Can patients with chronic schizophrenia stop taking antipsychotic medications?

Tapering or reducing antipsychotic medications in patients who have had schizophrenia for many years (e.g., over 15) is a complex and personal decision. Reasons for tapering medications can include that higher doses are associated with more severe side effects, such as extrapyramidal symptoms, sedation, metabolic syndrome, sexual dysfunction, sudden cardiac death, and possibly loss of brain tissue. Blockade of the dopaminergic mesolimbic reward system reduces motivation and drive, which may hamper recovery. But reducing the dose carries risk of relapse. Suicide-related mortality is also significantly greater in patients not receiving antipsychotics. A 2020 systematic review and meta-analysis examined outcomes for reducing antipsychotics from, January 1950 through June 2019 across 40 selected studies that included 1677 patients, mean age 43.1, with a mean duration of illness of 16.8 years. The authors conclude, “we believe that, generally speaking, discontinuation of antipsychotic medication is not recommended in patients with chronic schizophrenia” and note a higher risk of relapse with tapering if illness <15 years in duration, recent inpatient hospitalization, discontinuation (vs reduction), reducing to less than 5 mg haloperidol equivalent per day, and a fast reduction (compared to slow). Whether these results apply to your patient is something only you can determine.

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