Deprescription of Psychotropics in Children and Adolescents: Systematic Review of Guidelines and Development of a Deprescribing Algorithm

Abstract

Background

Psychotropics are increasingly prescribed in paediatrics despite limited evidence regarding their benefits and effectiveness. Although deprescribing approaches are established in adults, structured paediatric strategies remain poorly defined.

Aims

To identify and evaluate clinical practice guidelines (CPGs) on psychotropic deprescribing in youth, to describe and discuss recommendations regarding when and how to deprescribe in practice.

Methods

We systematically searched PubMed, Embase, PsycInfo, Scopus, Web of Science and grey literature (2015–2025). Two reviewers independently screened and evaluated the quality of the guidelines (AGREE II). We derived from this a psychotropic deprescribing algorithm in youth, supplemented with clinical expertise.

Results

Among the 1390 records identified, none strictly met the methodological criteria for formal CPGs. Nevertheless, we assessed two papers that provided practical deprescribing recommendations and shared several characteristics with CPGs. One systematic review focused on antidepressant discontinuation, recommending tapering after remission with gradual dose reduction and monitoring to distinguish withdrawal from relapse. One narrative review provided child-specific guidance for stimulants, recommending reassessment and possible discontinuation after 1 year of stability. Both were rated as ‘moderate’ using the AGREE II tool and provided limited practical detail on stepwise deprescribing procedures.

Conclusion

Critical gap and urgent need for paediatric-specific deprescribing guidelines. We propose an expert-informed stepwise deprescribing algorithm.