Five year outcomes of tapering antipsychotic drug doses in a community mental health center
Abstract
There is evidence that many individuals are on higher doses of antipsychotic drug than is required for optimal functioning yet there are limited guidelines on how to reduce them. This paper reports on 5 year outcomes for sixty-seven individuals who received treatment at a community mental health center and were offered the opportunity to gradually reduce their doses of antipsychotic drug in collaboration with the treating psychiatrist. Over a period of 6 months, the author invited patients who were clinically stable and able to participate in discussions of potential risks and benefits to begin gradual dose reductions. Initially, 40 expressed interest in tapering and 27 declined. The groups did not differ in age, sex, race, or diagnosis. The group who chose to taper began on significantly lower doses. Most patients succeeded at making modest dose reductions. At 5 years, there were no significant differences in the two outcomes measures, rate of hospitalization and employment status. Many patients were able to engage in these discussions which did not result in widespread discontinuation of drug. This is a naturalistic, small study of a topic that warrants further research.
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Tapering over months and years (by 25%-30% reductions of original dose every 3 months) demonstrated no significant difference in relapse rates between patients who continued or discontinued antipsychotics.
“Tapering over months and years (by 25%–30% reductions of original dose every 3 months) also demonstrated no significant difference in relapse rates between patients who continued or discontinued antipsychotics.74”
From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [74]
A more recent study found that in patients with 1 year of TD, 13% had symptoms resolve completely (taking 2-4 years, average 2.3), and the number defined as moderate or severe decreased from 63% to less than 20%.
“A more recent study examined patients with 1 year of TD in whom dopamine antagonists (including metoclopramide) were ceased after 5 years of exposure74: in 13% of the patients, symptoms resolved completely (taking 2–4 years, average 2.3), and the number defined as moderate or severe decreased from 63% to less than 20%.78”
From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [74]
It is likely that discontinuation studies employing linear dose reductions will be more likely to induce withdrawal reactions (including, potentially, withdrawal psychosis) because reductions in D2 antagonism become increasingly large, causing greater likelihood of dopaminergic rebound.
“It is, therefore, likely that discontinuation studies employing linear dose reductions,74,83,84,86,87 as recommended in some older guidelines,94 will be more likely to induce withdrawal reactions (including, potentially, withdrawal psychosis) because reductions in D2 antagonism become increasingly large, causing greater likelihood of dopaminergic rebound.”
From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [74]
This may account for the relative ease of reductions at higher doses of antipsychotic and the difficulties in tapering at lower doses.
“this may account for the relative ease of reductions at higher doses of antipsychotic and the difficulties in tapering at lower doses.45,51,74”
From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [74]
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A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse
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- Authors
- Steingard, S.
- Affiliations
- University of Vermont (US)
- Corresponding author
- Steingard, Sandra
- ORCID
- Steingard, Sandra
- Venue
- Community Mental Health Journal
- Published
- 2018-08-03
- Volume
- 54
- Issue
- 8
- Pages
- 1097-1100
- ISSN
- 0010-3853 (ISSN-L)
- 1573-2789
- OpenAlex
- W2886118487
- Cited by
- 15
- References
- 16
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 4 · 2022: 2 · 2021: 3 · 2020: 2 · 2019: 1
- FWCI
- 1.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Community Mental Health Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- antipsychotic drugs, community mental health centers, long-term outcomes, hospitalization, employment status, patient participation in treatment decisions
- MeSH terms
- Community Mental Health Centers, Employment, Female, Hospitalization, Humans, Male, Middle Aged, Schizophrenia, Antipsychotic Agents, Treatment Outcome
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