Deprescribing, initially conceptualized in geriatric medicine, can be defined as a systematic process of optimizing a person’s medication regimen by reducing mediations for which the benefits no longer outweigh the risks (Gupta and Cahill 2016). Deprescribing ideally accounts for a person’s medical status, functioning, and values and preferences. Some examples of scenarios of when to consider deprescribing may include: if a person is prescribed two or more antipsychotic medications with unclear benefit, if someone is prescribed a medication as an augmentation strategy without clear benefit, or if someone is taking multiple medications with redundant pharmacodynamic properties (e.g., a high anticholinergic burden).
The steps of deprescribing include: 1) assess the timing and the context, 2) medication reconciliation, 3) explore the patient’s experience and attitudes around treatment, 4) set the frame for the deprescribing intervention, 5) deciding which medication to deprescribe, 6) developing the deprescribing plan, 7) and implement, monitor, and adjust the plan (Gupta, Cahill, and Miller 2019). A 2×2 decision-making matrix (one axis on continuing and deprescribing the medication and another axis on risks and benefits) completed collaboratively by the prescriber, individual, and other supports can be helpful in developing a plan. For more details about deprescribing, please refer to this webinar on SMI Adviser presented by Dr. Gupta: A Delicate Dance: The Principles and Practice of Deprescribing Antipsychotic Medications. Another algorithm for deprescribing from Endsley et al. is available here.
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