Experiences of gradual reduction / discontinuation of antipsychotic medication in the 'RADAR' trial

Introduction 

Little is known about users’ experiences of gradually reducing and potentially stopping antipsychotic medication when this is done gradually with clinical guidance. The ‘RADAR’ randomised controlled trial (RCT) (results of which are presented by Moncrieff in the same symposium) provided a unique opportunity to investigate these experiences. Participants with recurrent psychosis in the trial intervention arm gradually reduced and sometimes discontinued their antipsychotics over a two year period.



Methods

Semi-structured interviews were conducted at trial end with 26 people sampled purposively for diversity in sociodemographic characteristics, trial variables, and pre-trial medication and clinical factors. Data were analysed using thematic analysis.



Results

Experiences of antipsychotic reductions over two years were dynamic and diverse. Most participants reported reduced adverse effects with dose reductions, primarily in mental clouding, emotional blunting and sedation, and some positive impacts on social functioning and sense of self. Over half experienced mental health deteriorations, of whom nine had a psychotic relapse. Medication reduction as an explicit part of clinical care was often experienced as novel, and the trial provided various learning opportunities. Some participants were highly engaged with reduction processes, and despite difficulties including relapses, developed novel perspectives on medication, dose optimisation, and how to manage their mental health. Others were ambivalent about reduction or experienced less overall impact.



Discussion

Service users reported a complex array of challenges, benefits and new insights related to antipsychotic reductions. Findings show how qualitative investigations of participants’ experiences complement quantitative trial findings and provide pointers to future research about who may be most suitable for dose reduction attempts and how to successfully implement reduction processes. Together with quantitative trial results, findings add to the evidence base that clinicians and service users seeking to optimise antipsychotic medication can draw on.