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Horowitz, 2020 Tapering Antipsychotic Treatment


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Horowitz MA, Murray RM, Taylor D.

Tapering Antipsychotic Treatment. 

JAMA Psychiatry. Published online August 05, 2020. doi:10.1001/jamapsychiatry.2020.2166

https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2769191

 

Quote

This Viewpoint discusses principles for tapering antipsychotic treatment when deprescribing them.

 

Mad in America published an article on the above study:

 

https://www.madinamerica.com/2020/09/slow-taper-best-antipsychotic-discontinuation/

 

"Antipsychotics’ effect on the brain follows a “hyperbolic” pattern. That is, doubling the dose doesn’t result in a doubled effect; instead, doubling the dose creates a linear increase in the drugs’ effect. Thus, to slowly taper off of the drug, the best strategy is a hyperbolic reduction—halving the amount of drug used every three to six months, resulting in eventual infinitesimal amounts of the drug.

 

According to the researchers, each time the dose is halved, the D2 blockade reduces by a small, linear amount (about 10%):

 

For example, risperidone doses of 8 mg, 4 mg, 2 mg, 1 mg, 0.5 mg, 0.25 mg, 0.125 mg, and 0 mg produce roughly 10–percentage point reductions in the extent of D2 blockade. This pattern of reduction may be less likely to provoke relapse because it avoids large increases in dopaminergic signaling.

 

They write that the final dose may need to be tiny, about 2.5% of the initial amount, and that liquid formulations might be an effective way of being able to provide these minimal doses."

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Psych drug history goes back, on and off, to 1999.  

Started in 2012/2013:     900 mg  Lithium         3 mg Risperidone               250 mg Lamotrigine

Attempted to taper off in 2014 w/ doctor's guidance and was unsuccessful, except that I was able to reduce risperidone to 1 mg.

2015-2018:                      900 mg  Lithium         1 mg Risperidone                250 mg Lamotrigine

Attempted to taper off again in 2018 and found much better info. about how:

Jan. 2018:                        0 mg  Lithium (CT)     1 mg Risperidone               250 mg Lamotrigine 

Jan. 2019:                        0 mg Lithium               0.625 mg Risperidone       175 mg Lamotrigine

Jan. 2020:                       0 mg Lithium               0.260 mg Risperidone       175 mg Lamotrigine

Feb. 2021:                        0 mg Lithium               0 mg Risperidone              175 mg Lamotrigine

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