Deprescribing antipsychotics: a guide for clinicians
Open accessAbstract
SUMMARY Polypharmacy and the risks of long term use of antipsychotic medications point toward the need for identifying practices for deprescribing in psychiatry. The following article gives a brief overview of key points around deprescribing antipsychotic medications in psychiatry, including identifying risks and benefits, considerations around timing, and steps involved. LEARNING OBJECTIVES • Be able to define the concept of deprescribing as it relates to antipsychotic medications • Know how to perform a risk–benefit analysis for a patient on antipsychotic medication • Be able to identify the key steps involved in deprescribing antipsychotic medications DECLARATION OF INTEREST None.
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Very low doses of depot antipsychotic (2.5-10 mg of fluphenazine decanoate every 2 weeks) were as effective in preventing a relapse as the standard recommended doses, 5-10 times that amount.
“For example, very low doses of depot antipsychotic (2.5–10 mg of fluphenazine decanoate every 2 weeks) were as effective in preventing a relapse as the standard recommended doses, 5–10 times that amount70,97”
From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [70]
It is possible that there would be an increase in symptoms following a dose reduction, but these symptoms might be expected to resolve over time as underlying adaptations resolve, though this can take weeks or even months.
“As outlined recently, it is possible that there would be an increase in symptoms following a dose reduction,70 but it might be expected that these symptoms would resolve over time, as underlying adaptations resolve (though this can take weeks or even months);”
From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [70]
Regimens recommend final diazepam doses of 0.2-0.5 mg (1%-2% GABA-A occupancy), with some patients requiring even smaller doses.
“This aligns with regimens recommending final diazepam doses of 0.2–0.5 mg (1%–2% GABA-A occupancy), with some patients requiring even smaller doses (Ashton, 2005; Gupta, Cahill, & Miller, 2018).”
From Pharmacological principles for safe benzodiazepine and Z-drug dose reduction (2026) · cites this paper as Gupta, Cahill, & Miller, 2018
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References 57 · Cited by 35
Research works printed but not linked: 3
- Lehman AF, Lieberman JA, Dixon LB, et al (2004) Practice guideline for the treatment of partients with schizophrenia. American Journal of Psychiatry, 161(2 SUPPL): 1-56.
- c Deprescribing antipsychotics BJPsych Advances (2018), vol. 24, 295-302 doi: 10.1192/bja.2018. · DOI
- Schooler NR (1993) Reducing dosage in maintenance treatments of schizo- phrenia: review and prognosis. British Journal of Psychiatry, 163(suppl 22): 58-65.
- Authors
- Gupta, S., Cahill, J. D., & Miller, R.
- Affiliations
- Yale University (US)
- Corresponding author
- Gupta, Swapnil
- Venue
- BJPsych Advances
- Publisher
- Royal College of Psychiatrists
- Published
- 2018-08-13
- Volume
- 24
- Issue
- 5
- Pages
- 295-302
- ISSN
- 2056-4678 (ISSN-L)
- 2056-4686
- OpenAlex
- W2885375796
- Cited by
- 35
- References
- 57
- Citations by year
- 2026: 7 · 2025: 2 · 2024: 7 · 2023: 6 · 2022: 3 · 2021: 4 · 2020: 3 · 2019: 1 · 2018: 2
- FWCI
- 1.40
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BJPsych Advances (publishedVersion)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- deprescribing, antipsychotic drugs, polypharmacy, risk-benefit assessment, long-term antipsychotic use, drug withdrawal
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