Strategies for long-term treatment with psychiatric medication and their discontinuation

Kristýna Drozdová

Pharmacological treatment of psychiatric disorders is part of the complex care of patients with mental health problems, in addition to psychotherapy and counselling, behavioral activation and psychosocial rehabilitation. The choice of psychiatric medication and the strategy for its administration should be individualized to the needs of the patient. The strategy for the administration of psychiatric medication should include from the outset considerations about the duration of administration and the possibility of discontinuation. In addition to possible side effects, patients themselves ask when the medication will be discontinued at the first consultation. This neglected topic is coming to the fore with the changing concepts of treatment, cure, and recovery in psychiatry. It is appropriate that the psychiatrist, and not the patient, should be the one who discontinues the medication. Well-conducted, long-term studies are the basis for responsible decisions about when and how to discontinue the medication.

(Fulltext in Czech)


Alda, M. (2013). Personalized psychiatry: many questions, fewer answers. Journal of Psychiatry & Neuroscience, 38(6), 363–365.…363.full.pdf

Almohammed, O.A., Alsalem, A.A., Almangour, A.A., Alotaibi L.H., Al Yami, M.S., & Lai, L. (2022). Antidepressants and health–related quality of life (HRQoL) for patients with depression: Analysis of the medical expenditure panel survey from the United States. PloS one, 17(4), e0265928.…pone.0265928

Alvarez-Jimenez, M., O´Donoghue, B., Thompson, A., Gleeson, J.F., Gonzalez-Blanch, C., Killackey, E., Wunderink, L., & McGorry, P.D. (2016). Beyond Clinical Remission in First Episode Psychosis: Thoughts on Antipsychotic Maintenance v. Guided Discontinuation in the Functional Recovery Era. CNS Drugs, 30(5), 357–368.…3-016-0331-x

Bhat, V., & Kennedy, S. (2017). Recognition and management of antidepressant discontinuation syndrome. Journal of Psychiatry &Neuroscience, 42(4).…3/jpn.170022

Cruickshank, G., MacGillivray, S., & Bruce, D. (2008). A cross-sectional survey of patients in receipt of long-term repeat prescriptions for the antidepressant drug in primary care. Mental Health in Family Medicine, 5(2), 105–109.

Davies, J., & Read, J. (2019). A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addict Behav, 97, 111–121.….2018.08.027

Fava, G.A., Gatti, A., Belaise, C., Guidi, J., & Offidani, E. (2015). Withdrawal symptoms after selective reuptake serotonin reuptake inhibitors discontinuation: A systematic review. Psychotherapy and Psychosomatics, 84, 72–81.

Fava, G.A., Benasi G., Lucente, M., Offidani, E., Cosci, F., & Guidi, J. (2018). Withdrawal symptoms after Serotonin-Noradrenaline Reuptake Inhibitor discontinuation: Systematic Review. Psychotherapy and Psychosomatics, 87, 195–203.

Foucalt, M. (1993). Dějiny šílenství. Hledání historických kořenů pojmu duševní choroby. Gallimard.

Groot, P., van Os, J. (2020). The outcome of antidepressant drug discontinuation with tapering strips after 1–5 years. Therapeutic Advances in Psychopharmacology, 10, 1–8.…125320954609

Ocisková, M., & Praško, J. P. (2015). Stigmatizace a sebestigmatizace u psychických poruch. Grada Publishing.

Kosová, J. (2002). Vysazení medikace u úzkostných a afektivních poruch. Psychiatrie pro praxi, 2.

Lembke, A. (2021). Dopamin. Jak přežít blahobyt a neubavit se k smrti. Triton.

Raja, S., Mahesh, N.M., & Panda, P. (2011). Withdrawal effects of tricyclic antidepressants and their management. Journal of Global Trends in Pharmaceutical Sciences, 2(3), 336–349.

Shelton, R. C. (2001). Steps Following Attainment of Remission: Discontinuation of Antidepressant Therapy. Prim Care Companion Journal Clinical Psychiatry, 3(4), 168–74.

Spousta, S. (2001). Syndrom z vysazení SSRI. Psychiatrie pro praxi, 1.

Wunderik, L., Nienhuis, F. J., Sytema, S., Slooff, C. J., Knegtering, R., Wiersma, D. (2007). Guided discontinuation versus maintenance treatment in remitted first-episode psychosis: relapse rates and functional outcome. Journal Clinical Psychiatry, 68(5), 654–661.

Zipurski, R.B., Odejayi, G., Agid, O., & Remington, G. (2020). When you say „schizophrenia“ and I say „psychosis“: Just tell me when I can come off this medication. Schizophrenia Research, 225, 39–46.

Show all Hide