Deprescribing Psychiatric Medications: A Guide for Patients

Dr. Alexander Sidawi

Dr. Sidawi is an Orlando based, UF trained physician who is happy to be serving the community he grew up in by offering a combination of psychiatric medication management and psychodynamic psychotherapy.

What Is Deprescribing?

Deprescribing refers to the process of tapering off and eventually discontinuing psychiatric medications that may no longer serve your needs. This process should be carefully managed to ensure safety and effectiveness, and it focuses on addressing medications that:

Are ineffective for your symptoms.
Cause significant side effects.
Interact negatively with other medications.

The goal of deprescribing is not to stop medications arbitrarily but to optimize your treatment plan, ensuring that you are only on medications that benefit you. It is important to have a target for your treatment, and in regards to medications the target should always be to find the lowest effective dose, striking a balance between improvement and side effects.

Psychiatric Medication Interactions: Why They Matter

Psychotropic medications can interact with each other in complex ways, potentially leading to undesirable effects. Common interactions include:

Altered Breakdown in the Liver: Some medications can speed up or slow down the metabolism of other medications in the liver, affecting the level of medication in your body.
Increased Medication Levels: Medications can affect the amount of free (active) medication in the bloodstream, potentially leading to side effects or toxicity. For example, aspirin can increase the amount of free valproic acid in the blood stream.
Excessive Receptor Activity: Combining medications that act on the same receptors can amplify their effects. For example, taking two sedative medications together might result in excessive drowsiness, or combining two serotonin reuptake inhibitors can heighten the risk of serotonin syndrome.

Understanding and managing these interactions is crucial for your safety and wellbeing.

Addressing Ineffectiveness of Psychiatric Medication

Over time working with a mental health prescriber, you may find that you’ve accumulated more and more prescriptions without more and more improvement. You may not wish to be on so many medications, and may not even need them if they haven’t been effective for you. Stopping them without discussing with your prescriber can cause unwanted side effects like flu like symptoms, insomnia, appetite changes, or even seizures depending on which class of medication it is. It is always best to consult with your provider before altering your medication regiment.

Managing Side Effects of Psychiatric Medication

While psychiatric medications can be life-changing, they also come with potential side effects. Some side effects, like mild headaches or gastrointestinal upset, may subside as your body adjusts. Others, however, can persist and significantly impact your quality of life. For example, medications like antidepressants can sometimes lower libido, leading to stress in personal relationships. For some, the side effects might outweigh the benefits, necessitating a discussion with your provider about alternatives.

Potential Treatment Options When Medications Cause Issues

If you’re experiencing challenges with your medications, there are several approaches your provider might recommend:

Tapering to a Lower Dose: Many side effects are dose-dependent. Lowering the dose may reduce side effects while retaining therapeutic benefits.
Stopping the Medication: If a medication is ineffective or causes severe interactions, discontinuing it may be the best option. This often involves tapering to prevent withdrawal effects.
Adding a Supportive Medication for Tapering: Some medications can be difficult to stop due to withdrawal symptoms, particularly those with short half-lives. In such cases, switching to or adding a longer-acting medication in the same class can ease the process.
Adding Medications to Manage Side Effects: If a medication is effective but causes unwanted side effects, additional medications may help. For example:
- Bupropion can alleviate sexual side effects of antidepressants.
- Aripiprazole can help with sexual side effects caused by dopamine blockers like risperidone.

Partnering with Your Provider

Deprescribing is a collaborative process between you and your provider. It involves open communication, regular evaluations, and personalized adjustments to your treatment plan. By working together, we can ensure your medication regimen supports your mental health goals effectively and safely.

If you have questions about your medications or are interested in exploring whether deprescribing might be right for you, please don’t hesitate to schedule an appointment with your provider.