- A new consensus statement recommends psychotropic medication regimens undergo periodic review to ensure they target relevant symptoms and have a favorable risk-benefit profile.
- Deprescribing of medications might be indicated for a variety of reasons, including the successful completion of a time-limited treatment, lack of efficacy, drug misuse, or others.
- Deprescribing should be followed by close clinical monitoring.
In a new consensus statement, a task force convened by the American Society of Clinical Psychopharmacology (ASCP) detailed circumstances in which the deprescribing of psychotropic medications may be clinically indicated.
The task force achieved consensus on 44 of 50 of the final Delphi statements, and unanimously agreed that "components of a pharmacotherapy regimen should undergo periodic review to ensure that treatments target relevant symptoms and have favorable risk-benefit ratios," wrote Joseph F. Goldberg, MD, MSc, of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues in JAMA Network Open.
Key points of consensus were that deprescribing:
- Should not occur before first assessing medication adherence
- Should be considered if less than partial therapeutic response is apparent, or if treatment goals have been reached and relapse prevention is not a long-term objective
- Should be carried out with consideration of "psychological ramifications that warrant attention"
- Should be followed by close clinical monitoring
- Should involve active patient participation within a shared decision-making model for risk-benefit decisions
"As many psychiatric disorders are chronic, recurrent, frequently comorbid, and often incompletely responsive to appropriate pharmacotherapy, little guidance exists to help clinicians navigate decisions about eliminating medications that warrant discontinuation," the authors wrote.
Deprescribing of medications might be indicated for a variety of reasons, including the successful completion of a time-limited treatment, lack of efficacy of a treatment, duplicative or contradictory drug mechanisms, drug misuse, or diagnostic revisions, among others, Goldberg told MedPage Today.
While previous recommendations have focused on tapering drug regimens and managing the effects of deprescribing, this time "the ASCP's approach to the topic was a little different," Goldberg noted. "It was more about recognizing situations and circumstances where deprescribing would be appropriate as opposed to the logistics of how to do that."
"The unmet need we perceived was that training programs teach psychiatrists and other prescribers how to start medicines, how to prescribe medicines, but they don't teach very much about how to stop medicines or how to recognize an endpoint," he said.
In an accompanying commentary, Jonathan E. Alpert, MD, PhD, of the Montefiore Medical Center and Albert Einstein College of Medicine in the Bronx, New York, and colleagues said that the consensus recommendations provide "a valuable framework for considering whether or when to embark on the purposeful, monitored discontinuation of psychiatric medications. The consensus statement brings discontinuation closer to the foreground of psychopharmacological practice and research, where it arguably belongs."
"Among the areas that will likely pique interest, a little over half of Task Force members disagreed with the common, longstanding practice of refraining from restarting a medication that a patient previously overdosed on, likely reflecting the recognition that this prevalent practice is based on clinical lore rather than research," they wrote.
"Perhaps most surprisingly," Alpert and team noted, "only about two-thirds of panelists agreed with regularly deprescribing valproate in women of childbearing potential. The authors believe that the dissenting panelists objected to the notion of routine discontinuation without evaluation of the broader clinical context. Nevertheless, as acknowledged in the manuscript, the use of valproate among women of childbearing potential is widely discouraged, including by the World Health Organization and by most reproductive psychiatrists due to definitive evidence for teratogenicity."
They concluded that the consensus statement is "an important milestone in psychopharmacology reflecting a growing understanding that the prescribing and deprescribing of psychotropic medications deserve comparable thoughtfulness and rigor."
To make these new recommendations, an ASCP task force including 45 psychopharmacology experts "sought to establish principles to help guide decisions about whether and when to stop a medication safely and appropriately," Goldberg and team wrote.
The panel developed and completed a multi-round Delphi survey and focused literature review between January and May of 2025 to identify areas of consensus or disagreement on a number of aspects of deprescribing psychotropic medications, including "collaborative risk-benefit assessments with patients; pharmacokinetic and pharmacodynamic factors; pharmacogenomics; distinguishing redundant or conflictual from complementary mechanisms of action; managing adverse effects; assuring medication adherence; drug tolerance or tachyphylaxis; medication misuse; and the psychological context and ramifications of deprescribing."
One of the first questions they asked was whether to continue using the term deprescribing, "given its sociolinguistic controversies as expounded by the antipsychiatry community," they wrote. "Ultimately, we retained the term since no alternative preferred descriptor emerged, alongside the desire to preserve consistency within the broader medical literature."
"Words matter, language is important, and we really want to impart this sense that prescribing is really a two-way interaction with patients, and the best that any prescriber can do is make sure the patient is an informed consumer," Goldberg said.
Funding/support for the study came from grants to individual researchers from the National Health and Medical Research Council, the Dauten Family Innovation Fund, the Thomas P. Hackett, MD Endowed Chair in Psychiatry at Massachusetts General Hospital, the NIH, the Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, and King's College London.
Goldberg reported relationships with AbbVie, Alkermes, Alvogen, Axsome, Bristol Myers Squibb, Genomind, Intracellular Therapies, Johnson and Johnson, Luye Pharmaceuticals, Neumora, Otsuka, Vanda Pharmaceuticals, American Psychiatric Publishing, and Cambridge University Press.
Co-authors reported multiple relationships with industry.
Alpert reported receiving grant support from the National Institute of Mental Health and Patient-Centered Outcomes Research Institute, royalties from Cambridge University Press, and honoraria from the Massachusetts General Hospital Psychiatry Academy. He serves on the Future DSM Strategic Committee of the American Psychiatric Association and on the Scientific Council of the American Foundation of Suicide Prevention.
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