Table 1 Summary of the major discontinuation evidence across medication classes.
From: Discontinuation of psychotropic medication: a synthesis of evidence across medication classes
Relapse/recurrence rates after discontinuation vs. continuation (%) | DS chances per cessation attempt (%) | When to discontinue | Specific drugs with discontinuation problems | Discontinuation interventions | |
|---|---|---|---|---|---|
Antidepressants | 27–86% [17] | For first-episode MDD: continue at least 4–6 months, longer after recurrent episodes [29, 31] | |||
Antipsychotics | 64% vs. 25% after 1 year [3] | 37–70% [47] | First episode of psychosis (FEP): continue at least 1–2 years (with rapid full remission and few risk factors, discontinuation after 6 months may be considered) [53] | Clozapine | Relapse prevention plan with patient and family [67] |
Mood stabilizers | 54% vs. 25% after 6 years [70] | Unknown | Continue maintenance treatment in already recurrent bipolar disorder for many years or even indefinitely [68] | Lithium; valproate | Relapse prevention plan with patient and family; frequent monitoring and continue monitoring for at least 1 year after discontinuation |
Benzodiazepines | Largely unknown beyond benzodiazepine use itself | Discontinue benzodiazepines as soon as possible [94] | Short half-life benzodiazepines (e.g., lorazepam, temazepam) [89,90,91, 158] | Pharmacological: valproate, pregabaline [93], carbamazepine, TCAs [83, 93] Psychological: CBT, minor interventions [87, 100] | |
Opioids | As analgesic: largely unknown As agonist treatment for illicit opioid use: 71% relapse into illicit opioid use | Unknown | As analgesic: discontinue opioids as soon as possible [132]. As agonist treatment: consider only if patient want to taper and risk of relapse into illicit opioid use is considered limited | Opioids with a short half-life (e.g., morphine, oxycodone), and opioids with high mu-receptor affinity (e.g., fentanyl) [121] | Pharmacological: Clonidine, anti-emetics, loperamide, lofexidine, guanfacine [137, 159] Rotation to long-acting agent to facilitate gradual tapering. Psychological: CBT. Mindfulness [138] |
Stimulants | Evaluate the use of stimulants annually [145] | N/A | Benzodiazepines [150] |
