title: Why is it so difficult to stop psychiatric drug treatment? It may be nothing to do with the original problem.
abstract: In this paper, I argue that the problems that occur after discontinuation or reduction of long-term psychiatric drug treatment may be caused by the process of drug withdrawal itself, rather than representing the course of the underlying illness. Adverse effects induced by discontinuation of psychiatric medication include: (1) a somatic discontinuation syndrome that includes psychological symptoms which may be mistaken for relapse, (2) a rapid onset psychotic reaction after withdrawal of both conventional neuroleptic drugs and some atypicals, notably clozapine (sometimes referred to as supersensitivity psychosis), (3) a psychological reaction to withdrawal, which may be mistaken for relapse or may itself precipitate relapse, (4) a genuine relapse of the underlying condition precipitated by the process of withdrawal. The implications of these effects include the possibility that much of the research on maintenance treatment is flawed and that the recurrent nature of psychiatric conditions may sometimes be iatrogenic. If withdrawal induced adverse effects could be effectively managed, the success of drug discontinuation might be much greater than usually assumed and might outweigh the disadvantages of continued treatment.
authors.affiliation: Department of Mental Health Science, University College London, Wolfson Building, 48 Riding House Street, London W1N 8AA, United Kingdom. j.moncrieff@ucl.ac.uk
authors.forename: Joanna
authors.initials: J
authors.lastname: Moncrieff
mesh_terms: D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008960:Models, Psychological; D011618:Psychotic Disorders / Q000188:drug therapy*; D013375:Substance Withdrawal Syndrome / Q000209:etiology* / Q000523:psychology*; D028761:Withholding Treatment
chemical_list: D014150:Antipsychotic Agents