Psychopharmacology and Deprescribing
Deprescribing refers to the cautious and skillful reduction or discontinuation of medication which is no longer needed, not helping, or which is causing unacceptable risks or adverse effects.
People who take psychiatric medication often wonder when or if or how they can safely discontinue them, especially when side effects are troublesome. Consideration of deprescribing always requires careful consideration of possible risks and benefits. Plans need to be made and put in place for optimizing supports for stability and monitoring for change in condition. These considerations need to be individualized. In some situations, it can be very important to have family and friends involved. My approach to deprescribing is to educate patients about risks and benefits, and to give recommendations that honor my patient’s values and priorities.
For some psychiatric conditions, discontinuation of medication involves risk of serious symptom recurrence and a worsened long term course of illness.
Discontinuation of medication is not a goal of treatment. The goal of treatment is the best long term quality of life. Sometimes recommendations from deprescribing evaluation entail measures to reduce side effects aside from dose reduction or discontinuation.
In geriatric medicine, deprescribing refers to eliminating medications for which the risk/benefit ratio worsens with advancing age, or which are no longer needed. My role as a psychiatrist in deprescribing for older adults is limited to consulting on psychotropic medications, usually in close collaboration with primary care providers or other medical specialists.