What is helpful and unhelpful when people try to withdraw from antipsychotics: an international survey

Purpose: Antipsychotics remain the first line treatment for psychotic disorders, despite adverse effects which lead many patients to stop their medication. Many stop without the support of the prescriber, who may fear relapse. The objective of this study is to better understand the process of withdrawal from antipsychotics from the perspective of people taking antipsychotics.
Methods: An international online survey elicited quantitative responses about pre-withdrawal planning (560), and qualitative responses about what was helpful and unhelpful when withdrawing from antipsychotics (443). Responses came from users of antipsychotics in 29 countries.
Results: 47% did not consult their psychiatrist before discontinuing. Only 40% made preparations, most commonly making a plan, gathering information and informing family. The most frequently reported helpful factors were focussing on the benefits of getting off the drugs (including ending adverse effects and feeling more alive), information about withdrawal symptoms and how to withdraw safely, withdrawing slowly, and support from psychologists, counsellors and psychotherapists. The most common unhelpful factor was the
psychiatrist/doctor, largely because of their lack of knowledge, refusal to support the patient’s wishes and the threat or use of coercion.
Conclusions: Evidence-based, respectful, collaborative responses to patients’ concerns about adverse effects and desires to withdraw would probably reduce relapse rates and improve long term outcomes. It would definitely help end pervasive breaching of the principle of informed consent and of human rights legislation.

This author manuscript is the peer reviewed version of the following article: Read, J. 2024. What is helpful and unhelpful when people try to withdraw from antipsychotics: an international survey. Psychology and Psychotherapy: Theory, Research and Practice 97(4), 665-685 which has been published in final form at https://doi.org/10.1111/papt.12551

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