Deprescribing Antipsychotic Medications in Psychotic Disorders: How and Why?

Abstract

Background: Standard guidelines for the management of chronic psychoses recommend the rapid initiation of treatment with antipsychotic medications (APs) and often, indefinite continuation. Ongoing treatment with APs is based primarily on evidence from AP discontinuation studies, which have several crucial flaws. Due to this equivocal evidence for continued treatment with APs and owing to their serious side effects, there is a critical need for considering controlled reduction and/or discontinuation of APs in persons with chronic psychoses. Discussion and Conclusion: Deprescribing has been defined as the systematic process of medication reduction and or discontinuation when current or potential harms outweigh current or potential benefits, taking into account a patient’s medical condition, functional status and their values and preferences. In this paper, we utilize the framework of deprescribing to answer the questions of why and how to reduce and/or discontinue treatment with APs. We first approach the complex issue of assessing the risk-benefit ratio of APs by examining the evidence for their continued benefit and their side effects. We emphasize deprescribing as a patient-centered process, using shared-decision making, psychosocial interventions and a flexible approach while prescribing. Finally, we present some of the limitations and challenges of using this approach in AP reduction and discontinuation.