Predictors of discontinuation of antipsychotic medication and subsequent outcomes in the European First Episode Schizophrenia Trial (EUFEST)

Attempting to discontinue antipsychotic medication: Withdrawal methods, relapse and success

“…Attempting to Discontinue Antipsychotic Medication 22 or the mental-health outcomes they experienced afterwards, which were explored as separate but related issues. Consistent with the longitudinal research focused primarily on groups who experience psychosis and bipolar disorder (Harrow et al, 2012, Wunderink et al, 2013, Landolt et al, 2016, this study shows that although attempted discontinuation is difficult, some people are successful in their attempts, remain off AMs long-term, and describe improved or unchanged mental health as a result.…”

“…They are also commonly prescribed to people with a range of other off-label conditions including depression, dysthymia, obsessive-compulsive disorder, other anxiety disorders, or specific symptoms like insomnia or agitation, often at lower doses or alongside other psychiatric medications, despite limited evidence to support these practices (Maher et al, 2011, Monasterio and McKean, 2011, Carton et al, 2015, Walton et al, 2008, Albert et al, 2016, Vanbronkhorst et al, 2018. Most of the existing AM research focuses exclusively on people diagnosed with psychotic disorders (Landolt et al, 2016, Wunderink et al, 2013, Jung et al, 2016, Wils et al, 2017 and little is known about whether the experiences and outcomes of this group represents the experiences of those who take AMs for other reasons.…”

“…Research has suggested people who experience psychosis and stop taking AMs show better functional outcomes and lower relapse rates in the long-term relative to those who maintain continuous use (Harrow et al, 2012, Landolt et al, 2016, Wunderink et al, 2013, Wils et al, 2017…”

What Is New about New Antidepressants?

“…In the long run, determining which patients are most likely to respond to which treatments or combinations of treatments could enhance the likelihood of finding marketable niches for new products, but the return on investment would not be rapid and might be difficult to predict. There has been some independent federal funding of practical clinical trials in psychiatry comparing aggregate outcomes with different medications, such as STAR*D (National Institute of Mental Health) [79], VAST-D (US Department of Veterans Affairs) [72], and the EUFEST (European Union) [80], but the development of new psychotropic medications has generally been deferred to industry. As an alternative, if antitrust laws permitted it, manufacturers might collaborate to conduct large-scale clinical trials examining the specific applications of new medications with different actions on depressive subtypes, perhaps sharing in jointly developed products.…”

The usefulness of rating scales in patients with schizophrenia

“…Ideally, attempts to replicate results should include observational and pragmatic trials, in which patients remain in the study even if they have discontinued medication or met relapse criteria. The European First Episode in Schizophrenia Trial (5) could serve as an exemplary study in this context. Lastly, the six-item PANSS would need to demonstrate its usefulness in prospective studies.…”