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Antipsychotic drugs are a central treatment for schizophrenia but they have a myriad of side effects which can make continued adherence challenging. Weighing up whether it’s best for a patient to continue with a drug or slowly come off it is difficult and best handled by a multi-disciplinary team. A recent review of the evidence from the Cochrane Collaboration finds there are a variety of factors that could inform what’s best for an individual.

In the review, researchers found more than 20 randomised controlled studies that investigated the outcomes where people were either taken off their medications or continued using. This data included over 2,000 participants with an average age of 38 and with follow-up over 12 weeks to 2 years. Sometimes the speed of the reduction in medications was very quick and the level of reduction significant – in some studies people were taken off completely and abruptly, though more studies involved a gradual reduction in dose over a period of two to 16 weeks.

The main findings of the review were that dose reduction seemed to lead to higher rates of relapse of symptoms and dropout from a study compared to continuing a drugs regime. But there were significant issues with the quality of those studies available – they tended to focus on relapse as an outcome, often without evaluating other factors such as potential improvements in quality of life and functioning. They call for more high-quality evidence to help doctors and patients weigh up the choice that is right for them.

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