Can Patients with Delusional Disorder Safely Discontinue Medication?

Inquiry about the course of delusional disorder?

I would like to ask the doctor, in clinical practice, do patients with delusional disorder who actively cooperate with treatment and take their medication on time have a chance to discontinue medication for observation? If there is an opportunity to discontinue medication, what is the actual proportion of patients who can successfully stop? Since my wife developed delusional disorder, she has been taking half a tablet of Sertraline and half a tablet of Quetiapine daily.
After about 2-3 days, her delusional symptoms stop.
Her attending physician mentioned that these medications work very well for her, so I would like to know about patients on low doses like hers.
What is the likelihood that they can discontinue medication and not relapse? Is it true that the majority of patients need to take medication for life? If lifelong medication is necessary, does not discontinuing medication lead to a higher chance of remaining stable without relapse? In clinical practice, is there a high proportion of patients who require increasing doses over time, or can most maintain a stable life on low doses? Thank you, doctor.

Bao Luo, 30~39 year old female. Ask Date: 2022/10/28

Dr. Qiu Junda reply Psychiatry

Hello.
The issue is quite complex.
Chuanxiong and Kexin fruit are primarily used for antidepressant purposes, but they can also help improve delusional symptoms.
A proper assessment of your wife's condition is necessary, and it is best to discuss this with her attending physician.
However, antidepressants are theoretically non-addictive.
If combined with treatment, as you asked, there is a possibility of maintaining a stable life on a low dose.

Reply Date: 2022/10/28

More Info

Discontinuing medication for patients with delusional disorder is a complex issue that requires careful consideration and should always be guided by a qualified healthcare professional. Delusional disorder, characterized by the presence of one or more delusions that persist for at least one month, can significantly impact a person's life and functioning. The treatment typically involves antipsychotic medications, which can help manage symptoms and improve quality of life.

In clinical practice, the decision to discontinue medication is often based on several factors, including the duration of the illness, the patient's response to treatment, the presence of any residual symptoms, and the overall stability of the patient's mental health. For patients who have been compliant with their medication regimen and have shown significant improvement, there may be an opportunity to consider a gradual tapering of medication under the supervision of their psychiatrist.

Research indicates that some patients with delusional disorder may achieve remission and can safely discontinue medication, particularly if they have been stable for an extended period. However, the likelihood of relapse after discontinuation can vary widely among individuals. Studies suggest that the risk of relapse is higher in patients who have had a longer duration of illness or more severe symptoms prior to treatment. Therefore, while some patients may successfully discontinue medication and remain symptom-free, others may experience a return of delusions or other symptoms.

Regarding the specific case of your wife, who has been taking a low dose of medication (half a tablet of fluoxetine and half a tablet of sertraline), it is essential to consult her psychiatrist about the possibility of tapering her medication. The psychiatrist will evaluate her current mental state, the duration of her stability, and any potential risks associated with discontinuation. If the decision is made to taper her medication, it should be done gradually to minimize withdrawal symptoms and monitor for any signs of relapse.

In terms of the proportion of patients who can successfully discontinue medication, it varies. Some studies suggest that approximately 30-50% of patients with delusional disorder may experience a relapse after stopping medication, while others may remain stable. The goal of treatment is not only to manage symptoms but also to help patients achieve a stable and fulfilling life. For many individuals, long-term medication may be necessary to maintain stability and prevent relapse.

It's also important to note that the notion of "increasing doses" over time is not universal. Many patients can maintain a stable and low dose of medication without needing to escalate their treatment. Regular follow-ups with a psychiatrist can help ensure that the treatment plan remains effective and that any necessary adjustments are made in a timely manner.

In conclusion, while some patients with delusional disorder may have the opportunity to discontinue medication safely, this decision should always be made collaboratively with a healthcare provider. Continuous monitoring and support are crucial in managing the condition effectively. If your wife is stable and her psychiatrist believes that a trial off medication is appropriate, it can be a positive step forward, but it should be approached with caution and care.

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