Twenty years after a first schizophrenia admission: stopping antipsychotics was tied to more rehospitalization and death
Finland, 8,719 first admissions. Against continuous use, the risk of rehospitalization or death was 1.63 times higher for those who stopped at discharge and 7.28 times higher for those who stopped after five years.
Reasonable evidence with real limitations. how we score evidence
Caveat on this rating: Observational between-person comparison with adjustment; confounding by reason for stopping cannot be removed. The five-year-plus group is small (wide interval, 2.78 to 19.05).
Guidelines have long suggested that after a first episode, medication can be tapered off after one to five stable years. This study looked for the evidence.
Significant findings
Tiihonen, Tanskanen and Taipale (American Journal of Psychiatry, 2018) followed "all patients hospitalized for the first time with a schizophrenia diagnosis in Finland during the period of 1996-2014 (N=8,719)."
"The lowest risk of rehospitalization or death was observed for patients who received antipsychotic treatment continuously (adjusted hazard ratio=1.00), followed by patients who discontinued antipsychotic use immediately after discharge from the first hospital treatment (hazard ratio=1.63, 95% CI=1.52-1.75), within 1 year (hazard ratio=1.88", "within 2-5 years (hazard ratio=3.26", "and after 5 years (a median of 7.9 years) (hazard ratio=7.28, 95% CI=2.78-19.05)."
"Risk of death was 174%-214% higher among nonusers and patients with early discontinuation of antipsychotics compared with patients who received antipsychotic treatment continuously".
Their conclusion: "the risk of treatment failure or relapse after discontinuation of antipsychotic use does not decrease as a function of time during the first 8 years of illness".
Worth asking
This is the hardest number for anyone who wants to believe the drugs are the problem. It is also observational, and the people who stop are not a random sample: some stop because they are doing well, many because they are unwell, homeless or using substances, and those things kill people too. The randomized trial in this wave (Wunderink) points the other way on recovery. What both agree on is that stopping abruptly and alone is the dangerous version. Never stop an antipsychotic on your own.
Source
20-Year Nationwide Follow-Up Study on Discontinuation of Antipsychotic Treatment in First-Episode Schizophrenia — Tiihonen J, Tanskanen A, Taipale H (2018)
Top-tier peer-reviewed journal
Read the source: https://doi.org/10.1176/appi.ajp.2018.17091001
DOI: 10.1176/appi.ajp.2018.17091001
How this was scored
- Study design
- Cohort study
- Funding
- Funding not disclosed
- Published in
- Top-tier peer-reviewed journal
- Sample size
- 8,719
- Preregistered
- not recorded
- Conflicts disclosed
- not recorded
- Independent of proponent
- not recorded
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published September 21, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "moderate evidence". Reasonable evidence with real limitations. It scores 56 out of 100 on our published rubric. One caveat travels with that badge: Observational between-person comparison with adjustment; confounding by reason for stopping cannot be removed. The five-year-plus group is small (wide interval, 2.78 to 19.05). The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
20-Year Nationwide Follow-Up Study on Discontinuation of Antipsychotic Treatment in First-Episode Schizophrenia — Tiihonen J, Tanskanen A, Taipale H (2018). Published in: Top-tier peer-reviewed journal. DOI: 10.1176/appi.ajp.2018.17091001. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Cohort study. Funding: Funding not disclosed. Independence from the proponent is not recorded. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.