#Deprescribing Psych Meds

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 #Deprescribing Psych Meds

Psychiatric medications save lives and make lives better. Advances in psychiatric pharmacology have led to better lives and greater well-being for a great many people in the world who suffer from disabling symptoms. Although the medications can be worth it, psychiatric treatments often come with severe side effect risks and problems as well. One of the most common problems is that people are taking too many meds, for too little benefit.

A lot of people take too many psych meds. Sometimes I’m the prescribing physician for too many meds. The patient and I work together to arrive at too many meds, while doing the best we can to solve serious distress and impairment. This happens:

  • When people fall between categories of illness that the medications treat, and there’s no med that truly fits their need. There are a lot of gaps between patient symptoms and medication effects. We patch together our best attempts, which aren’t always as effective as we’d like.

  • When a person’s mental health is fragile, and we make repeated desperate attempts to find a treatment that works well, but are afraid to remove meds with modest or unimpressive responses because losing ground is too risky. Too many medicines gets layered, one upon another.

  • When suicide is a constant looming possibility. We are searching for any way to make the pain subside for safety.

  • Sometimes desperate patients ask psychiatrists to please add something new, and please, please don’t try to remove any meds right now. They can’t bear what they are experiencing. They are overwhelmed and begging for relief.

When we arrive at excesses in psychiatric medication, many physicians can be afraid to reduce or remove meds. What if the patient becomes unstable? What if things get worse. Deprescribing can be harder than adding medications.

Deprescribing is a good thing that often scares doctors. We’ve seen the frightening abyss and reached down into the water to pull someone up, and we never want to see them go back to that suffering. But the fear of stopping medications, and comfort with adding them, is based on the biased belief that medications are innately “good.” We have to remind ourselves that:

  • Medications are imperfect.

  • All medications have side effects.

  • Medications are dangerous. Often necessary in one sense, but still dangerous in some other sense.

For all the obvious positives to reducing medications, it can be incredibly hard to implement in real medical practice. The psychology of taking treatments away is different, for patient and physician. Talking about medication reduction shouldn’t make doctors defensive or anxious. Fewer meds means fewer side effects, and when medications can be safely reduced, risk of harm goes down. We can all begin by considering medication reduction, and the situations where it might be the best course of treatment. To overcome barriers to deprescribing:

Address physician and patient fears and negative expectations

Test the waters and move slowly when necessary

Use objective measures and lean on science over intuition or subjectivity

Posted on May 27, 2019 .