Deprescribing

Understanding
Deprescribing

Medicines are usually started for good reasons. Over time, some stop helping or begin to cause harm. Deprescribing is the careful review of those medicines, and reducing or stopping one when that is the safer choice.

What is Deprescribing

More Than a
Tapering Algorithm

Deprescribing is the planned and supervised process of reducing or stopping a medication that may be causing harm or is no longer providing benefit. Initially associated with elderly care, its importance is now recognised across the lifespan and across medical specialties.

Algorithms exist for tapering benzodiazepines, opioids, and antidepressants, but they often don't account for the full complexity of polypharmacy, and they can fall short when applied rigidly, without clinical judgement.

Success in deprescribing often depends on more than a dosing schedule; relational factors can matter as much as pharmacological ones.

Related Resources
Patient info sheet → Clinician reference → Referral for GPs → What to expect →

Relational Principles

The following relational principles can shape whether a deprescribing process goes well, especially in complex, long-standing polypharmacy where standard protocols have already fallen short.

Each is supported by the references listed below.

Therapeutic AllianceA trusting, safe relationship between patient and clinician, shaped in part by attachment style, is an important foundation for deprescribing.[1][2][11]
Continuity of CareConsistent, ongoing clinical relationships can reduce dropout and improve outcomes over time.[3][4]
Understanding Personal MeaningPatients often attach deep significance to their medications. Acknowledging this can help build readiness for change.[5][6]
Recovery-Goal ExplorationDeprescribing is more likely to be effective when aligned with what the patient actually wants their life to look like.[7][8][9]
Flexibility in ApproachIn complex polypharmacy, rigid protocols can fall short. Clinical judgement and adaptability matter.[7][9][10]
A note on appropriate polypharmacy Not all polypharmacy is a problem, and deprescribing is not the right answer for every patient or every medication. Some combinations are carefully calibrated and clinically necessary; reducing them without good reason can destabilise well-controlled conditions. The decision to deprescribe should be weighed against the risk of not doing so, and made together with the patient. The goal is not a shorter list; it is a safer, more effective one.
  1. Totura et al. (2018). Therapeutic relationship & psychopharmacology. Psychiatr Serv.
  2. Zilcha-Mano et al. (2019). Alliance & expectancy in treatment. Front Behav Neurosci.
  3. Lampe et al. (2023). Continuity of care & polypharmacy. Drugs Aging.
  4. Maarsingh (2024). Wall of evidence for continuity of care. Ann Fam Med.
  5. Tutter (2006). Medication as object. J Am Psychoanal Assoc.
  6. Fain et al. (2008). Psychotropic medication & object relations. Int J Group Psychother.
  7. Scott et al. (2015). Reducing inappropriate polypharmacy. JAMA Intern Med.
  8. Reeve et al. (2013). Patient barriers to deprescribing. Drugs Aging.
  9. Reeve et al. (2014). Patient-centred deprescribing process. Br J Clin Pharmacol.
  10. Goldberg et al. (2026). Deprescribing psychotropics consensus. JAMA Netw Open.
  11. Monteiro de Castro et al. (2026). Attachment-informed psychopharmacology in psychiatric care. Br J Psychiatry.