“All roads lead to medication?” Qualitative responses from an Australian first-person survey of antipsychotic discontinuation.

Abstract

Participant accounts highlight the importance of context and relationships in their thinking about antipsychotic discontinuation. Although results cannot necessarily be generalized, participant descriptions of withdrawal syndromes suggest there may be a need to improve education, monitoring, and support strategies for some people during discontinuation. Shifting toward a more collaborative, transparent, and service-user-driven approach to discontinuation may help to mitigate some of the negative discontinuation impacts identified. The polarized discontinuation outcomes described highlight the individuality of every participant's recovery journey and the need to avoid generalizing about the role of antipsychotics in care.

Attempting to discontinue antipsychotic medication: Withdrawal methods, relapse and success

“…Our results support other studies showing withdrawal can be associated with psychotic or manic relapse severe enough to require hospitalisation, alongside a range of physical and emotional effects including suicidality, with a subsequent impact on self-care and daily functioning (Dilsaver and Alessi, 1988, Moncrieff, 2013, Breggin, 2013, Lehman, 2002, Geyt et al, 2016, Salomon and Hamilton, 2013, Roe et al, 2009). Withdrawal symptoms were described by 61.9% of the group but were by no means universal, with a fifth stating they experienced no withdrawal effects at all, similar to the findings of the largest existing qualitative study of discontinuation to date Hamilton, 2013, N=98, Salomon et al, 2014).…”

“…However, there is reason for caution when contemplating discontinuation and the choice to stop medication or consent to continuing use is not as straight forward as it may first seem. Discontinuation can entail a range of somatic, emotional, and cognitive withdrawal effects, and psychotic or manic relapse during the withdrawal period is common among those with schizophrenia spectrum and bipolar diagnoses M A N U S C R I P T Attempting to Discontinue Antipsychotic Medication 6 (Salomon and Hamilton, 2013, Gilbert et al, 1995, Harrow et al, 2012, Moncrieff, J., 2013, Boonstra et al, 2011, Gilbert et al, 1995, Harrow et al, 2012, Moncrieff, J., 2013, Buchanan et al, 1992. Little is known of whether psychotic or manic symptoms emerge during withdrawal following off-label use, but it may be common for the symptoms that were the original treatment targets to reappear during or following withdrawal of off-label AMs (Moncrieff, Joanna, 2006).…”

“…A small handful of studies represent the only existing information about how people attempt to withdraw from AMs (Roe et al, 2009, Salomon and Hamilton, 2013, Salomon et al, 2014, Geyt et al, 2016. Two small interview studies investigating the decision-making process found people with psychosis or bipolar disorder highlight the importance of 'weaving a safety net' of coping skills and supportive alliances (Geyt et al, 2016, Roe et al, 2009.…”

Antipsychotic medication side effect assessment tools: A systematic review

“…To intervene in this cycle, clinicians need to communicate about side effects resulting from antipsychotic medication in an open manner with mental health consumers, while also considering the potential benefits of taking medication (Gerlach and Larsen, 1999;Happell et al, 2004;Naber and Karow, 2001;Salomon and Hamilton, 2013). However, mental health consumers often experience difficulties in communicating openly with clinicians, possibly because they may be reluctant to fully disclose their personal circumstances, or the medication or the illness has journey for many mental health consumers (Dassori et al, 2003;De Leeuw et al, 2012;Dott et al, 2001).…”

“…Evidently, mental health consumers may find themselves in a perpetual pattern of illness occurrence, prescribed medication subsequently producing unendurable side effects, discontinuation of medication and eventual relapse (Llorca, 2008;Naber and Karow, 2001;Salomon and Hamilton, 2013).…”