Deprescribing in psychopharmacology: what is the risk versus reward?

INTRODUCTION: Deprescribing, the systematic reduction or discontinuation of psychotropic medications when risks outweigh benefits or treatment no longer serves its goals, has attracted increasing attention. However, empirical evidence and guidance remain limited across medication classes. AREAS COVERED: Building on recent consensus statements, this expert opinion examines unresolved questions: prioritizing deprescribing in complex regimens, distinguishing withdrawal or rebound from recurrence, adapting tapering schedules, defining success through symptoms and patient-centered functioning, and integrating psychosocial support, measurement-based care, and contingency planning. We propose a cross-diagnostic approach distinguishing dose optimization, discontinuation after goal attainment, harm reduction, discontinuation for inefficacy, polypharmacy rationalization, and personalized therapeutic approaches. EXPERT OPINION: Deprescribing should form part of recurring pharmacotherapy reassessment. A 'review and reconsider' stance supports evaluation of each medication's continuing purpose, benefits, and burdens. Although consensus supports regimen review, adherence assessment, monitoring, and shared decisions, clinicians differ regarding tapering pace, medication redundancy, and balancing relapse risk against long-term adverse effects. Individual circumstances preclude universal tapering rules. Decisions should specify why treatment is reconsidered, assess withdrawal and relapse risks, monitor symptoms and functioning, provide psychosocial support, and establish when to pause, reverse, or modify the plan. Medication continuation should likewise represent a documented, active therapeutic decision made with patients.