The evidence on the deprescribing of antipsychotic medication in people with psychotic disorders

ObjectiveTo examine the risks and benefits associated with tapering and ceasing antipsychotic medication after treatment for psychotic illness.MethodNarrative synthesis of major guidelines and meta-analyses, landmark trials and recent randomised controlled trials (RCTs).Results(1) Maintenance is consistently protective against relapse and associated harms in the first 1 to 2 years of illness. (2) Some evidence suggests long-term functional benefits from reduction in dose or medication discontinuation, but findings are inconsistent and of low certainty. (3) Relapse after abrupt cessation is common, often within 3 months, possibly due to dopaminergic super-sensitivity. (4) Hyperbolic tapering, with slow and progressively smaller dose reductions, may reduce withdrawal effects and relapse risk. Clinical features associated with safer tapering included sustained remission, insight, absence of substance use, strong social support and access to rapid review.ConclusionDeprescribing is not universally safe, but a structured, gradual and reversible approach is consistent with ethical and patient-centred treatment, and in a small proportion of patients is not followed by relapse. Clinicians should emphasise shared decision-making, hyperbolic tapering and robust relapse-prevention strategies.