While a 2 year outcome study by Wunderink et al has been cited as evidence that guided discontinuation of antipsychotics for people whose psychosis has remitted results in twice as much “relapse,” a followup of that study, extending it to 7 years using a naturalistic followup, finds that the guided discontinuation group had twice the recovery rates, and no greater overall relapse rate (with a trend toward the medication group having more relapse.)
A video of a presentation on this 7 year outcome study is at
Of course this study doesn’t prove that everyone will do better off medication. In the study, they only tried to help people off medication if people seemed to be doing well on medication for 6 months, and they felt they couldn’t tolerate people experiencing “florid psychosis” while off medication. But I think it does really support the contention that outcomes for long term use of antipsychotics varies from short term outcome, and that we should be trying to give more people a chance to experience the possible benefits of either never starting, or getting off, antipsychotics.
Nancy Andreason and colleagues recently released a study that indicated that both taking antipsychotic drugs, and having relapses into psychosis, cause a loss of brain tissue, but in different areas of the brain. In their conclusions they stated their belief that the cautious use of antipsychotics is justified despite the damage they cause to the brain, because such use is in their opinion the best way to prevent relapse which would also result in brain damage. But if, as the 7 year study above indicates, antipsychotics are not reducing relapse risk in the long term, it becomes more obvious that we should be looking hard for alternatives to antipsychotic use so we can help people find ways to avoid both the problems associated with relapse and the problems associated with antipsychotics themselves.
(And it may be that almost all the brain tissue loss is really due to the antipsychotics, see this critical analysis of the Andreason study, by psychiatrist Joanna Moncrieff.)