Article open access publication

Should psychiatrists be more cautious about the long-term prophylactic use of antipsychotics?

The British Journal of Psychiatry, Royal College of Psychiatrists, ISSN 0007-1250

Volume 209, 5, 2016

DOI:10.1192/bjp.bp.116.182683, Dimensions: pub.1064192209, PMID: 27802977,



  1. (1) King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London. UK
  2. (2) Maastricht University Medical Centre, grid.412966.e
  3. (3) King's College London, grid.13097.3c
  4. (4) University of Copenhagen, grid.5254.6, KU
  5. (5) King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, and MRC Clinical Sciences Centre, Imperial College London, London, UK


United Kingdom






Patients who recover from an acute episode of psychosis are frequently prescribed prophylactic antipsychotics for many years, especially if they are diagnosed as having schizophrenia. However, there is a dearth of evidence concerning the long-term effectiveness of this practice, and growing concern over the cumulative effects of antipsychotics on physical health and brain structure. Although controversy remains concerning some of the data, the wise psychiatrist should regularly review the benefit to each patient of continuing prophylactic antipsychotics against the risk of side-effects and loss of effectiveness through the development of supersensitivity of the dopamine D2 receptor. Psychiatrists should work with their patients to slowly reduce the antipsychotic to the lowest dose that prevents the return of distressing symptoms. Up to 40% of those whose psychosis remits after a first episode should be able to achieve a good outcome in the long term either with no antipsychotic medication or with a very low dose.


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