal effects from reduction of antipsychotics and may not necessarily represent unmasking of the underlying disorder.”

    Most definitely. As one who was inappropriately put on antipsychotics, to supposedly “cure” the common symptom of “brain zaps,” which were due to an inappropriate abrupt withdrawal from a non-“safe smoking cessation med,” an actual dangerous antidepressant.

    I will say, as one who dealt with blatant psychological / psychiatric malpractice, according to the DSM-IV-TR, at the time. Trying to treat the common adverse and withdrawal effects of the antidepressants (anticholinergic drugs) with multiple more anticholinergic drugs (the even worse, antipsychotic drugs) does NOT work.

    Twenty plus years later, I still have the brain zaps, which I’ve thankfully learned to control in my waking hours, so they aren’t that bothersome to me any longer, at least in my waking hours.

    But I will say, I do now have insight, by experience, and much subsequent psychopharmacology research, into what “psychosis” actually is. And I do so hope to help give the psychiatrists and psychologists insight into what “psychosis” actually is, how it relates to their dangerous anticholinergic drugs, and safe withdrawal from them.

    All dreams are NOT “psychosis,” as my former Holy Spirit blaspheming “holistic, Christian talk therapist” psychologist incorrectly believed. And brain zaps are NOT “psychosis” either.

    When an essentially healthy person is inappropriately put on an antipsychotic, however, it can make a person “psychotic,” via anticholinergic toxidrome poisoning. An anticholinergic toxidrome induced “psychosis” is a very nasty and evil form of “psychosis.”

    A slowly tapered withdrawal off of antipsychotics, as my psychiatrist did, after he stopped listening to the lies of my misdiagnosing, non-medically trained, psychologist. That did result in a drug withdrawal induced super sensitivity manic psychosis – but it wasn’t an evil “psychosis,” it functioned as an awakening to my dreams … where lots of my soul mates, within the collective unconscious, were trying to save me.

    “Horowitz and Moncrieff suggest that long-term treatment with antipsychotics may cause brain adaptations as the brain works to process and reach homeostasis.”

    I agree, since like many of us here, I also have done my homework. And I do have my drug history all written up in a one page synopsis spread sheet, if either of you are interested in getting a copy, Horowitz or Moncrieff? I’ll update it a little, since I first wrote it up in 2005, and Whitaker’s, et al, and my subsequent reporting and research did provide further insight into the actual etiology of the malpractice I dealt with.

    “Given the evidence presented above highlighting the convergence in relapse rates between the maintenance and discontinuation arms in antipsychotic discontinuation trials at three years, this suggests that tapering patients over approximately three years (although with substantial individual variability) …”

    My tapering period was a little longer, 3 – 7 years, depending upon whether to want to respect the psychological malpractice covering up crimes of the now FBI convicted Dr. V. R. Kuchipudi, his psychiatric “snowing” partner-in-crime, not to mention the similar crimes by my ex-religion. Albeit, my ex-religion’s psychological malpractice covering up crimes are still on-going … decades later.

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  4. If we could listen to our mind like we listen to the sound of traffic or observe the horizon, i.e. just to watch or listen to the thinking without reaction, hence without believing it is me thinking, without identifying with the thought, without saying ‘this is not my thought’, without saying this is right or wrong thinking, the brain, through this unpoluted clarity of awareness, would begin to observe and understand thought and therefore radically change, inevitably, because what it discovers is that there is no ‘me’ at all. Thought calls itself me, and is a mechanical process which causes physical and emotional reactions simply because the brain and body have not yet understood that this thought is not who anyone or anything is. It’s a mechanical function, a socially conditioned biological activity pretending to be what you actually are.

    And then the body has to learn that it is not a ‘me’ either. There is something that I call the ‘body consciousness’, but if you want to consider it in materialist terms, just think of the structure of the body and it’s central nervous system which needs to reflect an understanding that this thought is a false subject, a control mechanism, not who it is. This is the insight the body needs, if you like, to be reconditioned or transformed by. The brain is one thing that can gain insight immediately, the neurological adaptations take a bit longer, and then the general physiological adaptations take longer still. And when the body learns it is not thinking, it needs to learn that it is not a self either. It is a happening within the true self, the true self being awareness.

    You were always your awareness. You were nothing else. The life and the body and the world and everybody you know is a profound kind of dream happening in consciousness. Unsurprisingly this dream has an immeasurable significance, but nothing within the body or brain or world understand what this significance is. This IS suffering, this IS fear, this is mortality too, although nothing truly dies, except that which is becoming free.

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  5. Harmony is meaning to the brain, but harmony is not necessarily the truth. The truth is harmonious and therefore meaningful to the brain, but harmony alone, although meaningful, is not necessarily the truth. This is why music is meaningful but not the truth – how can it be when it doesn’t even know itself. But the meaning of music is true, if not the truth. The true is honesty, or faithful representation. The truth is beyond all representation, including by words. But honesty leads to the truth. The true leads to the truth.

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