Landmark International Consensus Defines When and How to Safely Deprescribe Psychotropic Medications in Mood Disorders
Despite widespread use of long-term pharmacotherapy in mood disorders, clinicians have historically lacked clear guidance on when continued treatment may no longer be beneficial—or may even be harmful. This study directly addresses that gap by identifying clinical scenarios where deprescribing is appropriate, emphasizing that deprescribing is not synonymous with undertreatment, but rather reflects thoughtful, patient-centered medication optimization.
The study achieved consensus on 63% of evaluated clinical scenarios, underscoring both the emerging clarity and the persistent uncertainty in this domain.
Key clinical findings include that experts agree that antidepressants should be discontinued when adequate trials yield minimal benefit (≤25% improvement), initial treatment response cannot be recaptured after relapse, and multiple agents with overlapping mechanisms are used unnecessarily. At the same time, indefinite maintenance treatment is often warranted for patients with recurrent major depressive disorder (≥3 lifetime episodes), reflecting the high risk of relapse. The panel strongly endorsed deprescribing antidepressants in bipolar disorder when rapid cycling is present, mixed features emerge, and mania or hypomania develops. Importantly, antidepressant discontinuation is discouraged if prior cessation leads to relapse, highlighting the need for individualized decision-making. For patients with nonpsychotic mood disorders, experts favor discontinuing antipsychotics when significant weight gain or metabolic dysfunction occurs and tardive dyskinesia emerges. Notably, clinicians preferred removing the offending agent rather than adding medications to counteract side effects, signaling a shift away from “prescribing cascades.” A major consensus finding was that pursuing a fully medication-free state is generally inappropriate for bipolar I disorder, even after sustained remission, due to the high lifetime risk of recurrence. In contrast, opinions were more divided for bipolar II disorder, highlighting an important area for future research. There was strong agreement that benzodiazepines and “Z-drugs” should be deprescribed within 1–3 months whenever possible and long-term use should be avoided due to risks of dependence and adverse outcomes.
The study emphasizes that deprescribing is not an anti-medication stance, but rather a core component of precision psychiatry. Appropriate deprescribing reflects evolving illness trajectories, changing risk–benefit profiles, and avoidance of pharmacodynamic redundancy or harm.
Clinicians are encouraged to view deprescribing as a dynamic and collaborative process, undertaken with careful monitoring and shared decision-making.
This consensus provides a practical roadmap for clinicians by identifying clear clinical triggers for considering medication discontinuation, reinforcing the importance of individualized risk–benefit assessments, discouraging reflexive polypharmacy and prescribing cascades, and supporting long-term maintenance strategies when relapse risk is high.
At the same time, the study highlights critical evidence gaps, including the need for randomized discontinuation trials to better identify which patients can safely taper medications and when.
The authors underscore the urgent need for prospective deprescribing trials, predictors of successful medication discontinuation, and better characterization of patient subgroups who may benefit from reduced pharmacotherapy.
This study represents one of the largest international expert consensus efforts on psychotropic deprescribing to date, combining systematic literature review with structured Delphi methodology to generate clinically actionable guidance.
As psychiatric treatment increasingly emphasizes long-term management, this landmark study provides essential guidance to help clinicians strike the right balance between therapeutic benefit and medication burden. Thoughtful deprescribing, grounded in evidence and clinical judgment, emerges as a cornerstone of high-quality, patient-centered psychiatric care.
Journal Reference
Goldberg JF, Swartz HA, Mcintyre RS, et al. The American Society of Clinical Psychopharmacology (ASCP) task force on the deprescribing of psychotropic medications for mood disorders: Delphi expert consensus. Br J Psychiatry 2026; Mar 25:1-9. doi: 10.1192/bjp.2026.10580. Online ahead of print.
About ASCP
The American Society of Clinical Psychopharmacology (ASCP) is a professional organization dedicated to advancing the science, practice, and education of clinical psychopharmacology to improve the health and well-being of patients. ASCP serves a diverse membership of psychiatrists, researchers, and other mental health professionals across the USA and internationally, providing access to cutting-edge research, educational opportunities, and networking with leaders in psychiatric treatment. The organization publishes resources through its official journal, The Journal of Clinical Psychiatry, and hosts an annual scientific meeting that serves as a premier gathering for professionals in the field. For more information, visit ascpp.org.
Rachel DeAngelo
American Society of Clinical Psychopharmacology
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