Brief Answer: Explained below. Detailed Answer: Hi, Welcome to Healthcare Magic! The decision to stop antipsychotic medication depends usually on the duration of psychotic symptoms and the severity. For example, if the symptoms lasted for less than a month, then it is recommended that the medicine be continued in the same dosage for at least a year before being tapered off. If the symptoms lasted for more than that and a diagnosis of schizophrenia was made, then guidelines suggest that the medication be continued for at least five years or more. If medicines are stopped earlier than the recommended duration, then it has been observed that there is a very high risk of relapse. Since you had a relapse in 2010 after stopping your medicines in 2009, you must understand that there is a high risk of relapse. If you were under my care, I would have preferred to keep you on the lowest possible dose of an antipsychotic for at least 5 years or more, before deciding whether to quit or not. But if you still wish to stop Zyprexa, I have a few suggestions. Rather than taking 10 mg or 5 mg every alternate night, it is better to take the half dose every night. You have mentioned that 5 mg every alternate night is really 2.5 mg every night, but it is not so. Since Zyprexa does not have a very long half-life that would justify alternate day dosing, 5 mg on alternate day simply means one day without antipsychotic and one day with antipsychotic. I would advise that you take 2.5 mg every night for at least a few months (not weeks) and see how you are on it. If there are no psychotic symptoms and no adverse effects, then decide whether to cut down or to continue on it for longer. You need to decide whether taking 2.5 mg every day is better than being off medicines for a few months, then falling ill again and needing to take a very high dose again for a long time. Another factor that should influence your decision is the harm that the relapse does to you. For people with very demanding jobs, even a small episode of mental illness can lead to serious consequences in career aspirations. There may also be losses in personal life like in relationships. Because of these factors, we try our utmost to reduce the risk of relapse as much as we can. If, however, you decide to quit Zyprexa after being on 2.5 mg every night then take the half tablet of 2.5 mg, that is 1.25 mg per night for a few months before stopping all together. The timing of reducing/stopping medicines should be such that no major stress or upheavals are expected and life is relatively stress free. This reduces the chances of a relapse. Hope this clears up things for you. Please feel free to ask if you need any clarifications. Best wishes. Dr Preeti Parakh MD Psychiatry

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