A 20-year Chicago follow-up: people with schizophrenia not on antipsychotics were working more from year four on
"Four years later and continually until the 20 year followups, patients with schizophrenia not prescribed antipsychotics had significantly better work functioning."
Reasonable evidence with real limitations. how we score evidence
Caveat on this rating: Naturalistic cohort of 139; treatment was not assigned, so confounding by illness severity is the central objection and the authors acknowledge other factors. Outcome is work, not relapse or admission.
Most drug studies last weeks. This one followed the same 139 people for twenty years and asked a question trials never ask: who is working?
Significant findings
Harrow, Jobe, Faull and Yang (Psychiatry Research, 2017) followed "70 patients with schizophrenia and 69 initially psychotic mood disordered control patients", assessed "6 times over 20 years", comparing those continuously prescribed antipsychotics with those not prescribed them, "using statistical controls for inter-subject differences."
"While antipsychotics reduce or eliminate flagrant psychosis for most patients with schizophrenia at acute hospitalizations, four years later and continually until the 20 year followups, patients with schizophrenia not prescribed antipsychotics had significantly better work functioning. The work performance of the patients who were continuously prescribed antipsychotics was at a low rate and did not improve over time."
Their conclusion is careful: "The data suggest that some patients with schizophrenia not prescribed antipsychotics for prolonged periods can function relatively well", and "the longitudinal data raise questions about prolonged treatment of schizophrenia with antipsychotic medications."
Worth asking
Nobody was randomized. People who came off medication and stayed off may simply have had a milder illness, and no statistical control fully fixes that. The Finnish register studies in this wave find the opposite for rehospitalization and death. Read together they suggest two things can both be true: the drugs prevent relapse in the short and medium term, and a subgroup does well without them over decades. The field cannot yet tell in advance who is in that subgroup. Never stop an antipsychotic on your own.
Source
A 20-Year multi-followup longitudinal study assessing whether antipsychotic medications contribute to work functioning in schizophrenia — Harrow M, Jobe TH, Faull RN, Yang J (2017)
Indexed peer-reviewed journal
Read the source: https://doi.org/10.1016/j.psychres.2017.06.069
DOI: 10.1016/j.psychres.2017.06.069
How this was scored
- Study design
- Cohort study
- Funding
- Independently funded
- Published in
- Indexed peer-reviewed journal
- Sample size
- 139
- 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 57 out of 100 on our published rubric. One caveat travels with that badge: Naturalistic cohort of 139; treatment was not assigned, so confounding by illness severity is the central objection and the authors acknowledge other factors. Outcome is work, not relapse or admission. 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?
A 20-Year multi-followup longitudinal study assessing whether antipsychotic medications contribute to work functioning in schizophrenia — Harrow M, Jobe TH, Faull RN, Yang J (2017). Published in: Indexed peer-reviewed journal. DOI: 10.1016/j.psychres.2017.06.069. 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: Independently funded. 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.