National Institute for Health and Care Research What is the impact of a gradual reduction of antipsychotics?
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Jan 13, 2025 
Join Joanna Moncrieff, a leading researcher in antipsychotic treatments, and Rachel Upthegrove, an expert in youth mental health, as they explore the complexities of gradually reducing antipsychotic medications. They delve into the significant side effects of these drugs, the RADAR trial's findings on relapse risks, and the importance of empowering patients in treatment decisions. The conversation highlights the need for individualized care and the challenges of predicting relapse while stressing the importance of shared decision-making in mental health treatment.
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Gradual Reduction Raised Relapse Risk
- Gradual, supported antipsychotic reduction increased relapse risk compared with maintenance over two years.
- The RADAR trial found higher hospital readmission rates despite slow tapering and clinical support.
Withdrawal Can Confound Relapse Risk
- Rapid discontinuation in prior trials may conflate withdrawal effects with relapse.
- Withdrawal symptoms like agitation and sleep problems can mimic or trigger psychosis during abrupt stops.
No Two-Year Functional Gain From Reduction
- Two-year social functioning did not improve after dose reduction despite lower medication exposure.
- There were also no differences in symptoms, quality of life, or side effects at two years.