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Nevertheless, many patients discontinue their medication at some point. Evidence-based guidance for patients, clinicians, and policymakers on rational discontinuation strategies is vital to enable the best, personalized treatment for any given patient. Nonetheless, there is a scarcity of guidelines on discontinuation strategies. In this perspective, we therefore summarize and critically appraise the evidence on discontinuation of six major psychotropic medication classes: antidepressants, antipsychotics, benzodiazepines, mood stabilizers, opioids, and stimulants. For each medication class, a wide range of topics pertaining to each of the following questions are discussed: (1) Who can discontinue (e.g., what are risk factors for relapse?); (2) When to discontinue (e.g., after 1 year or several years of antidepressant use?); and (3) How to discontinue (e.g., what\u2019s the efficacy of dose reduction compared to full cessation and interventions to mitigate relapse risk?). We thus highlight how comparing the evidence across medication classes can identify knowledge gaps, which may pave the way for more integrated research on discontinuation.<\/jats:p>","DOI":"10.1038\/s41380-024-02445-4","type":"journal-article","created":{"date-parts":[[2024,3,19]],"date-time":"2024-03-19T07:02:05Z","timestamp":1710831725000},"page":"2575-2586","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Discontinuation of psychotropic medication: a synthesis of evidence across medication classes"],"prefix":"10.1038","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3698-0744","authenticated-orcid":false,"given":"Christiaan H.","family":"Vinkers","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1662-7436","authenticated-orcid":false,"given":"Ralph W.","family":"Kupka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda W.","family":"Penninx","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6072-0358","authenticated-orcid":false,"given":"Henricus G.","family":"Ruh\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob M.","family":"van Gaalen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul C. 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HR received research funding from ZonMW, Hersenstichting, an unrestricted educational grant from Janssen and speaking fees from Janssen, Prelum, Benecke and Lundbeck. CV and HR are PIs of the TEMPO RCT examining different discontinuation strategies. SJ has received honoraria for educational talks given for Lundbeck, Boehringer-Ingelheim, Janssen and Sunovion. He has consulted for LLA Pharmaceuticals on an antipsychotic and has sat as panel member for a Wellcome Trust funding panel and expert member for a NICE panel on tardive dyskinesia. He is a Council Member for the British Association for Psychopharmacology (unpaid). JT has participated in research projects funded by grants from Janssen-Cilag and Eli Lilly to his employing institution. He has been a consultant to HLS Therapeutics, Janssen, Orion and WebMed Global and received lecture fees from Janssen and Otsuka. JR was on the speakers\u2019 bureau and\/or acted as consultant for Biogen, Janssen-Cilag, Novartis, Shire, Takeda, Bial, Shionogi, Sincrolab, Novartis, BMS, Medice, Rubi\u00f3, Uriach, Technofarma and Raffo in the last 3 years. He also received travel awards (air tickets\u2009+\u2009hotel) for taking part in psychiatric meetings from Janssen-Cilag, Rubi\u00f3, Shire, Takeda, Shionogi, Bial and Medice. The Department of Psychiatry chaired by him received unrestricted educational and research support from the following companies in the last 3 years: Janssen-Cilag, Shire, Oryzon, Roche, Psious, and Rubi\u00f3. EV has received grants and served as consultant, advisor or CME speaker for the following entities (unrelated to the present work): AB-Biotics, Abbott, Abbvie, Aimentia, Angelini, Biogen, Biohaven, Boehringer-Ingelheim, Casen-Recordati, Celon, Compass, Dainippon Sumitomo Pharma, Ethypharm, Ferrer, Gedeon Richter, GH Research, Glaxo Smith-Kline, Idorsia, Janssen, Lundbeck, Novartis, Organon, Otsuka, Rovi, Sage, Sanofi-Aventis, Sunovion, Takeda, and Viatris. RV, LW, WV, AS, SV, JL, BP, JG, RK, and PH have no conflict of interests to declare.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}