Medication can help to stabilise your symptoms, so it's possible that your psychotic symptoms may return if you stop taking it. But it's not certain that this will happen. There are several factors that can affect whether you will become ill again.
How long antipsychotic withdrawal will take is not the same for everyone. The onset of withdrawal symptoms can range from 36 – 96 hours, and symptoms may persist for weeks or even months.
Keep in mind that there is no “one-size-fits-all” when it comes to safely and effectively stopping or switching antipsychotics. Symptoms that were being treated with the antipsychotic, such as psychosis, depression, and agitation, can re-emerge after you stop taking the antipsychotic medication.
Thus, early exposure to antipsychotic drugs may permanently alter neuronal development with a lasting impact on behavior.
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.
Timely psychiatric treatment can improve not only immediate functioning, but also long-term prognosis. Because untreated psychosis can result in irreversible structural brain damage, clinicians must act swiftly to provide assertive treatment.
These side effects are fully reversible and can be helped by changing to a different drug, or by decreasing the dose of the medication. Most common with Typical Antipsychotics and risperidone and paliperidone.
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.
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.
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'.
After symptom remission, continuation of antipsychotic treatment is associated with lower relapse rates and lower symptom severity compared to dose reduction/discontinuation. Therefore, most guidelines recommend continuation of treatment with antipsychotic medication for at least 1 year.
Give yourself time
While it is sometimes possible to withdraw over a few weeks, it can be safer to do so over several months so that your body has a good amount of time to adjust. For some people who have been on medication for many years, withdrawing very slowly over a few years can also be helpful.
All antipsychotics are generally effective, although differences exist in terms of efficacy but also in side effect profile. So far, all antipsychotics block the dopamine-2 (D2) receptor in the brain, including recently available antipsychotics such as lurasidone, cariprazine and brexpiprazole.
The most common reasons for discontinuation were patient choice, lack of effect or intolerability of side-effects.
They can cause movement disorders such as twitching and restlessness, sedation and weight gain, and lead to diabetes. Because of these side effects, antipsychotic drugs are usually only used to treat severe mental illnesses such as schizophrenia or bipolar disorder.
Lieberman and team looked at clinical trials and neuroscientific data, and they found that the therapeutic benefits of antipsychotic medication far outweigh their side effects.
Some people find that complementary and alternative therapies help to manage their symptoms. For example, this may be aromatherapy, reflexology or acupuncture. Complementary therapies may also help manage some of the side effects of medication, if you decide to continue with it.
These antipsychotic drugs come in a long-lasting form: Aripiprazole (Abilify Maintena) Aripiprazole lauroxil (Aristada) Fluphenazine (Prolixin)
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.
Tardive dyskinesia (TD) is a common and potentially irreversible side effect of dopamine blocking agents, most often antipsychotics.
If an antipsychotic is providing substantial benefit, and the adverse effect is not life‐threatening, then the first management choice is to lower the dose or adjust the dosing schedule. The next option is to change the antipsychotic; this is often reasonable unless the risk of relapse is high.
27% of drug-treated patients experienced a relapse within 1 year. When we summarised the relapse rates of only the 11 studies included by Takeuchi et al, the results were more similar 55% v. 22% relapsed.