A deprescribing movement aimed at helping patients quit psychiatric medications on their own has been rising in popularity the last few years, leaving some leaders looking for ways to change prescription methods.
The movement began about 25 years ago with peer-support groups forming around withdrawing from psychiatric medications. These small groups turned into websites and online forums where people shared information about how to taper off medications, sometimes with reductions so small they require syringes or precision scales.
Recently, psychiatry has caught up to the movement and begun working to meet the need for patients wishing to get off their medication with safer methods. Some health groups have also taken updated guidance to acknowledge withdrawal and recommend regular reviews to discontinue unnecessary medications.
Moira Rynn, MD, interim co-division director of behavioral medicine and neurosciences and chair of psychiatry and behavioral sciences at Durham, N.C.-based Duke Health, told Becker’s she has seen many patients who deprescribe themselves without medical supervision.
“A lot of it is being driven by questions around psychiatric medications, or a desire to pull back and take more control over healthcare decisions,” Mason Turner, MD, senior medical director for the behavioral health clinical program at Salt Lake City-based Intermountain Health, told Becker’s.
Becker’s reached out to a dozen psychiatric leaders across the nation, but only a few said they had heard of the movement. Those who were familiar with it said they learned about the movement mostly through social media, patient requests and a New York Times report published in March.
The movement has grown more prominent in recent years, partly due to overprescribed psychiatric medications and limited follow-up availability.
“The trend makes sense as psychiatric medications, in general, are overprescribed,” Sahil Munjal, MD, program director psychiatry residency at Wake Forest (N.C.) Baptist Medical Center, told Becker’s. “Patients with complex psychiatric histories often accumulate multiple medications over time and many express frustrations that discussions about stopping were not discussed when these were started. The field has not done a good job of studying withdrawal of psychiatric medications very well and many patients are turning to online communities for advice on how to tackle it.”
This can be further complicated by the number of professionals who are able to prescribe psychiatric medication, including primary care physicians and specialists, Dr. Rynn said. Although these other providers are well-positioned to prescribe, issues can arise if patients cannot get regular follow-up appointments to discuss drug side effects and deprescribing.
This is compounded by more patients who want to take an active role in medical decision-making, especially since the pandemic, Dr. Turner said.
“Patients want a bigger say in their behavioral health decisions,” he said. “If we view the deprescribing movement in that context, it helps explain where this is coming from.”
What systems should take away
This rising deprescribing movement has many leaders pushing for reform in how medications are discussed and prescribed. Here are three things systems can change:
Dr. Munjal: “Polypharmacy can often take place due to fragmented care, lack of coordination and time pressures, highlighting the need to fix these systematic barriers. Electronic health records could alert long-term medication use and prompt regular reassessment. There is a need to develop standard protocols for gradual taper and billing codes for patient messaging pertaining to this. Educators like myself must teach the importance of deprescribing as a part of pharmacologic knowledge to our trainees. More funding should be allocated in studying deprescribing just as rigorously as prescribing. Having diversity in formulations, including liquid and multiple lower-strength dosages, makes the case for an easier taper, which could be done by coordinating with a compounding pharmacy.”
Dr. Turner: “What we can learn — as leaders and healthcare providers — is the importance of bringing the patient’s voice into treatment decisions. When a patient considers deprescribing without medical advice, it’s essential to have that conversation. Talk with the prescribing physician about the goals of the medication, the reasons for wanting to stop, and how to do so safely. If someone is determined to pursue this, we need to engage them, understand their reasoning and support them. It’s about putting the patient back in the driver’s seat, while still guiding them with sound medical advice on how their decisions will impact their overall health and wellness.”
Dr. Rynn: “I wonder if the issue is tied to how our healthcare system is structured. Ideally, I’d like to see medication management include more time with providers to have these conversations, but often, that’s not possible. We can do all the education we want, but when people report on these patterns across different groups, I find myself frustrated by how little of it is systematically studied. It would be really helpful to formally study this, to understand the actual issues and challenges, rather than relying on anecdotal reports. Some people may not do well, but we don’t have enough reliable data. Unless we study this systematically, we can’t know for sure.”
