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Antipsychotic Dose After First Bout of Psychosis: Less Is More?

July 11, 2013. Most clinical guidelines suggest that people in remission after first-episode psychosis should continue their original dose of antipsychotic drugs for one year. However, better long-term recovery may be achieved with a dose reduction or discontinuation of the drugs during this period, according to a new study published online July 3, 2013, in JAMA Psychiatry.

Led by Lex Wunderink of Friesland Mental Health Services in Leeuwarden, the Netherlands, the new study is a follow-up from an early trial that found that a clinician-guided reduction or discontinuation of antipsychotics for 18 months produced symptom relapse rates double those for treatment maintenance. The new study examined recovery much further down the road—five years later—and found a very different picture. Although relapse rates were initially higher in those who reduced or discontinued the drugs compared to those who maintained their original dosage, by three years the two rates were equal. More importantly, the long-term recovery rate of the dose reduction/discontinuation group was more than twice that of the maintenance group.

The findings suggest that a zero-tolerance approach to relapse may have a downside in terms of recovery. In an accompanying editorial, Patrick McGorry and colleagues of the University of Melbourne, Australia, added that "the findings appear to put relapse into perspective," and suggest that slight aggravation of symptoms might be a price worth paying for better odds of recovery down the road. Wunderink and colleagues caution that future trials are needed to confirm their findings. (For more details on this study, see the related news story.)—Allison A. Curley.

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