Discontinuation of psychotropic medication: a synthesis of evidence across medication classes

Christiaan H. Vinkers*, Ralph W. Kupka, Brenda W. Penninx, Henricus G. Ruhé, Jakob M. van Gaalen, Paul C.F. van Haaren, Arnt F.A. Schellekens, Sameer Jauhar, Josep A. Ramos-Quiroga, Eduard Vieta, Jari Tiihonen, Stijn E. Veldman, Wim Veling, Roeland Vis, Laura E. de Wit, Jurjen J. Luykx

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)
23 Downloads (Pure)

Abstract

Pharmacotherapy is an effective treatment modality across psychiatric disorders. Nevertheless, many patients discontinue their medication at some point. Evidence-based guidance for patients, clinicians, and policymakers on rational discontinuation strategies is vital to enable the best, personalized treatment for any given patient. Nonetheless, there is a scarcity of guidelines on discontinuation strategies. In this perspective, we therefore summarize and critically appraise the evidence on discontinuation of six major psychotropic medication classes: antidepressants, antipsychotics, benzodiazepines, mood stabilizers, opioids, and stimulants. For each medication class, a wide range of topics pertaining to each of the following questions are discussed: (1) Who can discontinue (e.g., what are risk factors for relapse?); (2) When to discontinue (e.g., after 1 year or several years of antidepressant use?); and (3) How to discontinue (e.g., what’s the efficacy of dose reduction compared to full cessation and interventions to mitigate relapse risk?). We thus highlight how comparing the evidence across medication classes can identify knowledge gaps, which may pave the way for more integrated research on discontinuation.

Original languageEnglish
Pages (from-to)2575–2586
Number of pages12
JournalMolecular Psychiatry
Volume29
Early online date19-Mar-2024
DOIs
Publication statusPublished - 2024

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