Deprescribing
Every medication should earn its place.
Deprescribing is the planned, supervised work of reducing or stopping a medication once it has stopped helping, or once the reason it was started no longer holds. Reviewing what you take is part of ordinary care here, not an afterthought.
A gradual taper. The steps get smaller as the dose gets lower, because the last stretch is where people feel the most, so we slow down through it.
What it is
Planned, supervised, and reversible.
Over years of treatment, often with different providers along the way, medications can accumulate. Some keep doing important work. Others stop helping, or start causing problems that outweigh what they give, or simply outlast the reason they were prescribed. Deprescribing is the deliberate process of finding those and easing them out, safely.
It is not quitting cold turkey, and it is not a verdict that you were overtreated. Sometimes the honest answer, after a careful look, is to leave a medication exactly as it is. The point is to keep asking the question rather than letting a prescription run on by default.
What deprescribing is
A planned reduction, taken one step at a time, tracked with your symptoms, decided together, and paused or reversed whenever it needs to be.
What it isn't
Stopping abruptly, doing it on your own, or a push to be medication-free when a medication is genuinely keeping you well.
When it makes sense
A medication becomes a candidate when the balance shifts.
None of these means a medication has to go. Each is a reason to take a closer look, together.
The symptom it was meant to treat hasn't meaningfully changed, even after a fair trial at a real dose.
It once helped but no longer does, and raising the dose hasn't brought the benefit back.
Weight gain, sedation, or movement problems have started to take more than the medication returns.
You're taking more than one medication that works the same way, without added benefit from the overlap.
It was started for something where medication isn't first-line. Some anxiety, PTSD, and personality-related conditions fit here.
You've had a long, steady stretch of remission, and staying on it indefinitely isn't necessary for you.
How we do it
Slowly, one change at a time.
Most tapers happen over months. Some run longer than a year. Going slowly is what keeps the process comfortable and safe.
List everything, and why
We write down each medication you take and the reason it's there. A surprising amount of clarity comes from just seeing the whole picture.
Weigh benefit against burden
For each one, we look honestly at what it's giving you and what it's costing, in side effects, in interactions, in daily life.
Start where it's easiest
We begin with the medication offering the least and carrying the lowest withdrawal risk, so the first step is a gentle one.
Taper by shrinking steps
The dose comes down in stages, and the reductions get smaller as the dose gets lower. That final stretch is eased through, not rushed.
Watch closely, adjust as we go
Visits get more frequent during a taper. We track your symptoms as we move, and we can slow down, pause, or step back up at any point.
One change at a time
If something shifts, we know exactly what caused it, never guessing between two moves at once.
Decided together
You set the pace. Nothing changes without your say, and you can bring a partner or someone you trust into the conversation.
Therapy alongside
Pairing a taper with therapy, for sleep, anxiety, or coming off a benzodiazepine, improves how it goes.
Measured, not assumed
We use symptom tracking to tell real progress from the ordinary bumps of a dose change.
What to expect
The dip is usually temporary.
Coming off a medication can bring some short-lived symptoms. With antidepressants that's often dizziness or nausea, sometimes brief electric-shock sensations, usually starting a few days after a change and easing within a couple of weeks. Fluoxetine, because it leaves the body slowly, rarely causes much at all.
These withdrawal effects are not the same as your original condition returning. Telling the two apart is a large part of my job, and going slowly keeps the symptoms mild enough to read clearly.
Some medications need extra care
Reducing isn't always the right move, and a few situations call for real caution:
- After three or more episodes of depression, staying on an antidepressant long-term is often the safer path.
- Bipolar I disorder generally calls for ongoing medication. A medication-free goal isn't safe here.
- If stopping something caused a relapse before, that history carries weight in what we decide.
- Lithium and benzodiazepines are never stopped abruptly, which is exactly why we taper them with care.
Please don't stop or change a psychiatric medication on your own. If one is bothering you, that's a conversation, not a solo decision.
Why we work this way
The slow approach is the evidence-based one.
Withdrawal symptoms in a paroxetine taper stretched over roughly nine months, compared with nearly 80% when it was stopped abruptly.
Adding therapy to a benzodiazepine taper roughly doubles the odds of coming off successfully and staying off.
Long-term benzodiazepine use raises the risk of hip fracture in older adults by about a third, one reason we revisit sedatives over time.
Boise Psychiatry
Wondering whether you're on the right amount?
Bring your medication list to your next visit, or reach out to start the conversation. We'll look at it together, and only change what's worth changing.
Start the conversation