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Deprescribing

deprescribing psychiatric medication

Deprescribing Psychiatric Medication: 6 Essential Steps

Deprescribing psychiatric medication is the planned, supervised process of reducing or stopping a medication when it is safe and clinically appropriate to do so. Sometimes the medication that once helped no longer does. Sometimes the side effects have come to outweigh the benefits. And sometimes people simply want to know whether they still need what they are taking. Doing it properly matters as much as starting a medication properly — and Mindora Health provides supervised deprescribing in Wollongong and by telehealth, without a waitlist.

When deprescribing psychiatric medication may be considered

Deprescribing may be worth discussing if:

You have tried multiple medications and the benefit has gradually lessened over time
You are experiencing side effects you find intolerable — weight gain, sedation, emotional blunting, sexual side effects or others
You have been stable for an extended period and want to explore whether the medication is still needed
You are taking several psychiatric medications and would like a review of whether all are necessary
You prefer non-pharmacological approaches and want to reduce medication as part of a broader plan
A medication was started during a crisis or a life event that has since resolved

Deprescribing is recognised as good clinical practice when done carefully. The Australian Deprescribing Network brings together clinicians and researchers working on exactly this — reducing medicines that are no longer providing benefit, safely and with the patient.

coming off antidepressants safely

Which medicines can be deprescribed?

We consider deprescribing psychiatric medication by class rather than by product, because the approach differs:

Antidepressants — the most common request. Many can be tapered successfully after a sustained period of recovery; some need a slower, more finely graded reduction than others because of discontinuation effects.
Sleep and anxiety medicines — including those with dependence potential. These need particularly careful, slow tapering and close monitoring, and are an area where our practitioner's addiction medicine background is directly relevant.
Antipsychotics and mood stabilisers — deprescribing psychiatric medication in these classes carries a higher relapse risk for some diagnoses. Reduction may still be appropriate — for example, where a medication was started for a short-term indication — but often requires psychiatrist involvement, and we will say so.

No medicine names are listed here deliberately; the right approach depends on your assessment, not the label.

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Investigations

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Treatment Planning

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Who deprescribing may not be suitable for

Deprescribing psychiatric medication is not appropriate for everyone, and we will be honest if we don’t think it is the right time. For some conditions — including bipolar disorder, schizophrenia and recurrent severe depression — continued medication is often the safest option, and stopping can lead to relapse with serious consequences. Recent instability, a recent hospital admission, high current stressors or limited supports can all make now the wrong moment even where the long-term goal is reasonable.

Decisions are individual, evidence-based and made with you, not for you. That is why every deprescribing request begins with a comprehensive assessment.

6 essential steps for deprescribing psychiatric medication safely

Comprehensive evaluation. A 60-minute in-person assessment in Wollongong: diagnosis, treatment history, current stability, risk factors, physical health, alcohol and other drug use, supports, and your reasons for wanting to reduce. Where indicated, investigations establish a baseline.
A shared decision. We discuss the likely benefits, the risks — including discontinuation symptoms and relapse — the alternatives, and what we would watch for. You decide, with our clinical advice. If our advice is to wait, we explain why and what would need to change.
A gradual, individualised taper. Dose reductions are planned in steps, usually slowly, with the pace set by how you respond rather than by a calendar. Reductions typically get smaller as the dose gets lower. Abrupt stopping is generally not advised for most psychiatric medications.

Close monitoring. Regular telehealth follow-ups — more frequent during the taper — to check for withdrawal effects and early signs of relapse. Prescriptions for the reduced doses are issued electronically.

A safety plan. What to do and who to contact if symptoms return, and an agreed plan to pause or reverse the taper if needed. Returning symptoms are information, not failure.
Non-pharmacological supports. Psychological strategies, sleep, exercise and lifestyle factors, and referral to psychology or other services to support you through and after the taper.

Your GP is kept informed with your consent, so that everyone involved in your care is working from the same treatment plan.

Discontinuation symptoms versus relapse

The two are often confused, and telling them apart is a core part of supervised deprescribing. Discontinuation symptoms tend to appear within days of a dose reduction, are often physical as well as emotional (dizziness, nausea, “brain zaps”, sleep disturbance, irritability), and usually settle as the body adjusts or if the previous dose is briefly restored. Relapse tends to emerge more gradually — weeks later — and looks like the original condition returning. Monitoring closely lets us respond to each correctly rather than guessing.

Our approach to deprescribing psychiatric medication

Nurse Practitioners prescribe — and deprescribe — within their scope of practice under the Nursing and Midwifery Board of Australia’s Nurse Practitioner Standards for Practice. Some medications and some conditions require psychiatrist involvement in a deprescribing decision, and we will tell you if that applies to you.

Deprescribing sits naturally with our practitioner’s research background in addiction medicine and in the care of people with co-occurring mental health and substance use problems (Merrick et al., 2022) — areas where careful, monitored medication decisions and honest conversations about dependence, tolerance and withdrawal are central to good care. We take the same evidence-based, whole-person approach to reducing medication as we do to starting it. And where the right answer is to continue, we say so and manage it through medication management. Read about our practitioner.

stopping antipsychotic medication safely

Fees

AppointmentDurationFeeMedicare rebate
Initial comprehensive assessment — evaluation and deprescribing plan60 min$250$117.20
Long follow-up — taper review and plan revision40 min$150$75.60
Standard follow-up — taper monitoring20 min$100$52.55
Brief follow-up — quick check-in during taper10 min$50$27.80

Frequently asked questions

(01) Can I just stop my antidepressant?
For most psychiatric medications, stopping abruptly is not advised; it can cause discontinuation symptoms and increase the risk of relapse. A supervised, gradual taper is the safer approach. Please speak to a clinician before making changes.
(02) How long does deprescribing take?
It varies widely — from weeks to many months — depending on the medication, the dose, how long you have taken it and how you respond. We go at the pace that is safe for you, and the pace can change.
(03) What if my symptoms come back during the taper?
That is exactly what the monitoring is for. We can slow, pause or reverse the taper. Returning symptoms are information, not failure, and they do not mean you can never reduce.
(04) Do you deprescribe all psychiatric medications?
We assess each request individually. Some medications and some conditions require psychiatrist involvement, and we will tell you if that applies to you.
(05) Will you tell me if you think I shouldn't stop?
Yes. An honest "not now, and here's why" is part of the service. Deprescribing is not suitable for everyone, and pretending otherwise would not be safe care.
(06) Do I need a referral?
No, though a referral and medication history from your GP or psychiatrist is very helpful.

Services

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