What is deprescribing?

Deprescribing is the planned, physician-supervised process of reducing or stopping medications whose current harms or burden may outweigh their benefit. It usually starts with a comprehensive medication review, followed by an individualized taper and close monitoring. It is a gradual, collaborative process rather than an abrupt stop.

Is deprescribing uncomfortable?

Deprescribing itself involves office visits and does not include any physical procedure. Reducing a dose can sometimes bring temporary discontinuation symptoms, such as dizziness, sleep changes, or irritability, which often ease over the following days to weeks. A slower, more gradual taper is generally used to keep any discomfort as mild as possible.

Is deprescribing safe?

Deprescribing is generally considered safe when it is planned and supervised by a qualified clinician, with a gradual taper and regular monitoring. It is not appropriate in every situation, and it is never done abruptly or without medical supervision. See the safety section above for specific risks and situations where it may not be recommended.

How long does deprescribing take?

The timeline is individualized and depends on the medication, how long it has been taken, and how a person responds. A single tapering step may span weeks, while a full plan often unfolds over several months and sometimes longer. Follow-up visits are typically more frequent during active tapering.

What should I expect during deprescribing?

The process usually begins with a comprehensive medication review and a shared decision about whether tapering is appropriate. If it is, the clinician designs an individualized, gradual taper and monitors closely to distinguish temporary withdrawal symptoms from a return of the underlying condition, adjusting the pace as needed.

Who may not be a candidate for deprescribing?

Deprescribing may not be appropriate for people with active, severe, or unstable illness or a recent relapse, or for conditions where long-term maintenance is often indicated, such as bipolar disorder, recurrent or severe depression, and psychotic disorders. In these situations continuing treatment is often the safer course. A thorough evaluation helps determine the right approach for each individual.

Deprescribing in San Francisco

Deprescribing is the planned, physician-supervised process of reducing or stopping medications whose current harms or burden may outweigh their benefit. In psychiatry it typically begins with a comprehensive medication review, followed by an individualized taper schedule, close monitoring to distinguish discontinuation symptoms from relapse, and shared decision-making between patient and clinician. It is a gradual, collaborative process – never an abrupt stop – and is often paired with psychotherapy and other support during tapering.

Mario A. Benitez-Lopez · Founder & Psychiatrist

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At a Glance

National survey data indicate that about one-third of U.S. adults in their 60s and 70s take five or more prescription medications, a pattern known as polypharmacy^[1]

Deprescribing is generally defined as the systematic process of identifying and reducing or stopping medications when their potential risks outweigh the benefits or the benefits are unclear^[3]

Research suggests at least half of people who stop an antidepressant may experience withdrawal symptoms, and a more gradual taper can help reduce their severity^[4]

A minority of people who stop long-term benzodiazepines may experience a protracted course of withdrawal symptoms, which is why slow, individualized tapering is generally recommended^[5]

Overview

Deprescribing is a structured, collaborative process in which a clinician and patient revisit an existing medication regimen to decide whether any drugs can be safely reduced or stopped. It applies when the balance of benefit and harm may have shifted over time – for example, when side effects accumulate, when several medications interact, or when a medication was continued long after the situation that prompted it has resolved.

In psychiatry, deprescribing usually starts with a comprehensive medication review that considers the original reason for each medication, how long it has been taken, the current symptom picture, and the person's own goals and preferences. The aim is not simply fewer pills, but a regimen that best matches the person's needs while minimizing avoidable burden.

Because the brain adapts to long-term medication, stopping too quickly can provoke withdrawal or rebound symptoms. For this reason deprescribing relies on an individualized taper – often a gradual, proportional (sometimes called hyperbolic) reduction for antidepressants and benzodiazepines – with regular check-ins to monitor how the person responds and to separate temporary withdrawal effects from a genuine return of the underlying condition.

Deprescribing is fundamentally a shared decision. It weighs the potential benefits of reducing medication against the risk of relapse, and it is not appropriate in every situation. For some conditions, ongoing maintenance treatment remains the safer course, and the decision to taper is revisited collaboratively rather than assumed.

What to Expect

Comprehensive medication review, including the reason for each medication, how long it has been taken, current symptoms, side effects, other prescriptions, and the person's goals.
Collaborative discussion of whether deprescribing is appropriate, weighing the potential benefits of reducing medication against the risk of relapse for the specific condition.
Shared decision-making and informed consent, covering what to expect, the difference between withdrawal and relapse, and the importance of not stopping abruptly on one's own.
Selection of which medication to address first when several are involved, typically one at a time, prioritizing the agent whose harms or burden are most likely to outweigh its benefit.
Design of an individualized taper schedule, often using gradual, proportional (hyperbolic) dose reductions for antidepressants and benzodiazepines rather than fixed equal steps.
Implementation of the first dose reduction, with clear guidance on what symptoms to watch for and how to stay in contact between visits.
Regular monitoring visits to assess tolerability, distinguish discontinuation symptoms from relapse, and decide whether to continue, slow, pause, or temporarily reverse the taper.
Provision of psychotherapy or other support during the taper to help manage symptoms and reinforce coping strategies.
Reassessment at the end of the process to confirm stability, document the outcome, and agree on a plan for follow-up or, if needed, reinstatement.

How does Deprescribing work?

Deprescribing works by carefully reversing the adaptations the brain and body make to long-term medication. Rather than reflecting a single drug action, it is a process built on comprehensive review, individualized dose reduction, and close monitoring over time.
The process begins with a medication review that maps each medication to its purpose, duration, and current benefit-versus-harm balance. Structured tools that clinicians may use to guide this review include criteria for potentially inappropriate medications, which help flag drugs that are commonly candidates for reduction in certain populations.
Tapering is central to how deprescribing is done safely. Many psychiatric medications are reduced gradually and proportionally – smaller and smaller steps as the dose gets lower, sometimes called a hyperbolic taper – so that the change the body must absorb at each step stays roughly even. This approach is often used for antidepressants and benzodiazepines to reduce withdrawal severity.
Throughout the taper, the clinician monitors for two distinct possibilities: temporary discontinuation (withdrawal) symptoms that tend to emerge soon after a dose reduction and ease over time, versus a genuine relapse of the underlying condition. Distinguishing between them guides whether to continue, pause, or adjust the taper.
Shared decision-making runs through the whole process. The clinician integrates clinical judgment with the person's values, goals, and lived experience, and psychotherapy or other support is often provided alongside tapering to help manage symptoms and reinforce coping strategies.

When It's Recommended

Polypharmacy or overmedication, where a person is taking multiple medications and the overall burden or interaction risk may outweigh benefit
Adverse effects, side effects, or drug interactions that are affecting quality of life
Medications continued past their original indication, such as a treatment kept long after the episode that prompted it has resolved
Sustained remission or stability where a clinician and patient wish to explore whether a medication can be reduced
A patient's informed preference to take fewer medications, explored within a supervised plan
Medications with limited or unclear ongoing benefit relative to their risks

Is a deprescribing right for you?

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Request a call Call (415) 857-3575

Recovery & Aftercare

Deprescribing is typically a gradual process that unfolds over weeks to many months, and sometimes longer for medications taken over long periods
Temporary withdrawal symptoms, when they occur, often emerge soon after a dose reduction and tend to ease over the following days to weeks
The pace is individualized and may be slowed, paused, or partially reversed based on how a person responds, rather than following a fixed timeline
Regular follow-up continues throughout and after the taper to confirm stability and to respond quickly if symptoms return
For some people, the outcome is a reduced regimen rather than full discontinuation, and for others continuing the medication remains the most appropriate choice

Alternative Treatments

Continuing the current medication regimen with ongoing monitoring, when its benefits still outweigh its burden
Dose optimization or switching to a different medication rather than stopping, when side effects are the main concern
Psychotherapy and other non-medication supports, which may be introduced or expanded during or in place of tapering
Lifestyle approaches such as sleep, exercise, and stress management as part of a broader treatment plan

Frequently Asked Questions

Deprescribing is the planned, physician-supervised process of reducing or stopping medications whose current harms or burden may outweigh their benefit. It usually starts with a comprehensive medication review, followed by an individualized taper and close monitoring. It is a gradual, collaborative process rather than an abrupt stop.
Deprescribing itself involves office visits and does not include any physical procedure. Reducing a dose can sometimes bring temporary discontinuation symptoms, such as dizziness, sleep changes, or irritability, which often ease over the following days to weeks. A slower, more gradual taper is generally used to keep any discomfort as mild as possible.
Deprescribing is generally considered safe when it is planned and supervised by a qualified clinician, with a gradual taper and regular monitoring. It is not appropriate in every situation, and it is never done abruptly or without medical supervision. See the safety section above for specific risks and situations where it may not be recommended.
The timeline is individualized and depends on the medication, how long it has been taken, and how a person responds. A single tapering step may span weeks, while a full plan often unfolds over several months and sometimes longer. Follow-up visits are typically more frequent during active tapering.
The process usually begins with a comprehensive medication review and a shared decision about whether tapering is appropriate. If it is, the clinician designs an individualized, gradual taper and monitors closely to distinguish temporary withdrawal symptoms from a return of the underlying condition, adjusting the pace as needed.
Deprescribing may not be appropriate for people with active, severe, or unstable illness or a recent relapse, or for conditions where long-term maintenance is often indicated, such as bipolar disorder, recurrent or severe depression, and psychotic disorders. In these situations continuing treatment is often the safer course. A thorough evaluation helps determine the right approach for each individual.

What are the risks of Deprescribing?

Who should avoid this

Active, severe, or unstable psychiatric illness, or a recent relapse, where continuing effective treatment is generally the priority
High relapse-risk conditions where long-term maintenance is often indicated – such as bipolar disorder, recurrent or severe major depression, and psychotic disorders including schizophrenia and schizoaffective disorder – where deprescribing may be inappropriate
Abrupt discontinuation is never appropriate for benzodiazepines, antidepressants, or mood stabilizers, because sudden cessation can cause withdrawal, rebound, or with some agents more serious effects
Recent suicidal ideation, self-harm risk, or other instability that could be worsened by changing an effective regimen
Situations where a medication continues to provide clear benefit that outweighs its burden
Absence of a monitoring plan or an inability to attend follow-up, since deprescribing requires supervision

Possible risks

Discontinuation (withdrawal) symptoms such as dizziness, flu-like sensations, insomnia, irritability, or sensory disturbances, which vary by medication and taper speed
Rebound symptoms, in which the original symptoms return, sometimes more intensely than before treatment
Relapse of the underlying condition, which can be difficult to distinguish from temporary withdrawal
Protracted withdrawal, a prolonged course of symptoms that a minority of people may experience after stopping long-term benzodiazepine or antidepressant use
With certain medications, abrupt or overly rapid reduction can cause serious effects, which is why supervised, gradual tapering is used
This is not an exhaustive list of potential risks; discuss any medication change with your prescribing clinician before making it

Your practitioner

Mario A. Benitez-Lopez, MD

I am a board-certified adult psychiatrist and the founder of San Francisco Concierge Psychiatry. I completed my psychiatry residency at the University of Washington and hold a master's in clinical research from Stanford. I offer bilingual (English and Spanish) care in a concierge model built around small panels and longer sessions, spanning medication management, deprescribing, and evidence-based individual and couples therapy.

Sources & references

This article draws on 6 sources, including government health agencies, peer-reviewed research.

Government & research

Medically reviewed by Mario A. Benitez-Lopez, MD · Last reviewed: 2026-07-26