Exploring Barriers and Facilitators to Deprescribing Psychotropics in Child and Adolescent Psychiatry: A Qualitative Study from India.

BACKGROUND

Deprescribing, a structured, planned, and supervised approach to medication discontinuation, is increasingly recognized as an imperative rather than an elective component of rational psychopharmacological practice. Deprescribing is particularly compelling in child and adolescent psychiatry, where, despite accumulating evidence for pharmacotherapy, uncertainties regarding long-term risks and benefits persist. This makes deprescribing an important and often complex clinical consideration. Despite growing international attention, deprescribing remains challenging to implement in routine clinical care and is relatively understudied, especially in low- and middle-income countries. This study examined clinicians' perspectives on perceived barriers and facilitators to deprescribing psychotropics in tertiary Child and Adolescent Mental Health Services in India.

METHODS

The Reflexive Thematic Analysis framework, proposed by Braun and Clarke, was followed. Fourteen child mental health practitioners were recruited through purposive sampling to ensure diverse representation of clinical experience and practice settings. The sample included six consultants, seven specialty trainees, and one general psychiatry resident. Data were collected through in-depth interviews. Data collection and analysis were conducted iteratively.

RESULTS

Five interrelated themes were identified: Evolving clinical philosophy; Illness Trajectory, Clinical Risk, and the Timing of Deprescribing; Shared and Shifting Roles in Deprescribing Decision-Making; Health System Constraints and (lack of) Care Continuity; and Cultural and Socioeconomic Context Shaping Deprescribing processes. Together, these themes showed that deprescribing was viewed as a negotiated process influenced by clinician confidence, illness severity, caregiver readiness, adolescent agency, service limitations, and sociocultural pressures.

CONCLUSIONS

Deprescribing in child and adolescent psychiatry is an evolving clinical competency influenced by clinician, family, health-system, and cultural factors. Structured training, context-specific guidelines, active involvement of children and families, and improved service coordination can support safe deprescribing practices.