Someone has been on antipsychotics for years. They work, to a certain extent, but there are side effects too. Weight gain, jadedness, tiredness, and the feeling of losing yourself. One day, you will have the desire to stop. Not impulsively, but after a long period of deliberation. And that is when the problem starts.

Not the actual stopping, but the reaction that follows.

Friction between guidance and self-management

In many care settings, reducing medication is still seen as a risk that needs to be avoided, instead of a reality you need to handle carefully. The question is often not: what do you need to explore this safely, but: why would you want this? It’s like stopping is a sign of disloyalty to the treatment plan, or a lack of insight. Whilst research and experience show us different results. Most people do stop one day. Often multiple times. And that doesn’t just happen for no reason.

For many people, stopping is not a statement against their care, but an attempt to keep their lives liveable. Side effects keep piling up. Identity and purpose come under pressure. The wish to have more control grows. These are not peripheral matters, they’re core questions about recovery. Still they are often made subordinate to an abstract risk of relapsing.

And that’s where the fundamental friction lies. Care providers often think in populations, guidelines, and averages. But people live in their own bodies, with their own histories and priorities. What’s an acceptable risk for one person, is unbearable for another. You can’t solve this distinction with a generic advice on stopping medication.

Reducing your medication: Deciding together is fundamental

What you can do, is taking the conversation about reducing the medication seriously. Don’t just decide for someone, but explore together. Explain the risks, but talk about the uncertainties as well. Create room for doubt, and most importantly: stay involved, even when someone makes a different choice than you would make as a professional.

In some countries, Norway for example, this is a legal requirement. There, people have a right to proper guidance when reducing their medication, even if their healthcare provider doesn’t agree. There are specialist teams that can help with slow, flexible, and careful reduction of medications. Recent experiences have shown that this doesn’t lead to chaos or massive relapse-issues, but to a better relationship and collaboration.

This requires a different approach. Not micromanaging patients’ cases out of fear, but the principle of taking probable risk seriously. Acknowledge that recovery doesn’t mean you ignore all the risks, but that you learn how to deal with uncertainty, with the proper support.

Make room for difference!

So maybe the most important question isn’t whether stopping or reducing is sensible, but how we deal with the difference. Difference in values, in tolerance to risk, and in what someone finds important in life. If the mental healthcare sector doesn’t have a place for this, people stop asking for help. If the care moves forward with the patient, the dialogue remains open.

And exactly that honest, equal, and thorough conversation, might be the best protection there is.

Translated from Dutch by S.G.M. Taplin