Deprescribing is not synonymous with denying treatment; it’s about enhancing holistic, client-centred care. This article explores how therapists can support deprescribing.
Related articles: Neurodiversity, Neurodivergence and Being Neurotypical, Using Cognitive Behavioural Therapy (CBTp) to Treat Psychosis, Treating Generalised Anxiety with Motivational Interviewing.
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Introduction
Mental health professionals often work with clients prescribed multiple psychotropic medications. While these medications can be life-changing, overprescription or prolonged use without review can result in adverse effects, dependency, or polypharmacy—especially among older adults and clients with comorbid conditions. In recent years, the concept of deprescribing has gained attention as a structured and patient-centred approach to reduce or cease medications that may no longer be beneficial or may be causing harm (Reeve et al., 2014).
Although deprescribing is primarily initiated by medical prescribers, mental health professionals play a crucial role in supporting the psychosocial and behavioural components of this process. This article explores the benefits and challenges of deprescribing, offers therapeutic strategies, and provides detailed clinical vignettes and scripts to aid therapists in effectively supporting clients through medication reduction or discontinuation.
What is deprescribing?
Deprescribing is the process of tapering, reducing, or stopping medications that may no longer be necessary, are potentially inappropriate, or are causing adverse effects (Scott et al., 2015). It is a collaborative and planned intervention, guided by ongoing clinical assessment and shared decision-making among the client, prescriber, and other care providers, including mental health clinicians.
Deprescribing is not synonymous with denying treatment. Instead, it aims to optimise medication regimens, improve quality of life, and reduce the risk of harm associated with unnecessary or excessive pharmacological treatment.
Common triggers for deprescribing include:
- Ineffectiveness of medication
- Adverse side effects
- Drug-drug interactions
- Polypharmacy
- Client preference to explore non-pharmacological options
- Improvement or resolution of the original condition
The role of mental health professionals
Although clinicians such as psychiatrists and GPs have prescriptive authority, therapists can advocate for clients, provide psychoeducation, monitor psychological responses to medication changes, and offer behavioural and emotional support during deprescribing. Importantly, they can help ensure that clients are not left unsupported when reducing medications that have had a significant psychological impact.
Therapists can also help clients explore their beliefs and fears around medication discontinuation, manage withdrawal symptoms, and develop non-pharmacological coping strategies.
Clinical benefits of deprescribing
Understanding the full scope of deprescribing requires an appreciation for both its physiological and psychological impacts. Benefits are not limited to the alleviation of side effects or physical symptoms. For many clients, deprescribing can be an empowering process that validates their progress and reinforces autonomy in their mental health journey. The benefits outlined below underscore the importance of approaching deprescribing as a therapeutic opportunity, rather than a risk to be avoided.
- Physical and cognitive improvements: Deprescribing, particularly in older clients, has been associated with improvements in cognitive function, balance, and sleep, especially when reducing benzodiazepines or anticholinergic medications (Tannenbaum et al., 2014).
- Reduction in polypharmacy risks: Multiple medications increase the risk of adverse events, including falls, confusion, and hospitalisation. A reduction in medications reduces these risks and may simplify treatment regimens, improving adherence (Page et al., 2016).
- Psychological empowerment: When done collaboratively, deprescribing can restore a sense of agency and autonomy to clients, particularly those who feel dependent on medication for emotional regulation or functioning.
Therapeutic interventions and approaches
Supporting clients through deprescribing requires more than just behavioural strategies—it demands a holistic understanding of each individual’s psychological, relational, and contextual realities. The interventions outlined in this section highlight the importance of building trust, addressing ambivalence, reinforcing self-efficacy, and integrating tailored therapeutic modalities to promote sustainable change.
Motivational interviewing (MI)
Motivational interviewing is a client-centred approach that can explore ambivalence about medication use. It is particularly useful when clients are uncertain about stopping medication due to fear of relapse or withdrawal.
MI script example:
Therapist: “On one hand, it sounds like the medication helped during a difficult period. On the other, you’re wondering if you still need it. What would feel different for you if you were able to manage without it?”
Client: “I’d feel more like myself, but I’m scared I won’t cope.”
Therapist: “That’s understandable. Let’s explore what coping might look like, and how we can support you along the way—even if the medication is gradually reduced.”
Useful MI resource: Motivational Interviewing: Quick Clinical Guide.
Case Illustration: Anna, Age 28, Generalised Anxiety Disorder
Anna has been taking a benzodiazepine for daily anxiety for two years. She expresses a desire to “not feel foggy” and to rely on non-drug strategies. Through MI, her therapist helps Anna weigh the pros and cons of continuing her medication. Together, they develop a plan to increase her CBT-based skills while liaising with her psychiatrist to initiate a slow taper. The therapist continues to monitor her emotional regulation and reinforces behavioural strategies throughout.
Psychoeducation and reframing
Clients may associate medication with safety and fear withdrawal effects. Psychoeducation involves providing accurate, non-judgmental information about what to expect during deprescribing, including common symptoms, timelines, and rebound effects.
Example therapist script:
“Some people experience a return of symptoms when reducing a medication—not because they ‘need’ it forever, but because the brain takes time to re-adjust. It’s not a sign of failure. Think of it like training a muscle that hasn’t been used in a while.”
Behavioural activation and coping skills
In parallel with medication reduction, therapists can teach or reinforce skills such as relaxation, mindfulness, and behavioural activation. These can buffer the return of symptoms and offer alternatives to reliance on pharmacotherapy.
Case illustration: Robert, Age 54, Depression and Sleep Difficulties
Robert was prescribed antidepressants and sleeping tablets following a divorce and job loss. Now employed and emotionally stable, he wants to reduce medication. The therapist collaborates with his GP and uses behavioural activation to strengthen mood stability while introducing CBT-I (Cognitive Behavioural Therapy for Insomnia) to manage sleep. As medication is slowly reduced, Robert is taught progressive muscle relaxation and sleep hygiene strategies to maintain gains.
Relapse prevention planning
Therapists can help clients prepare for setbacks, offering clear plans for how to respond if symptoms re-emerge, without assuming that medication needs to be resumed immediately.
Here’s a relapse prevention template:
- Early warning signs: e.g., sleep disruption, irritability.
- Coping strategies: journalling, therapist check-ins, mindfulness apps.
- Support team: GP, therapist, family member.
- Reassessment criteria: Symptoms persisting > 2 weeks and interfering with functioning.
Liaison with prescribers
Collaboration with prescribers is essential. Therapists should not recommend stopping medication without medical consultation but can act as advocates for the client’s preferences and progress.
Therapist-prescriber communication example:
“I’m writing with [client’s] consent to share that they’ve been discussing a desire to taper their SSRI. They’ve been demonstrating stable mood in therapy for over three months, using multiple self-regulation strategies. We would like to collaborate with you on a safe taper plan.”
Narrative therapy approaches
Some clients perceive themselves through the lens of their diagnosis and prescription. Narrative therapy can help separate identity from medication use.
Therapist prompt:
“How would you describe yourself before you began taking this medication? What would you like to reclaim about that version of you?”
Deprescribing in the context of neurodiversity
Neurodivergent clients—such as those with autism, ADHD, or intellectual disability—often face complex medication regimes aimed at reducing behaviours perceived as problematic. Yet, some of these medications are prescribed off-label, continued long-term without review, or used in lieu of environmental and therapeutic interventions.
Mental health professionals supporting neurodivergent clients must approach deprescribing with enhanced sensitivity to communication needs, self-advocacy challenges, and behavioural interpretations. A neurodiversity-affirming framework emphasises respect for difference and autonomy rather than “fixing” behaviour.
Clinical tip:
When supporting deprescribing in neurodivergent clients, clinicians should:
- Involve support networks (family, support workers, speech therapists) in the discussion.
- Use accessible communication tools (e.g., visuals, simplified scripts).
- Reinforce the individual’s strengths and preferences.
- Monitor for not only withdrawal symptoms but also emotional expression that may have been muted by the medication.
Case Illustration: Maya, Age 16, Autistic
Maya was prescribed risperidone at age 10 to manage “aggression” in school. Six years later, she reports emotional numbness and fatigue. Her therapist, using a neurodiversity-affirming approach, explores Maya’s sensory needs and helps her reframe her past behaviour as communication. With her consent and family support, her psychiatrist begins a tapering plan. During this time, her therapist introduces sensory integration strategies and assertiveness training. Maya begins to reclaim emotional expression and greater autonomy in her care.
Ethical considerations, risks, and challenges
Mental health professionals have an ethical responsibility to support deprescribing within the boundaries of their role. While they (except for psychiatrists) cannot initiate or alter medication regimens independently, they are essential in ensuring that the process is psychologically safe and respectful of client autonomy. Ethical deprescribing support requires transparency, collaborative planning, and careful monitoring.
- Scope of practice: Therapists must not direct clients to stop medication but can support informed decision-making.
- Consent and autonomy: Support clients in making autonomous choices, even when those choices involve continuing medication.
- Harm reduction: Monitor for psychological or physical instability during the deprescribing process and liaise as necessary.
- Cultural sensitivity: Acknowledge different cultural beliefs about mental illness and medication. For some clients, medication is seen as essential to dignity or spirituality, while others may feel shame or stigma attached to taking psychotropics.
Despite its benefits, deprescribing is not without challenges. Clients may experience distress, uncertainty, or re-emergence of symptoms. The therapeutic relationship must provide a container for these experiences, validating and preparing clients while offering hope and evidence-based alternatives.
- Withdrawal symptoms: Anxiety, insomnia, mood swings, and physical symptoms are common. Therapy must address these as legitimate and manageable.
- Fear of relapse: Address catastrophic thinking and equip clients with alternative regulation strategies.
- Therapeutic rupture: Some clients may interpret therapist support for deprescribing as judgment or coercion. Emphasise collaborative, non-directive care (Norton et al, 2023).
Conclusion
Deprescribing is a complex but essential component of modern mental health care. While prescribers direct the pharmacological aspects, mental health professionals have an indispensable role in supporting the behavioural, emotional, and psychological facets of the process. By integrating techniques like motivational interviewing, psychoeducation, behavioural activation, and narrative therapy, clinicians can empower clients to explore their relationship with medication and make informed, supported choices about their care.
With compassion, competence, and collaborative practice, mental health professionals can reduce stigma, foster agency, and promote healthier, more autonomous lives for their clients.
Key takeaways
- Deprescribing involves safely reducing or stopping medications that may no longer be necessary or are causing harm.
- Mental health professionals are vital in supporting clients through the emotional and behavioural aspects of deprescribing.
- Techniques such as motivational interviewing, psychoeducation, behavioural activation, and narrative therapy enhance outcomes.
- Collaboration with prescribers is essential for ethical and safe practice.
- Therapists must maintain boundaries around their scope, ensuring that support is client-led and medically guided.
Questions therapists often ask
Q: How do I decide whether deprescribing is genuinely in a client’s best interest rather than simply reducing medication burden?
A: Start with the client’s goals and current symptom profile, not the abstract idea of “fewer meds is better.” The article emphasises looking for medications that are no longer effective, causing adverse effects, or interacting poorly with others. If the drug isn’t improving functioning or quality of life, that’s your cue to explore tapering. The rationale must be clinical, collaborative, and grounded in shared decision-making rather than ideology.
Q: What’s the most clinically sound way to introduce deprescribing to a client who is anxious about medication changes?
A: Anchor the conversation in safety and collaboration. The article highlights normalising the fear (“Many people worry about changes because their meds helped at tough points”) and framing deprescribing as a structured, gradual trial rather than a leap into the void. Emphasise monitoring, clear contingency plans, and the reversibility of the process. Clients tolerate change better when the plan feels controlled and reversible.
Q: How do I work effectively with prescribers when I’m not the one managing medication?
A: Treat the prescriber as a teammate rather than a gatekeeper. The article stresses sharing observations of side-effects, functional impairment, or diminished efficacy with concise clinical evidence. Offer behavioural data, not opinions. A coordinated plan—roles, timelines, review points—keeps everyone aligned and reduces client confusion. Good communication reduces the classic problem of the client getting mixed messages from different professionals.
Q: What should I monitor during a taper to catch problems early without over-pathologising normal adjustment effects?
A: Track baseline symptoms before the taper and use that as your comparison point. The article recommends monitoring functional capacity, mood stability, sleep changes, emerging withdrawal signs, and any resurgence of the original target symptoms. Mild fluctuations are expected; what matters is the trajectory. Escalation, prolonged destabilisation, or functional decline are your signals to pause, slow, or reverse the taper.
Q: What do I do when the client wants to deprescribe for reasons that aren’t clinically sound (e.g., stigma, pressure from family, social media influence)?
A: The article redirects therapists to explore the meaning behind the wish to stop medication rather than reacting to the content. Validate the concerns, then work through the potential risks and benefits using a structured discussion: what problem are they trying to solve, and will deprescribing address it? If not, help the client identify other strategies while keeping medication decisions grounded in evidence and safety. The aim is to protect autonomy while ensuring decisions aren’t driven by misinformation or external pressure.
References
- Norton, J. D., Zeng, C., Bayliss, E. A., Shetterly, S. M., Williams, N., Reeve, E., Wynia, M. K., Green, A. R., Drace, M. L., Gleason, K. S., Sheehan, O. C., & Boyd, C. M. (2023). Ethical Aspects of Physician Decision-Making for Deprescribing Among Older Adults With Dementia. JAMA network open, 6(10), e2336728. https://doi.org/10.1001/jamanetworkopen.2023.36728
- Page, A. T., Potter, K., Clifford, R., & Etherton-Beer, C. (2016). Deprescribing in older people. Maturitas, 91, 115–134. https://doi.org/10.1016/j.maturitas.2016.06.006
- Reeve, E., Shakib, S., Hendrix, I., Roberts, M. S., & Wiese, M. D. (2014). Review of deprescribing processes and development of an evidence-based, patient-centred deprescribing process. British journal of clinical pharmacology, 78(4), 738–747. https://doi.org/10.1111/bcp.12386
- Rydzewska, E., Hughes-McCormack, L. A., Gillberg, C., Henderson, A., MacIntyre, C., Rintoul, J., & Cooper, S. A. (2018). Prevalence of long-term health conditions in adults with autism: observational study of a whole country population. BMJ open, 8(8), e023945. https://doi.org/10.1136/bmjopen-2018-023945
- Scott, I. A., Hilmer, S. N., Reeve, E., Potter, K., Le Couteur, D., Rigby, D., Gnjidic, D., Del Mar, C. B., Roughead, E. E., Page, A., Jansen, J., & Martin, J. H. (2015). Reducing inappropriate polypharmacy: the process of deprescribing. JAMA internal medicine, 175(5), 827–834. https://doi.org/10.1001/jamainternmed.2015.0324
- Song M, Rubin BS, Ha JW, Ware RS, Doan TN, Harley D. Use of psychotropic medications in adults with intellectual disability: A systematic review and meta-analysis. Aust N Z J Psychiatry. 2023 May;57(5):661-674. doi: 10.1177/00048674221149864. Epub 2023 Jan 26. PMID: 36700564.
- Tannenbaum, C., Martin, P., Tamblyn, R., Benedetti, A., & Ahmed, S. (2014). Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA internal medicine, 174(6), 890–898. https://doi.org/10.1001/jamainternmed.2014.949