Neuroleptic discontinuation in clinical and research settings: Scientific issues and ethical dilemmas

The ethics of neuroleptic discontinuation in clinical and research settings are currently a topic of much discussion. The issues underlying this debat e are complicated by rite fact that these medications can be fairly effecti ve in managing the symptoms and preventing relapse in schizophrenia and oth er psychotic disorders, yet these drugs have therapeutic limitations and th eir prolonged use is associated with a risk of serious, potentially persist ent side-effects such as tardive dyskinesia. Over the past 47 years, the pu blic perception about the value of neuroleptics has undergone dramatic shif ts, based partly on the data available at different time periods. The risk- benefit ratio is better for rite atypical antipsychotics compared to the co nventional ones, but long-term experience with the newer agents has been li mited. At present, a prudent strategy for most clinical and research purpos es is to gradually taper the medications in clinically stable, carefully se lected, consenting subjects to the lowest doses on which individual patient s can be effectively maintained. In this article we discuss clinical, resea rch, and ethical aspects of neuroleptic discontinuation, it is critical to protect potentially vulnerable patients with serious mental illnesses, whil e allowing them to benefit from appropriate investigations.