What Is Deprescribing? A Guide to Reviewing Psychiatric Medications

Alternative to Meds Editorial Team
Medically Reviewed by Dr John Motl MD

What is deprescribing?

Deprescribing is the planned, supervised process of reviewing the medications you take, then reducing or stopping ones that may no longer be helping, or whose risks now outweigh their benefits.¹ It is a normal part of good medical care, not a rejection of it.

In psychiatry, deprescribing means taking an honest look at antidepressants, antipsychotics, benzodiazepines, mood stabilizers, sleep medications, and stimulants, one person at a time.² For some people the answer is a lower dose. For some it is fewer medications. For some it is coming off completely. And for some, the right answer is to stay on what they take.

“It wasn’t supposed to be forever”

Many people started a psychiatric medication during a hard season: a loss, a breakdown, a crisis, a stretch of sleepless nights. It may have helped. But somewhere along the way, a few months turned into years.

That is common. In the United States, about one in four people taking an antidepressant has taken it for 10 years or longer.³ Long-term use has grown steadily,⁴ and so has taking several psychiatric medications at once. Between 1996 and 2006, the share of psychiatry visits that ended with three or more psychiatric medications nearly doubled, from about 17% to 33%.⁵

Often, no one ever scheduled a check-in on whether the medication is still needed. If you’ve been on Cymbalta, Lexapro, Seroquel, or Xanax for years and wonder whether you still need it, that is a reasonable question to ask, and deprescribing is how it gets answered safely.

Psychiatric medication has a role

Deprescribing isn’t anti-medication. Psychiatric medications can be helpful and sometimes lifesaving, especially in a crisis, with severe symptoms, or when other approaches haven’t worked.

Stopping also carries real risks. In a large 2021 trial of people who felt well on long-term antidepressants, those who switched to a placebo relapsed more often (56%) than those who stayed on their medication (39%).⁶ Some of those “relapses” may have been withdrawal symptoms, but the point stands: coming off is a medical decision with trade-offs, best made carefully and with support.

That is why good deprescribing starts with a review, not a taper.

Who should consider a medication review?

A review is worth asking for if any of these sound familiar:

• It’s been years. You started for a specific reason, and that season of life has passed.
• You take several. One medication was added to treat the side effects of another, and the list kept growing.
• Side effects are wearing on you. Weight gain, emotional numbness, sexual side effects, fatigue, or brain fog.
• It isn’t working well anymore. The dose keeps going up, or symptoms have returned anyway.
• Your life has changed. Pregnancy plans, a new health condition, or new medications that interact.
• You’ve tried to stop before and withdrawal was too hard, so you went back on.

What a psychiatric medication review covers

A thorough review looks at the whole picture before anything changes:

• Why each medication was started, and whether that reason still applies.
• What it’s doing now: real benefits you notice, and side effects you live with.
• Interactions and duplicates, especially when several psychiatric medications are combined.
• Your physical health, including lab work (more on that below).
• Your history with dose changes, including any past withdrawal.
• Your goals, whether that’s a lower dose, fewer medications, or coming off completely.

The result is a plan: what to change first, what to leave alone, and how to tell if it’s working.

Why lab work and physical health belong in the review

Mental health and physical health are closely connected. Several common medical problems can cause or worsen symptoms like low mood, anxiety, fatigue, and poor concentration. They are worth checking, both before deciding a medication is needed and when reviewing one:

• Thyroid problems are linked with depression and anxiety.⁷
• Low vitamin D is associated with depression.⁸
• Low B12 or folate can affect mood and how well depression responds to treatment.⁹
• Iron deficiency is associated with higher rates of psychiatric conditions.¹⁰
• Blood sugar, hormones, and sleep all affect how you feel day to day.

This doesn’t mean every psychiatric symptom comes from a deficiency, or that supplements can replace needed treatment. They can’t. Some nutrients have research support as an addition to treatment, while many others don’t.¹¹ But finding and correcting a real problem, such as an underactive thyroid or a vitamin deficiency, can make a meaningful difference, and it can make a taper easier to tolerate.

Nutrition matters too. In one trial, adults with depression who improved their diet with support from a dietitian improved more than those who received social support alone.¹² Read more about blood tests for depression and anxiety and lab testing at ATMC.

How deprescribing is done safely

Every plan is individual, but safe deprescribing generally means:

• One change at a time, so it’s clear what is causing any new symptoms.
• Going slowly, with smaller reductions near the end, because of how these medications act on the brain at low doses.¹³
• Adjusting as you respond. If symptoms flare, the pace slows.
• Close monitoring of sleep, mood, and withdrawal symptoms.
• A plan if symptoms return, including when to pause or go back up.
• Support for what’s underneath: counseling, nutrition, sleep, and stress.

Stopping suddenly is what most often leads to severe withdrawal.¹⁴ If you take an antidepressant, our complete guide to coming off antidepressants explains what withdrawal can feel like and how long it lasts.

How ATMC approaches deprescribing

Alternative to Meds Center has specialized in medication tapering for nearly 20 years. Clients live at our residence in Sedona, Arizona, for about 60 days on average, with our clinical team on site. Each plan includes:

• A full review and lab work, including metabolic, liver and kidney function, blood count, thyroid, blood sugar, iron, hormones, cortisol, trace minerals, and amino acids.
• An individualized taper, with each dose step planned by our medical team, using half tablets or liquid preparations as needed.
• Daily support from medical and nursing staff who monitor symptoms, sleep, and mood, and adjust the plan.
• Nutrition and targeted supplementation based on your results, through our orthomolecular and naturopathic team.
• Counseling and comfort therapies such as massage, sauna, yoga, and acupuncture.

Not everyone comes off everything. Your goals guide the plan, and for many people the goal is being on less medication, or none, while feeling well. Learn more about our inpatient medication tapering.

Deprescribing at home vs. at ATMC

How to talk to your prescriber about deprescribing

You don’t need a crisis to ask. A few questions can open the conversation:

• “Why was I started on this, and does that reason still apply?”
• “How will we know if I still need it?”
• “Could any of my symptoms be side effects, or from something physical we haven’t checked?”
• “If we reduce it, how slowly would we go, and what would we watch for?”
• “What’s the plan if symptoms come back?”

Bring a list of everything you take, including supplements. If your prescriber isn’t comfortable helping you taper, it’s reasonable to look for one who is, or for a program that specializes in it.

Get help reviewing your medications

If you’ve been on psychiatric medication for years and it was never meant to be forever, you don’t have to figure out the next step alone. Our admissions team can talk through your situation and whether residential deprescribing is a good fit.

Deprescribing FAQs

Sources:

1. Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015 May;175(5):827-834. PMID: 25798731. [cited 2026 Oct 15]

2. Gupta S, Cahill JD. A Prescription for “Deprescribing” in Psychiatry. Psychiatr Serv. 2016 Aug;67(8):904-907. PMID: 26975524. [cited 2026 Oct 15]

3. Pratt LA, Brody DJ, Gu Q. Antidepressant use among persons aged 12 and over: United States, 2011–2014. NCHS Data Brief No. 283. National Center for Health Statistics. 2017. [cited 2026 Oct 15]

4. Mojtabai R, Olfson M. National trends in long-term use of antidepressant medications: results from the U.S. National Health and Nutrition Examination Survey. J Clin Psychiatry. 2014 Feb;75(2):169-177. PMID: 24345349. [cited 2026 Oct 15]

5. Mojtabai R, Olfson M. National trends in psychotropic medication polypharmacy in office-based psychiatry. Arch Gen Psychiatry. 2010 Jan;67(1):26-36. PMID: 20048220. [cited 2026 Oct 15]

6. Lewis G, Marston L, Duffy L, et al. Maintenance or Discontinuation of Antidepressants in Primary Care. N Engl J Med. 2021 Sep 30;385(14):1257-1267. PMID: 34587384. [cited 2026 Oct 15]

7. Hage MP, Azar ST. The Link between Thyroid Function and Depression. J Thyroid Res. 2012;2012:590648. PMID: 22220285. [cited 2026 Oct 15]

8. Anglin RE, Samaan Z, Walter SD, McDonald SD. Vitamin D deficiency and depression in adults: systematic review and meta-analysis. Br J Psychiatry. 2013 Feb;202:100-107. PMID: 23377209. [cited 2026 Oct 15]

9. Coppen A, Bolander-Gouaille C. Treatment of depression: time to consider folic acid and vitamin B12. J Psychopharmacol. 2005 Jan;19(1):59-65. PMID: 15671130. [cited 2026 Oct 15]

10. Chen MH, Su TP, Chen YS, et al. Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study. BMC Psychiatry. 2013 Jun 4;13:161. PMID: 23735056. [cited 2026 Oct 15]

11. Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta-analyses of randomized controlled trials. World Psychiatry. 2019 Oct;18(3):308-324. PMID: 31496103. [cited 2026 Oct 15]

12. Jacka FN, O’Neil A, Opie R, et al. A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Med. 2017 Jan 30;15(1):23. PMID: 28137247. [cited 2026 Oct 15]

13. Horowitz MA, Taylor D. Tapering of SSRI treatment to mitigate withdrawal symptoms. Lancet Psychiatry. 2019 Jun;6(6):538-546. PMID: 30850328. [cited 2026 Oct 15]

14. Warner CH, Bobo W, Warner C, Reid S, Rachal J. Antidepressant discontinuation syndrome. Am Fam Physician. 2006;74(3):449-456. [cited 2026 Oct 15]

Originally Published October 15, 2026 by Alternative to Meds Editorial Team

This content has been reviewed and approved by a licensed physician.

Dr. John Motl, M.D.

Dr. Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona.  He holds a Bachelor of Science degree with a major in biology and minors in chemistry and philosophy. He graduated from Creighton University School of Medicine with a Doctor of Medicine.  Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.

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Diane Ridaeus

Diane is an avid supporter and researcher of natural mental health strategies. Diane received her medical writing and science communication certification through Stanford University and has published over 3 million words on the topics of holistic health, addiction, recovery, and alternative medicine. She has proudly worked with the Alternative to Meds Center since its inception and is grateful for the opportunity to help the founding members develop this world-class center that has helped so many thousands regain natural mental health.