Stopping Antipsychotic Medication: What Patients, Families, and Clinicians Need to Know

Many patients and families ask an important and understandable question:

“Now that I’m feeling better, do I really need to stay on antipsychotic medication?”

This article explains the benefits, risks, and clinical reasoning behind continuing or, in rare cases, carefully reducing or discontinuing antipsychotic medication, based on the most recent scientific evidence and international guidelines.

Key Scientific Publication Discussed

Correll, C. U., Rubio, J. M., & Kane, J. M. (2025)

Title: Benefits and risks of antipsychotic discontinuation in people with first and multi-episode psychotic disorders or with schizophrenia: why, when, how and in whom?

Journal: Schizophrenia (Nature Portfolio)

Volume: 11

Article number: 151

Publication date: 17 December 2025

Access: Open access

This paper represents one of the most up-to-date expert reviews on antipsychotic discontinuation and is highly relevant to everyday clinical practice.

Why This Topic Matters

Antipsychotic medications are one of the most effective treatments in psychiatry for preventing relapse in psychotic disorders. At the same time, they can cause side effects that understandably make some patients want to stop treatment.

The challenge is balancing:

quality of life today with long-term mental health stability

What the Evidence Clearly Shows

1. Stopping Antipsychotics Greatly Increases Relapse Risk

According to Correll et al. (2025) and multiple large studies:

People who stop antipsychotic medication have a much higher risk of relapse

Relapse often occurs within months

Relapse may require hospitalization and can disrupt work, relationships, and independence

Importantly, each relapse may make future episodes harder to treat.

First Episode Psychosis vs Schizophrenia: Why the Approach Differs

First Episode Psychosis (FEP)

Patients experiencing a first psychotic episode often:

• recover well

• regain full functioning

• feel “back to normal”

Because of this, early discontinuation is sometimes requested.

What guidelines and evidence say:

NICE (UK) and APA (USA) recommend continuing antipsychotics for at least 1–2 years after remission

Stopping earlier significantly increases relapse risk

There is no reliable way to predict who will remain well off medication

Clinical approach:

Medication should usually be continued, but at the lowest effective dose, with regular review and shared decision-making.

Schizophrenia and Multi-Episode Psychotic Disorders

For individuals with:

a diagnosis of schizophrenia

more than one psychotic episode

previous relapses after stopping medication

The evidence is much clearer:

Long-term or lifelong maintenance treatment is often necessary

Discontinuation carries a high risk of relapse and long-term functional decline

Most international guidelines strongly advise against routine discontinuation

 Clinical approach:

Focus on dose optimization, side-effect management, and quality of life, rather than stopping treatment altogether.

What About Side Effects?

Side effects are real and must be taken seriously. These may include:

• weight gain

• fatigue

• emotional blunting

• metabolic changes

However, the key message from Correll et al. (2025) and major guidelines is:

Side effects should usually be managed by adjusting treatment — not by stopping it abruptly.

Options often include:

• lowering the dose

• switching to a different medication

• treating side effects directly

• lifestyle and metabolic monitoring

When Might Discontinuation Be Considered? (Exceptional Cases)

The paper emphasizes that complete discontinuation should be rare, but may be considered when all of the following apply:

• sustained remission for a significant period

• strong insight and engagement in care

• minimal or no substance use
• stable housing and psychosocial support

• significant side-effect burden despite optimized treatment

• full understanding and acceptance of relapse risk

Even in these cases:

• reduction must be very gradual

• monitoring must be frequent

• a clear relapse action plan must be in place

• Abrupt stopping is strongly discouraged.

Why Taking This Risk Is Sometimes Discussed

In carefully selected individuals, clinicians may explore dose reduction or discontinuation to:

• improve quality of life

• reduce long-term physical health risks

• respect patient autonomy within safe limits

However, this is a shared medical decision, not a routine recommendation.

Key Messages for Patients and Families

• Feeling well does not mean the illness has disappeared

• Medication often prevents relapse, even when symptoms are quiet

• Relapse can be more damaging than staying on medication

• Any change should be slow, planned, and supervised

• Staying on medication is not a failure — it is often a sign of good self-care

Clinical Bottom Line

Based on:

• Correll et al. (2025)

• NICE guidelines

• APA guidelines

• and decades of clinical evidence

Antipsychotic maintenance treatment remains the safest option for most people with psychotic disorders.

Discontinuation should be:

• rare

• individualized

• carefully monitored

• and never abrupt

Key References

Correll CU, Rubio JM, Kane JM.

Benefits and risks of antipsychotic discontinuation in people with first and multi-episode psychotic disorders or with schizophrenia.

Schizophrenia. 2025;11:151.

National Institute for Health and Care Excellence (NICE).

Psychosis and schizophrenia in adults: prevention and management.

NICE Guideline CG178.

American Psychiatric Association (APA).

Practice Guideline for the Treatment of Patients With Schizophrenia.

3rd Edition.

Leucht S et al.

Relapse prevention in schizophrenia with antipsychotic maintenance treatment.

The Lancet.