Title:Deprescribing for Psychiatry: The Right Prescription?
Volume: 14
Issue: 1
Author(s): John D. Cahill*Swapnil Gupta
Affiliation:
- Yale University School of Medicine, New Haven, CT 06510,United States
Keywords:
Deprescribing, psychotropic medication reduction, psychosocial, polypharmacy, anti-epileptic drug, antipsychotic drug.
Abstract: Background: The term “deprescribing” has been coined to describe a specific intervention
designed to optimize the reduction or cessation of medications for which benefits no longer
outweigh the risks. As a wider concept, it may also come to embody a shifting perspective in the
management of chronic illnesses where multiple, changing factors add complexity and nuance to the
risk/benefit calculations that underlie prescription. Despite a burgeoning literature in geriatric medicine
and palliative and primary care, the term is only recently being introduced to psychiatry.
Objective: This article seeks to raise the question of whether deprescribing may be useful as a construct,
clinical intervention and novel field of research in the field of psychiatry.
Method: A focused review of the literature is used to provide context and frame some arguments for
and against the adoption of deprescribing concepts and practice in psychiatry at this time.
Results: With both potential risks as well as benefits, the relative expertise in complex shared decision-
making and psychosocial aspects of prescribing, mean the specialty of psychiatry has much to
gain from and contribute to the field of deprescribing.
Conclusion: Existing deprescribing guidelines may be adapted to guide initial implementation
strategies in psychiatry. These should then undergo rigorous clinical trials to establish effectiveness
and/or identify populations of most benefit. Further research is warranted to help guide decisionmaking
around long-term psychotropic use.
