Antipsychotic Withdrawal Syndrome – Understanding the Hyperbolic Curve and Tapering Antipsychotic Treatment to Reduce the Risk of Relapse

Posted on:October 16, 2021
Last Updated: November 9, 2022
Time to read: 9 minutes

We previously covered antidepressant withdrawal. Antipsychotic withdrawal can pose similar challenges. Despite the challenges and a serious risk of relapse, there are no clear guidelines on managing antipsychotic discontinuation and dose reduction. [Shimomura et al. 2020]

Read more on Antidepressant Withdrawal. 

Most guidelines recommend continuous therapy after a first psychotic episode to prevent a recurrence; however, some studies have questioned this approach. [Wunderink et al 2013]; [Harrow et al 2017]

  • First-line treatment for psychotic disorders remains drugs with antagonist properties at dopamine D2 receptors.  
  • Long-term continuous therapy with antipsychotics upregulates D2 receptors, and when treatment is abruptly stopped, receptor supersensitivity can manifest. 
  • Notably, this can result in movement disorders (i.e., tardive dyskinesia [TD]) and supersensitivity psychosis. [Miller and Chouinard 1993]

Abruptly stopping antipsychotic therapy comes with a high risk of withdrawal symptoms that include a variety of somatic, motor, and psychological symptoms. [Chouinard et al. 2017]