“Doctor, do you deprescribe?”
As a psychiatrist, I rarely hear this request. People come to me not because I deprescribe, but because I prescribe.
However, there is a movement in the United States and worldwide to deprescribe both mental health and physical health medications.
“Is your medicine working for you?” I ask my patients. “How about considering reducing or tapering off the medicine?”
“These meds are working for me,” I often hear. “Why should I change them?”
“You and I are working together to find the least number of medicines at the lowest doses that do what you want them to do,” I respond to one patient, like a mantra. She had been taking four milligrams of an anti-anxiety medicine for many years without seriously considering reducing it.
Deprescribing
On the one hand, “deprescribing” is new terminology for the standard practice of reducing or gradually tapering off a medication. On the other hand, the term reflects new understanding of the physiology of medication reduction.
I am in favor of deprescribing when possible. Reasons to deprescribe include when a medicine isn’t effective enough, causes problematic side effects, is no longer needed, duplicates the effect of another medicine the person is taking, or if the treatment is not evidence-based or evidence-informed.
Deprescribing is a common practice. As stated in a 2026 American Psychiatric Association position statement, “In psychiatry, as in all areas of medicine, prescribing and deprescribing occur every day as part of individualized, evidence-based treatment planning between physicians and patients.”
Discussion about deprescribing revolves around possible withdrawal symptoms. How severe are they? How long do they last? How can we minimize or prevent withdrawal effects? Some research supports the position that severe withdrawal symptoms rarely happen, while other data support the hypothesis that withdrawal symptoms are significant and prolonged.
In my experience, many people have a manageable time of reducing medicine as long as the medicine is decreased gradually. If side effects emerge, we wait longer before reducing another step, or we increase the dose a little to allow the body more time to adapt.
“Go slowly,” advises an international panel of pharmacology experts surveyed by the American Society of Clinical Pharmacology in 2026. Tailor the taper to the person.
I’m also aware that some people have difficulty tapering. “It took me a year to come off my medication,” one online blogger wrote.
Another individual wrote about their deprescribing experience. “It’s one of the hardest things I’ve ever done.”
For individuals facing challenges with deprescribing, there are deprescribing guidelines and specialized clinics and programs to assist in the process.
How to deprescribe
One method of optimal deprescribing practice is based on dose reduction by percentage, not quantity. A traditional taper plan involves reducing by a predetermined number of milligrams at each step, such as reducing a 100-milligram daily dose by 10 milligrams every two weeks.
In contrast, the trend is toward tapering based on a standard percentage reduction rather than a certain dose reduction.
To illustrate, consider a parking lot whose parking spaces are all occupied with cars. This is akin to how, at higher doses, brain receptors are filled up by medication ‘molecules.’ Dropping from 100 milligrams to 90 milligrams, a 10% decrease, leaves the receptors, or “parking spaces,” still mostly full.
The problem comes as the taper progresses, which opens up many more receptor sites. For example, a ten-milligram dose reduction from 20 milligrams to 10 milligrams is a 50% drop. A 50% decrease all at once is significant and could trigger withdrawal symptoms.
To address this situation, current practice replaces a fixed dose reduction, such as 10 milligrams at a time, with a taper based on a fixed percentage reduction, such as 10% reduction at a time. Thus, a 20-milligram dose reduced by 10%, or two milligrams, would decrease from 20 milligrams to 18 milligrams daily.
How do we reduce a dose from 20 milligrams to 18 milligrams daily when the smallest strength available is a ten-milligram pill?
We might turn to a liquid form, if available, which allows a decrease of one milligram or less at a time. Or we might consider pulverizing a tablet, mixing the powder with water or juice, and drinking a measured amount each day. For medicines in capsule form, people have been known to open a capsule and count a certain number of granules each day, placing the granules in an empty capsule case available at most pharmacies.
Alternatively, an accredited, licensed compounding pharmacy, available in some communities as well as online, can formulate a required dose.
Precautions
Deprescribing is not the solution to our mental health crisis any more than prescribing is the cause. As I said, I am in favor of deprescribing. But deprescribing is only half the truth.
I am also in favor of prescribing. I have witnessed medicine reduce suffering and save lives. As we acknowledge the potential harm of medication, we must also recognize the potential good. I am concerned that attention to deprescribing could increase stigma toward individuals who take medicine to sustain their mental health.
Over-prescribing is not the primary problem. We know that there are shortages of doctors, clinics, and hospitals in all medical fields, including mental health. Many people suffer due to lack of access to care.
My psychiatric colleagues and I approach clinical care broadly, considering medication as well as other evidence-based treatments, such as individual or group psychotherapy, exercise, and nutrition, as well as addressing physical health and socioeconomic factors that impact mental health.
That said, in 2025, the US Department of Health & Human Services reported that the percentage of US adults who take any medication for mental health increased by over 20% between 2019 and 2024. On the other hand, interestingly, a just-published study found that from 2013 to 2024 the annual United States prescriptions for benzodiazepines, an anti-anxiety group of medicines, decreased by 26.7%, according to the American Journal of Psychiatry this September.
If we look at total knee replacement surgery, the number of United States adults who have this procedure is projected to increase 673% by the year 2030, according to the American Academy of Orthopedic Surgeons in 2024.
Just as it would be simplistic to presume that the increase in total knee replacement surgery reflects orthopedic surgeons “over-operating,” we must exercise caution about assuming that an increase in prescribing some medications reflects that physicians are over-prescribing.
Clearly, more research is needed to inform prescribing and deprescribing decision-making. Some people feel better on medicine and some feel better without medicine. There is no shame in pursuing the goal of optimal health, no matter the journey to get there.
When considering deprescribing, one patient said, “After four years, I’ve finally found the right medicine combination. No way am I going to change it!”
Another said, “Since we talked a few weeks ago about weaning down on my anti-anxiety medicine, I haven’t taken any at all. It’s been no problem. I feel fine.”
Regarding the patient mentioned who had been on a daily dose of four milligrams of an anti-anxiety medicine for years, she tapered slowly over a year to two milligrams per day. She is currently in a stable spot of good health.
Will she continue to taper? In our shared decision-making process, she and I discuss her values, priorities, and health care needs. Regardless of national and international spotlights on deprescribing, the decision is still, at this time, hers to make.
Dr. Diane Roston is on the clinical faculty at the Geisel School of Medicine at Dartmouth College and is a physician at West Central Behavioral Health in Lebanon.