A randomized trial: seven years on, people assigned to early dose reduction had twice the recovery rate
"The DR patients experienced twice the recovery rate of the MT patients (40.4% vs 17.6%)." Dose reduction or discontinuation versus maintenance, first-episode psychosis, seven-year follow-up.
Reasonable evidence with real limitations. how we score evidence
Caveat on this rating: Small (103 followed up), open label, and after the 18-month trial treatment was at clinicians' discretion, so the two arms converged in practice. Applies only to remitted first-episode patients. Not yet replicated at this length.
Register studies watch what people do. This is the rare study that assigned them at random, and then came back seven years later.
Significant findings
Wunderink and colleagues (JAMA Psychiatry, 2013) took people whose first episode of psychosis had been in remission for six months and "randomly assigned to DR strategy or MT for 18 months", where DR is guided dose reduction or discontinuation and MT is maintenance treatment. Earlier reports from the same trial had shown "higher relapse rates but no other disadvantages" with dose reduction.
At seven years, 103 of the original 128 were assessed. "The DR patients experienced twice the recovery rate of the MT patients (40.4% vs 17.6%). Logistic regression showed an odds ratio of 3.49 (P = .01). Better DR recovery rates were related to higher functional remission rates in the DR group but were not related to symptomatic remission rates."
The authors: "Dose reduction/discontinuation of antipsychotics during the early stages of remitted FEP shows superior long-term recovery rates", and "additional studies are necessary before these results are incorporated into general practice."
Worth asking
Recovery here means working, relating and looking after yourself, not just the absence of symptoms. That is a different outcome from rehospitalization, and the two can pull apart: more relapses early, better lives later. The trial is small, open label, and only in people who had already been well for six months; it does not apply to someone who is acutely ill. The reduction was guided by clinicians, step by step. It is the reason "stay on it forever" is not a settled fact, and it is not a licence to stop. Never stop an antipsychotic on your own.
Source
Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial — Wunderink L, Nieboer RM, Wiersma D, Sytema S, Nienhuis FJ (2013)
Top-tier peer-reviewed journal
Read the source: https://doi.org/10.1001/jamapsychiatry.2013.19
DOI: 10.1001/jamapsychiatry.2013.19
How this was scored
- Study design
- Randomised controlled trial
- Funding
- Funding not disclosed
- Published in
- Top-tier peer-reviewed journal
- Sample size
- 103
- Preregistered
- Yes
- 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 68 out of 100 on our published rubric. One caveat travels with that badge: Small (103 followed up), open label, and after the 18-month trial treatment was at clinicians' discretion, so the two arms converged in practice. Applies only to remitted first-episode patients. Not yet replicated at this length. 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?
Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial — Wunderink L, Nieboer RM, Wiersma D, Sytema S, Nienhuis FJ (2013). Published in: Top-tier peer-reviewed journal. DOI: 10.1001/jamapsychiatry.2013.19. 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: Randomised controlled trial. 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.