What we need is more research to work out who benefits and who doesn’t. If drugs are stopped too quickly, people can get withdrawal symptoms (which for antipsychotics can include insomnia, tremors and sometimes psychotic symptoms) or can be de-stabilised by the process of coming off.ĭr Horowitz said: “In clinical practice, I often see patients perking up when they reduce their antipsychotic medication and telling me that they ‘feel more themselves.’ It is also true that some people get worse when their drugs are reduced. The reason for stopping drugs gradually is that our brains adapt to long-term use of drugs like antipsychotics (as they do to nicotine, caffeine or opioids). In parallel, the first study in England to look at the effect of slowly reducing antipsychotics in people with a diagnosis of schizophrenia, called RADAR, is currently being undertaken, led by Professor Joanna Moncrieff (UCL Psychiatry).**** Liquid versions of the drug or small dose formulations will be needed to help patients to do this, to avoid having to crush up the tablets themselves. The principles are similar: doing so cautiously by small amounts, and ensuring patients are stable (with suggested three-to-six month intervals between dose reductions) before making further reductions. These new guidelines on how to reduce antipsychotics align with guidelines the same researchers published recently on how to stop taking antidepressants safely***. They describe research, which finds that people with schizophrenia who are slowly taken off their antipsychotics, have twice the chance of functioning well than those who stay on the same dosage, with no worsening in their symptoms. The authors of this proposal reviewed existing evidence into antipsychotic withdrawal, and the mechanisms of the drugs themselves. Some patients say they are helpful in the short-term but harmful in the long-term.Ĭurrently there are no established guidelines on how to stop taking antipsychotics, which is partly why psychiatrists are reluctant to do so. However, some people find the drugs do not help them or that the side effects (which can sometimes contribute to long term health complications) outweigh the benefits, while many people who then stop taking antipsychotics experience withdrawal effects, which can be severe**. These drugs are also increasingly prescribed for conditions like insomnia and anxiety ‘off-label’ (without being licensed for these conditions by the UK’s MHRA). Stopping medications is an important part of the job of a psychiatrist, yet it has received relatively little attention.”Īntipsychotics are one of the fastest growing classes of drugs being prescribed in England*, growing from 660,000 people (9.4 million prescriptions) in 2015/2016 to 750,000 people in 2019/2020.Īntipsychotics are often recommended life-long for people diagnosed with schizophrenia or other serious mental illnesses because they are effective at controlling psychotic symptoms in the short term and might reduce the risk of relapse. From my own experience I know how hard it can be to wean off psychiatric medications – so we set out to write guidance on how to withdraw safely from antipsychotics. Lead author Dr Mark Horowitz (UCL Psychiatry) said: “Surprisingly, there are no published guidelines on how to come off antipsychotics. Withdrawal symptoms can be severe, and may include psychotic symptoms similar to the underlying condition, which can result in patients being advised to remain on the medication indefinitely, even though the new symptoms might have been avoidable with a carefully-managed withdrawal. The review, published in Schizophrenia Bulletin, is the first ever scientific paper outlining how exactly antipsychotic medication should be reduced in order to minimise both withdrawal effects and the risk of relapse. Withdrawing from antipsychotics may require months or even years, and patients need to gradually reduce to very low doses, according to a new analysis led by UCL and King’s College London academics.
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