How to reassess and discontinue psychiatric medications?
Psychiatric Deprescribing Guidance Signals a Turning Point in Mental Health Care
A new international consensus statement suggests clinicians should reassess psychiatric medications at least annually, verify adherence before declaring treatment failure, and involve patients in shared decision-making when considering deprescribing.
A 45-member international task force convened under the American Society of Clinical Psychopharmacology released new consensus guidance on deprescribing psychiatric medications. The statement was published in JAMA Network Open in February 2026.
The guidance addresses a long-standing gap in psychiatric training and research. While clinicians are extensively trained in how to start medications, formal instruction on when and how to discontinue them has historically received far less emphasis.
The panel reached consensus on 44 out of 50 recommendations, signaling broad agreement on foundational principles, even if some areas remain debated.
Methodology
To develop the guidance, the task force conducted a structured review of the existing scientific literature on psychiatric medication discontinuation and clinical practice patterns. They then used a Delphi consensus process between January and May 2025. In this approach, expert panelists reviewed proposed recommendations anonymously across multiple rounds, with feedback incorporated and statements revised after each cycle. Agreement or disagreement by at least 75% of members was required to reach consensus. This method allows experts to identify areas of strong agreement while also highlighting topics where evidence is limited or opinions remain divided, making the final recommendations both systematic and transparent.
Key Findings
All psychotropic medications should be reassessed periodically, at minimum annually.
A formal risk-benefit analysis should precede any deprescribing decision.
Only one medication change should be made at a time in patients on multiple psychiatric drugs.
Medication adherence must be assessed before labeling a drug ineffective.
Clear communication and shared decision-making are essential.
Benzodiazepine use should be carefully reevaluated as patients age.
Cumulative anticholinergic burden should be reviewed in older adults.
No consensus was reached on routine discontinuation of valproate in all women of childbearing potential.
Panelists were divided on restarting medications involved in prior overdoses, reflecting limited empirical evidence.
One notable theme was caution against passive prescription renewal without reassessment.
Implications for Practice
For Patients
This guidance may encourage more regular conversations about whether medications remain necessary, effective, and aligned with current goals.
Patients may benefit from:
Annual medication reviews
More structured discussions about side effects
Clearer expectations regarding duration of therapy
Collaborative decision-making when stopping a medication
Importantly, deprescribing does not mean anti-medication. It means periodically asking whether a medication is still serving its intended purpose.
For Clinicians
For prescribers, this statement reinforces several practice shifts:
Move from automatic renewal to deliberate reassessment.
Evaluate adherence before escalating therapy.
Avoid making multiple medication changes simultaneously.
Consider cumulative medication burden, especially in older adults.
Recognize that pharmacologic endpoints in chronic psychiatric illness are often nuanced and individualized.
The consensus also highlights areas requiring further research, particularly around overdose-related restart decisions and valproate use in women of reproductive potential.
Experts have described the guidance as an important milestone, formalizing deprescribing as a core competency within psychopharmacology rather than an afterthought.