Should Psychiatrists Help People Try to Get Off Antipsychotics?

Psychiatrists are commonly expected to be persuading people to take drugs called “antipsychotics” whenever they experience psychosis, or when there is risk of psychosis returning. But people taking those drugs commonly dislike them, and there is much evidence that many people can recover without continuing to take them, and there is evidence that the drugs can cause various kinds of long term harm.

There is also evidence that the drugs create a kind of dependency, meaning people have an especially rocky time if they try to quit the drugs suddenly, and for the first year or so after quitting. This makes getting off the drugs tricky, and increases the chances people will need help to do it successfully.

So that raises the question, when might it be a wise choice, rather than a foolish or “crazy” choice, for people to try getting off antipsychotic drugs? And when should a psychiatrist be offering to help with that attempt?

These are questions and issues that were addressed by psychiatrist Helen Speyer in a recent webinar titled “Navigating Complex Choices in Antipsychotic Reduction.” The recording of that webinar is now available:

Here’s the official description for the webinar:

“Stopping or reducing antipsychotic medication raises tough ethical questions in both everyday care and research. One big issue is balancing safety with respect for the wishes of the person taking the medication.

“In clinical practice, tension arises when a service user asks to reduce or stop medication. If a doctor says no, the service user might go ahead and stop on their own, which can be more dangerous without support. But a doctor agreeing without clear evidence of safety can also carry risks. So who gets to decide what level of risk is okay—the doctor, or the service user?

“If the service user is capable of making decisions, most would agree they should have the power to decide. Ignoring that can be disrespectful, especially if we assume professionals always know best, without truly listening to lived experience. Research also runs into problems. In studies where people are meant to stick to certain treatment plans, many don’t, especially when it involves stopping medication.

“That makes it hard to tell what the results really mean. On top of that, most studies look at group averages, which may not reflect how any one person will actually respond. What works for some might harm others.

“So instead of one-size-fits-all answers, we need research and care that are flexible and focused on the individual. This includes using real-world data and creating more supportive, respectful ways for service users and professionals to make decisions together. Ways to accomplish this will be discussed in this webinar.”