Clinical Risk Following Abrupt and Gradual Withdrawal of Maintenance Neuroleptic Treatment

Abstract

The relapse risk was high within 6 months of discontinuing oral neuroleptic therapy, particularly in hospitalized patients. Most patients who remained stable for 6 months continued to do so for long periods without medication, indicating clinical heterogeneity. Drug-withdrawal stressors, related to long-term pharmacodynamic adaptations, are implicated. Since the risk was lower after gradually discontinuing oral neuroleptic therapy or stopping depot injections, early relapse may be spared by a slow removal of drugs.

RNA Editing of the Human Serotonin 5-HT2C Receptor Alterations in Suicide and Implications for Serotonergic Pharmacotherapy

“…Receptor supersensitivity may explain the clinical phenomenon of clozapine-withdrawal psychosis (Meltzer et al 1996), in which a high incidence of rapid relapse occurs in schizophrenic patients when clozapine treatment is discontinued. Based on the results of the current manuscript, receptor supersensitivity would not be predicted after typical neuroleptics, consistent with the clinical observation that withdrawal psychosis is not common after discontinuation of typical neuroleptics (Viguera et al 1997).…”

Tolerance in Antidepressant Treatment

“…This relationship suggests that pharmacodynamic dependence may develop as treatment is continued, with an associated risk of withdrawal-emergent depression, including after reassignment to placebo. Excess risk of early relapse, especially after rapid drug-withdrawal, is better documented with benzodiazepines, antipsychotics, and lithium [1, 18, 19]. This phenomenon raises clinical and ethical concerns, and can confound interpretation of research findings.…”

Frontale Hirnvolumenminderung durch Antipsychotika?

“…Eine Dosisminderung kann vermutlich manche unerwünschten Effekte der Antipsychotika auf das Hirnvolumen abschwächen. Ein plötzliches Absetzen von Antipsychotika ist jedoch kontraindiziert, auch aufgrund des erhöh-ten Rückfallrisikos [117,118,119,120]. In einer Übersichtsarbeit [121] war dies allerdings nicht nachweisbar, wobei die durchschnittliche Dauer des Ausschleichens in den ausgewerteten Studien nur etwa 4 Wochen betrug.…”