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

Abstract

Highlights Among 105 people who attempted to stop taking antipsychotic medication, less than half consulted a doctor in preparation and approximately a third used a gradual withdrawal method. Just over half described successfully stopping and half reported no current use.  Unwanted withdrawal effects were reported by 61.9% of the group and spanned emotional, cognitive, physical, and functional domains. Withdrawing gradually across more than one month showed significant, positive associations with self-described success and no current use. AbstractFew studies explore subjective experiences of attempting to discontinue antipsychotic medication, the withdrawal methods people use, or how their efforts affect their outcomes. People who take antipsychotics for off-label purposes are poorly represented in the literature. This study investigates experiences of attempting to discontinue antipsychotics in a cross-sectional sample and explores potential associations between withdrawal methods, relapse, and success. An anonymous online survey was completed by 105 adults who had taken antipsychotics for any reason and had attempted discontinuation at least once. A mixed methods approach was used to interpret the responses. Just over half (55.2%) described successfully stopping for varying lengths of time. Half (50.5%) reported no current use. People across diagnostic groups reported unwanted withdrawal effects, but these were not universal. Withdrawing gradually across more than one month was positively associated, and relapse was negatively associated with both self-defined successful discontinuation and no current use. Gradual withdrawal was negatively associated with relapse during withdrawal. We conclude it is possible to successfully discontinue antipsychotic medication, relapse during withdrawal presents a major obstacle to successfully stopping AMs, and people who withdraw gradually across more than one month may be more likely to stop and to avoid relapse during withdrawal.

Positive and Negative Effects of Antipsychotic Medication: An International Online Survey of 832 Recipients

“…The finding that 65% of the current sample reported ‘withdrawal effects’ (self-defined) is similar to a recent finding that 65 of 105 (62%) people trying to come off antipsychotics experienced withdrawal effects [20]. Withdrawal effects can, and should, be distinguished from a relapse of the pre-existing psychosis symptoms [42] so that people can receive the acknowledgement and support they need to gradually come off if they wish to do so [20-22, 42].…”

Barriers to stopping neuroleptic (antipsychotic) treatment in people with schizophrenia, psychosis or bipolar disorder

“…27 A research survey also found an association between gradual tapering over a period of 4 weeks or more and self-reported successful discontinuation and absence of relapse. 64 However, another meta-analysis of discontinuation studies did not find any difference in overall relapse rates between studies using abrupt versus gradual discontinuation, also using a definition of gradual as 4 weeks or more (or when depot injection was abruptly stopped). 13 This suggests that this may not be not gradual enough.…”

“…On the other hand, families, carers and clinicians may be reluctant to take the risk of having to endure another relapse, and this makes the process of withdrawal even more difficult, since many people report that they benefit from having support from other people when they try to reduce medication. 46,53–57…”

“…Even if people do not succeed in stopping neuroleptics altogether, attempting to discontinue can be worthwhile by leading to lower doses and reduced adverse effects. 53…”

“…People report using a variety of coping mechanisms to prepare for, and endure a period of, withdrawal including psychological, behavioural and medication-based strategies. 46,47,53,67 People also seek support from a variety of sources, including clinicians, friends and personal acquaintances. Several studies of non-pharmacological clinical interventions or strategies have been found to improve the outcomes for people who reduce, or wish to avoid, the use of medication.…”