Submission of symposium abstract for ANCIPS 2022 Topic - Deprescribing in psychiatry: What the practitioner needs to know?

Deprescribing, a term originally used in geriatric medicine, refers to the systematic process designed to identifying and optimize (taper or cessation) those medications for whom, the benefits no longer outweigh the risks. The concept has been gaining traction in mental health; this may be owing to an increasing appreciation of the dynamic nature of the risk-benefit considerations, involved in prescribing psychotropic medications, over time. The process of deprescribing has intricate links with the psychosocial context of pharmacotherapy and, in a way, seeks to unify the two. Emerging literature in mental health suggests the need for anchoring deprescribing practices in a shared decision-making model involving patients, practitioners, and other stakeholders. Today’s psychiatrists must be equipped to analyze and discuss the changing risk-benefit considerations as well as prepare a plan to deal with relapses/withdrawal following cessation or taper of drugs. It is in this context that the present symposium will critically examine the relevance of deprescribing in psychiatry. We will discuss the pros and cons as well as the various indications for deprescribing in psychiatry. We will present an evidence-based framework for implementing deprescribing in psychiatry; this framework emphasizes the individualization of risk-benefit analysis which is both medication specific and time specific for a given patient. Finally, we will end with an overview of ethical challenges, documentation, and medico-legal concerns around the process of deprescribing. Additionally, we discuss how deprescribing may also offer a framework for renewed research into the practice of chronic psychotropic use. Proposed topic division 1.Introduction to deprescribing: Why we need to deprescribe in Psychiatry? – Dr Sai Krishna Tikka; 2.Indications for deprescribing in Psychiatry and its pros and cons – Dr Siddharth Sarkar; 3.Implementing deprescribing in Psychiatry: A seven step approach – Dr Vikas Menon; 4.Ethical challenges, documentation, medico-legal concerns, and future directions – Dr Susanta Kumar Padhy.