Dose reduction and discontinuation of antipsychotics in psychotic disorders: a systematic review of qualitative studies and meta-synthesis

Abstract Antipsychotic dose reduction and discontinuation are increasingly discussed in the management of psychotic disorders, yet clinical decisions remain challenging and evidence on lived experiences is fragmented. This systematic review and meta-synthesis aimed to synthesize qualitative evidence on subjective experiences of antipsychotic dose reduction and discontinuation among people with psychotic disorders, clinicians, and caregivers. A systematic search was performed on PubMed, Scopus, and PsycINFO. Peer-reviewed qualitative studies exploring subjective experiences with antipsychotic dose reduction and/or discontinuation in subjects with affective and non-affective psychotic disorders were included. Findings were integrated using thematic synthesis. A total of 13 studies were included. Eight studies focused on patients ( N = 431), three on clinicians ( N = 86), and two on caregivers ( N = 26). From subjects’ lived experiences, adverse effects were frequently reported as a driver for considering dose reduction, while concerns about relapse and the effort required to maintain stability contributed to ambivalent or cautious attitudes. Caregivers often reported unfavorable views, expressing fear of symptom recurrence, emotional distress, and risks to relational safety. Clinicians highlighted limited evidence and insufficient resources to support safe, long-term tapering and described uncertainty intensified by negative prior experiences and concerns about professional accountability in the event of relapse. Antipsychotic dose reduction and discontinuation are experienced as complex, preference-sensitive processes shaped by competing priorities and high perceived risks. The findings support the need for triadic shared decision-making that includes caregivers and for the development of structured, case-specific tapering protocols supported by adequate clinical resources and long-term monitoring.