Deprescribing Antipsychotic Medications

This chapter discusses some of reasons for considering a deprescribing intervention with neuroleptic medications, including clear instances such as irrational antipsychotic polypharmacy and off-label use, as well as other situations driven by stakeholder pressures or medical comorbidity. The indefinite prescription of antipsychotic medications for psychotic disorders such as schizophrenia is commonly considered a recommended practice, although some uncertainty remains. The confidence of treatment recommendations also hinges on the accuracy of diagnoses—syndromes and classifications which typically evolve over time. This chapter describes a collaborative process of decision-making about the long-term use of antipsychotic medications as many patients wishing to attempt to decrease or discontinue these medications may do so without support of the prescriber, risking harm. The ability of current data to identify which patients may need long-term medication management versus those who may not is lacking. Considering the potential serious neurological and metabolic side effects of these medications, a patient’s preferences versus risks must be carefully weighed. Nonpharmacological interventions that may support the reduction of antipsychotic medications (but should not yet be presented as validated alternatives, alone) include psychoeducation, strategies for early identification and management of relapse, cognitive behavioral therapy for psychosis, and open dialogue are reviewed. The process is illustrated by case examples at the end of the chapter.