Recommendations for the Deprescribing of Psychotropic Medications: A Consensus Statement From the American Society of Clinical Psychopharmacology Task Force.
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Goldberg Joseph F, McIntyre Roger S, Swartz Holly A, Freeman Marlene P, Mago Rajnish, Citrome Leslie, Rosenblat Joshua D, Thase Michael E, Tohen Mauricio, Vieta Eduard, Malhi Gin S, Sajatovic Martha, Shelton Richard C, Macaluso Matthew, Berk Michael, Perlis Roy H, Ostacher Michael J, Khan Arifulla, Iosifescu Dan V, Sanacora Gerard, Rubio Jose Manuel, Kane John M, Goodman David W, Nierenberg Andrew A, Correll Christoph U, Kupka Ralph, Kasper Siegfried, Furukawa Toshi A, Davis Lori, Aaronson Scott T, Gitlin Michael J, Jha Manish K, Cohen Lawrence J, Papakostas George I, Mitchell Philip B, Gorwood Philip, Gupta Swapnil, Frye Mark A, Young Allan H, Zohar Joseph, Steingard Sandra, Zarate Carlos A, Clayton Anita H, American Society of Clinical Psychopharmacology Task Force on the Deprescribing of Psychotropic Medications
Аннотация
OBJECTIVE: To address circumstances warranting psychotropic medication deprescribing.
EVIDENCE REVIEW: The American Society of Clinical Psychopharmacology convened a panel of 45 international psychopharmacology experts who developed and completed a multiround Delphi survey and conducted a focused literature review between January and May of 2025, in order to identify areas of consensus or disagreement on key aspects of the deprescribing of psychotropic medications. These included 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.
FINDINGS: Consensus was achieved on 44 of 50 final Delphi statements (88%). Panelists 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. Key points of consensus were that deprescribing: (1) should not occur without first assessing medication adherence; (2) merits consideration if less than partial therapeutic response is apparent, or if treatment goals have been reached and relapse prevention is not a long-term objective; (3) involves psychological ramifications that warrant attention; (4) should be followed by close clinical monitoring; and (5) risk-benefit decisions should ideally involve active patient participation within a shared decision-making model.
CONCLUSIONS AND RELEVANCE: Through this Consensus Statement, the Task Force identified circumstances in which the selective elimination of certain psychotropic medications may be clinically indicated. Empirical trials are needed to assess the implementation of deprescribing protocols and gauge their safe, effective, and acceptable outcomes.