About Psychotropic Deprescribing

Antidepressants, benzodiazepines, sleep drugs, and opioids are all psychotropics, meaning that they are drugs that modify the nervous system. Most often prescribed in psychiatric treatment, psychotropics are also used in many other medical specialties, such as gynecology, rheumatology, and pain medicine.

“Deprescribing refers to the thoughtful and systematic process of identifying problematic medications and either reducing the dose or stopping these medications in a manner that is safe, effective, and helps people maximize their wellness and goals of care.” — US Deprescribing Research Network (USDeN)

There are many reasons a doctor and patient might agree that it’s time to reduce or discontinue a psychotropic, among them:

Adverse drug effects
Lack of efficacy
End of course of treatment
Resolution of indication
Excessive medication burden
Health concerns
Patient preference

Generally, it’s a medical best practice to minimize drug risk by prescribing the lowest effective dose for the shortest amount of time, and not to keep patients on unnecessary drugs.

Deprescribing psychotropic drugs is different from deprescribing other kinds of drugs because psychotropics require tapering to avoid withdrawal symptoms, which can be debilitating and even disabling. This aspect of deprescribing is not well understood by many doctors.

The nervous system and body all gradually adapt to a regularly taken psychotropic. For some, this adaptation makes the drug difficult to quit. Careful tapering allows gradual re-adaptation to minimize withdrawal symptoms.

The Psychotropic Deprescribing Council was established to bring clinicians, patients, other healthcare workers, and the general public together to address the safe tapering of psychotropic drugs as well as their deprescription.

The need for informed psychotropic deprescribing is enormous. There is overlap in drug use, with some individuals taking more than one drug, but the National Center for Health Statistics found that in a month, about 23% of Americans 18 and older were taking drugs prescribed for psychiatric conditions. This does not include psychotropics prescribed for pain or other reasons.

National Center for Health Statistics. U.S. Census Bureau, Household Pulse Survey, 2020–2022. Mental Health Care. Generated interactively: from https://www.cdc.gov/nchs/covid19/pulse/mental-health-care.htm

Psychotropic drugs are very widely prescribed, while in many areas, deprescribing is not routine. Patients may refill psychotropic prescriptions long past the need for treatment because they find they get withdrawal symptoms when they try to stop.

A current estimate that 20% to 25% of US adults are regularly taking at least one prescribed psychotropic is not unrealistic. Many millions of people are at risk for inappropriate discontinuation of psychotropics.

* Based on National Center for Health Statistics. U.S. Census Bureau, Household Pulse Survey, 2020–2022. Mental Health Care.

Deprescribing psychotropics with harm reduction tapering techniques requires close collaboration between clinician and patient and among the entire care team – reviving a patient-centered model of care.

Join us in advancing psychotropic deprescribing and patient safety through research and education in best clinical practices.

The deprescribing movement started among pharmacists in hospital geriatric units, who found patients were taking many unnecessary drugs that could complicate life-saving treatment such as complex heart surgery. They devised deprescribing algorithms to reduce the drug burden and make treatment safer.

The patient safety issue has been recognized by the World Health Organization, which has made deprescribing central to its global campaign to reduce avoidable medication-related harm.

“Medication Without Harm”, a global initiative driving a process of change to reduce patient harm generated by unsafe medication practices and medication errors. Polypharmacy and inappropriate prescribing have been identified as an area of high priority.

However, none of the existing deprescribing advice specifically addresses psychotropic deprescribing. Reducing a psychotropic drug requires extensive understanding of tapering to avoid withdrawal symptoms.

Brody, D. J., & Gu, Q. (2020). Antidepressant Use Among Adults: United States, 2015-2018 (377; Data Briefs). https://www.cdc.gov/nchs/products/databriefs/db377.htm

Centers for Disease Control and Prevention. (2018). 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes—United States [Surveillance Special Report]. U.S. Department of Health and Human Services. https://www.cdc.gov/overdose-prevention/media/pdfs/pubs/2018-cdc-drug-surveillance-report.pdf

Maust, D. T., Lin, L. A., & Blow, F. C. (2019). Benzodiazepine Use and Misuse Among Adults in the United States. Psychiatric Services, 70(2), 97–106. https://doi.org/10.1176/appi.ps.201800321

Mangin, D., & Garfinkel, D. (2019). Foreword to the first special collection: Addressing the invisible iatrogenic epidemic: the role of deprescribing in polypharmacy and inappropriate medication use. Therapeutic Advances in Drug Safety, 10. https://doi.org/10.1177/2042098619883156

National Center for Health Statistics. U.S. Census Bureau, Household Pulse Survey, 2020–2022. Mental Health Care. Generated interactively: from https://www.cdc.gov/nchs/covid19/pulse/mental-health-care.htm

Reuben, C., Elgaddal, N., & Black, L. (2023). Sleep medication use in adults aged 18 and over: United States, 2020.(462; Data Briefs). National Center for Health Statistics. https://doi.org/10.15620/cdc:123013

WHO. (2024). Medication without harm: Policy brief. World Health Organization. WHO Global Patient Safety Challenge: Medication Without Harm. https://www.who.int/publications/i/item/9789240062764