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. 2020 Sep 29:11:569912.
doi: 10.3389/fpsyt.2020.569912. eCollection 2020.

Antipsychotic Withdrawal Symptoms: A Systematic Review and Meta-Analysis

Lasse Brandt  1 , Tom Bschor  2 , Jonathan Henssler  1 , Martin Müller  3   4 , Alkomiet Hasan  5   6 , Andreas Heinz  1 , Stefan Gutwinski  1
Affiliations

Antipsychotic Withdrawal Symptoms: A Systematic Review and Meta-Analysis

Lasse Brandt et al. Front Psychiatry. .

Abstract

Objective: Avoiding withdrawal symptoms following antipsychotic discontinuation is an important factor when planning a safe therapy. We performed a systematic review and meta-analysis concerning occurrence of withdrawal symptoms after discontinuation of antipsychotics.

Data sources: We searched the databases CENTRAL, Pubmed, and EMBASE with no restriction to the beginning of the searched time period and until October 1, 2019 (PROSPERO registration no. CRD42019119148).

Study selection: Of the 18,043 screened studies, controlled and cohort trials that assessed withdrawal symptoms after discontinuation of oral antipsychotics were included in the random-effects model. Studies that did not implement placebo substitution were excluded from analyses. The primary outcome was the proportion of individuals with withdrawal symptoms after antipsychotic discontinuation. We compared a control group with continued antipsychotic treatment in the assessment of odds ratio and number needed to harm (NNH).

Data extraction: We followed guidelines by the Cochrane Collaboration, PRISMA, and MOOSE.

Results: Five studies with a total of 261 individuals were included. The primary outcome, proportion of individuals with withdrawal symptoms after antipsychotic discontinuation, was 0.53 (95% CI, 0.37-0.70; I2 = 82.98%, P < 0.01). An odds ratio of 7.97 (95% CI, 2.39-26.58; I2 = 82.7%, P = 0.003) and NNH of 3 was calculated for the occurrence of withdrawal symptoms after antipsychotic discontinuation.

Conclusion: Withdrawal symptoms appear to occur frequently after abrupt discontinuation of an oral antipsychotic. The lack of randomized controlled trials with low risk of bias on antipsychotic withdrawal symptoms highlights the need for further research.

Keywords: antipsychotics; discontinuation symptoms; meta-analysis; systematic review; withdrawal symptoms.

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Figures

Figure 1
Figure 1
The square data markers indicate the proportion of individuals with withdrawal symptoms in each study, with sizes reflecting the study’s statistical weight using random-effects meta-analysis of proportions. The horizontal lines indicate 95% CIs. The blue diamond data marker represents the overall proportion and 95% CI. The vertical dashed line shows the summary effect estimate.
Figure 2
Figure 2
The square data markers indicate the proportion of individuals with withdrawal symptoms in each study, with sizes reflecting the statistical weight of the study using random-effects meta-analysis of proportions. The horizontal lines indicate 95% CIs. The blue diamond data marker represents the subtotal and overall proportion and 95% CI. The vertical dashed line shows the overall effect estimate for both target and control together.
Figure 3
Figure 3
The square data markers indicate the proportion of individuals with withdrawal symptoms in each study, with sizes reflecting the statistical weight of the study using random-effects meta-analysis. The horizontal lines indicate 95% CIs. The blue diamond data marker represents the overall proportion and 95% CI. The vertical dashed line shows the overall effect estimate, and the continuous line represents the line of no effect (OR = 1).
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