Mental health professionals’ views and experiences of antipsychotic reduction and discontinuation
Open accessAbstract
BACKGROUND: The widely established treatment for psychosis is long-term antipsychotic medication. However, many people stop taking this treatment, and request other options. There are also growing concerns about adverse effects, but currently no professional guidelines to support reducing or stopping these drugs. The views and experiences of individual mental health professionals around reducing and stopping antipsychotics are therefore crucial in treatment decisions. METHODS: We conducted 7 focus groups with prescribing psychiatrists and other members of community-based statutory mental health services in London. Participants discussed their views about, experiences, and processes of antipsychotic reduction and discontinuation. Data were analysed using thematic analysis. RESULTS: Participants acknowledged that antipsychotics can have severe adverse effects. They were generally supportive of trying to reduce these drugs to the lowest effective dose, although stopping antipsychotics was less acceptable. Prior experiences of adverse events after reduction or discontinuation meant that both were approached with caution. Reduction was also reported to be hampered by organisational and knowledge barriers. Lack of resources, pressure to discharge, and poor continuity of care were seen as organisational barriers. Knowledge barriers included inadequate evidence about who might be best suited to reduction, and lack of guidance about how this could be done safely. This meant that reduction was often prompted by patients, and sometimes actively discouraged, and stability with maintenance treatment was often favoured. CONCLUSIONS: Concerns about risk and other barriers means that clinicians are often reluctant to implement reduction or discontinuation of antipsychotic medication. In order to increase the treatment options available to service users, more research and guidance on how to minimise the risks of antipsychotic reduction and discontinuation is required to enable clinicians to engage more constructively with service users requests, offering people more choice and control in managing their mental health condition.
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“…are reluctant to discuss stopping antipsychotics is because there is a lack of knowledge about and no consensus on when to stop, which antipsychotic users can safely stop and even if antipsychotics should be stopped at all (Cooper et al., 2019; Correll et al., 2018; Harrow et al., 2017).”
Koch, T., von Peter, S., Weinmann, S., & Ruiz‐Pérez, G. (2025) · Psychiatry Research · doi:10.1016/j.psychres.2025.116685 · Cited by 1 · see citing works
“At least ambivalent attitudes should be attested, which is also stated by other authors (Asian Network of Early Psychosis Writing Group et al., 2022; Cooper et al., 2019b), now reinforced by the data of our study.”
InfluentialMatete, R. P., & Rathobei, L. M. (2023) · New Voices in Psychology · doi:10.25159/2958-3918/14085
“However, many people report unpleasant and debilitating effects from antipsychotics (Cooper et al., 2019).”
BackgroundYen, K., Hsieh, M. H., Chien, Y., Liu, C., Lin, Y., Hwang, T., Liu, C.-I., & Liu, C.-C. (2025) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2025.104534
Boland, M., Higgins, A., Kwak, S., & Cadogan, C. A. (2025) · Health Expectations · doi:10.1111/hex.70384
“Despite this, service users have previously reported challenges in having their autonomy and choice respected and being involved in decisions around their medication [33].”
Uso racional de antipsicóticos en pacientes mayores: un abordaje cualitativo
Vivacqua, M. N., Ratti, M. F. G., & Faccioli, J. L. (2025) · Revista Española de Geriatría y Gerontología · doi:10.1016/j.regg.2025.101720
Ruiz‐Pérez, G., Ulrich, N., Bettin, J., Lippert, J., Koch, T., & von Peter, S. (2025) · Der Nervenarzt · doi:10.1007/s00115-025-01922-7
“Gleich-zeitig ist die Einnahme von AP mit erhebli-chen unerwünschten Wirkungen verbun-den, die kurz-und langfristig die Lebens-qualität der Betroffenen beeinträchtigen können[2,3].”
Crellin, N. E., Priebe, S., Morant, N. J., Lewis, G., Freemantle, N., Johnson, S., Horne, R., Pinfold, V., Kent, L., Smith, R., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19366114
Richter, S., & Carol, S. B. (2026) · Research Square · doi:10.21203/rs.3.rs-8935281/v1
Richter, S., & Carol, S. B. (2026) · Research Square · doi:10.21203/rs.3.rs-8935281/v2
Richter, S., & Carol, S. B. (2026) · Research Square · doi:10.21203/rs.3.rs-8935281/v3
Moncrieff, J., Long, M., Priebe, S., Akther-Robertson, J., Barnes, T. R. E., Bray, G., Cooper, R. E., Crellin, N. E., Darton, K., Freemantle, N., et al. (2025) · Programme Grants for Applied Research · doi:10.3310/gjjm0506
Koch, T., Peter, S., Weinmann, S., & Ruiz‐Pérez, G. (2026) · Neuropsychiatrie · doi:10.1007/s40211-026-00583-5
Christian, R. B., Annis, I. E., deJong, N. A., Davis, S., Hughes, P. M., & Thomas, K. C. (2026) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.70456
- Authors
- Cooper, R. E., Hanratty, É., Morant, N., & Moncrieff, J.
- Affiliations
- Queen Mary University of London (GB)
- North East London NHS Foundation Trust (GB)
- University College London (GB)
- Corresponding author
- Cooper, Ruth E.
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2019-06-20
- Volume
- 14
- Issue
- 6
- Pages
- e0218711
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6586401
- OpenAlex
- W2952448336
- Cited by
- 49
- References
- 55
- Citations by year
- 2026: 7 · 2025: 13 · 2024: 8 · 2023: 7 · 2022: 7 · 2021: 3 · 2020: 4
- FWCI
- 2.78
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, other-oa)
- Greenwich Academic Literature Archive (University of Greenwich) (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Programme Grants for Applied Research (RP-PG-0514-20004)
- 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 reduction, antipsychotic discontinuation, psychosis, mental health professionals' perspectives, adverse drug reactions, organizational barriers, continuity of care, long-term antipsychotic treatment, community mental health services
- MeSH terms
- Adult, Attitude, Decision Making, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Health Personnel, Humans, Health Knowledge, Attitudes, Practice, London, Male, Mental Health, Middle Aged, Perception, Psychotic Disorders, Antipsychotic Agents, Focus Groups, Withholding Treatment, Drug-Related Side Effects and Adverse Reactions
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