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.
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')7.
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.
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.
However, some patients are able to sustain a psychosis-free existence after the cessation of antipsychotics. Several studies show that only 25%–55% of patients with schizophrenia who stopped taking antipsychotic medication experienced the relapse of symptoms in the first 6 to 10 months after they stopped taking them.
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.
Antipsychotic drugs can cause various abnormal motor syndromes, but abruptly stopping them has been associated with the seemingly paradoxical development of similar motor syndromes, such as withdrawal dyskinesias, parkinsonian symptoms, dystonias, and neuroleptic malignant syndrome.
We know that antipsychotics shrink the brain in a dose-dependent manner (4) and benzodiazepines, antidepressants and ADHD drugs also seem to cause permanent brain damage (5).
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.
Even though the majority of patients receive antipsychotics and benefit from reduction in psychotic symptoms, many patients continue to have negative symptoms, cognitive impairments, and progressive brain tissue loss.
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.
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.
The studies in our review (8, 23–26) reported that most withdrawal symptoms started within 4 weeks after abrupt antipsychotic discontinuation and subsided after up to 4 weeks even though certain symptoms such as hyperkinesia may last for months (23).
The studies in our review (8, 23–26) reported that most withdrawal symptoms started within 4 weeks after abrupt antipsychotic discontinuation and subsided after up to 4 weeks even though certain symptoms such as hyperkinesia may last for months (23).
The half-life of most drugs is roughly 24 hours. However, some may take up to 4-5 days to completely leave your system.
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.
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.
It is safest to come off slowly and gradually.
You should do this by reducing your daily dose over a period of weeks or months. The longer you have been taking a drug for, the longer it is likely to take you to safely come off it. Avoid stopping suddenly, if possible.
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.
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.
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.
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.
Some antipsychotic medications may cause you to experience side effects. These can often go away after a few weeks, or they may be long term.
The reasons people gave for discontinuing their meds included fear of health risks and side effects of long-term use. I am also aware that often psychiatrists offer drugs too quickly, and without also strongly advising the patient concurrently do therapy to help deal with emotional issues.