Antipsychotics induce long-lasting changes to nerve cells in the brain and they need to be withdrawn very slowly (and in a particular way) to allow time for the brain to re-set.”
Some people may be able to stop taking antipsychotics without problems, but others can find it very difficult. If you have been taking them for some time, it can be more difficult to come off them. This is especially if you have been taking them for one year or longer.
Antipsychotic discontinuation syndrome symptoms generally appear within the first few days after you stop use or significantly reduce use. The symptoms tend to be the most severe around the one-week mark and subside after that.
Antipsychotic medications can help to calm and clear confusion in a person with acute psychosis within hours or days, but they can take up to four or six weeks to reach their full effect.
If you stop antipsychotics suddenly it can cause 'rebound psychosis'. This means that the symptoms of your illness return suddenly, and you may become unwell again. This is also known as 'relapse'. If you or your family or friends think you are becoming unwell again, you should speak to your doctor.
Some people need to keep taking it long term. If you have only had one psychotic episode and you have recovered well, you would normally need to continue treatment for 1–2 years after recovery. If you have another psychotic episode, you may need to take antipsychotic medication for longer, up to 5 years.
For neurological, neuropsychological, neurophysiological, and metabolic abnormalities of cerebral function, in fact, there is evidence suggesting that antipsychotic medications decrease the abnormalities and return the brain to more normal function.
If drugs are stopped too quickly, people can get withdrawal symptoms (which for antipsychotics can include insomnia, tremors and sometimes psychotic symptoms) or can be de-stabilised by the process of coming off.
Amongst the many adverse effects of the first generation, or 'typical' antipsychotics, the most disturbing was Tardive Dyskinesia, which involves uncontrollable movements of face, hands and feet [2].
After a first episode of psychosis in schizophrenia and related disorders, stopping antipsychotics is considered when the patient has made a full recovery and been well for at least 12 months.
To mitigate the symptoms of antipsychotic withdrawal, the dose is gradually reduced or tapered to the minimum effective dose. Gradual tapering involves a slow tapering in dose to allow drug-induced neuroadaptations to return to baseline.
One reported that 48% of relapses occur in the first 12 months after antipsychotic discontinuation (40% in the first 6 months), with only 2% per year after this.
Previous research has also shown that the use of antipsychotics may raise the risk of metabolic syndrome in patients with schizophrenia. Metabolic syndrome has, in turn, been associated with heart disease and diabetes.
But with the right treatment, most people can live complete and fulfilling lives – thanks mainly to their antipsychotic medication. But of course, all medications have side-effects and for some people on antipsychotics these side-effects can range from mildly debilitating to life threatening.
Clozapine and olanzapine have the safest therapeutic effect, while the side effect of neutropenia must be controlled by 3 weekly blood controls.
Of the atypical antipsychotics, risperidone is the weakest in terms of atypicality criteria.
Evidence of the rapidity at which antipsychotics can affect brain volume in humans was recently provided by Tost and associates. These investigators found a significant, reversible decrease in striatal volume in healthy subjects within 2 hours after they were treated intravenously with haloperidol.
You may find it's possible to manage your symptoms, or to make a full recovery, without medication. If you are taking antipsychotics, you may also want to use other options to support your mental health, as well as your medication.
Some studies suggest that glycine, sarcosine, NAC, several Chinese and ayurvedic herbs, ginkgo biloba, estradiol, and vitamin B6 may be effective for psychotic symptoms when added to antipsychotics (glycine not when added to clozapine).
Meyer-Lindberg himself published a study last year showing that antipsychotics cause quickly reversible changes in brain volume that do not reflect permanent loss of neurons (see "Antipsychotic deflates the brain").
Eventually, it may be possible to wean off the medication, but the decision should always be made with a health professional. With psychiatric drugs, it's important to wean yourself slowly. This allows your brain chemicals to adjust to the change without causing uncomfortable side effects.
So while treatment with some antipsychotics seems to increase intelligence, others reduce symptoms without that effect. Other medications that are known to cause improved cognitive functioning had no effect when combined with those antipsychotics.
For people with schizophrenia, long-term antipsychotic use is usually accompanied by adverse effects such as weight gain, metabolic syndrome, diabetes, and ischemic heart disease, demonstrating their important role in increased mortality.
Conclusions. Viewed together with data from animal studies, our study suggests that antipsychotics have a subtle but measurable influence on brain tissue loss over time, suggesting the importance of careful risk-benefit review of dosage and duration of treatment as well as their off-label use.
An episode of psychosis is treatable, and it is possible to recover. It is widely accepted that the earlier people get help the better the outcome. 25% of people who develop psychosis will never have another episode, another 50% may have more than one episode but will be able to live normal lives.