Deprescribing for Psychiatry: The Right Prescription?

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.