Deprescribing in San Francisco
Deprescribing is the planned, physician-supervised process of reducing or stopping medications whose current harms or burden may outweigh their benefit. It begins with a comprehensive medication review, moves to an individualized taper schedule, and depends on close monitoring to separate discontinuation symptoms from a genuine return of the underlying condition. It is gradual and collaborative, never an abrupt stop. I built much of my practice around this work. Patients often reach me already knowing they want to come off something, and because I provide the psychotherapy that supports a taper alongside the prescribing, the plan is never split across two clinicians who each see one half of it.
At a Glance
- National survey data indicate that about one-third of U.S. adults in their 60s and 70s take five or more prescription medications, a pattern known as polypharmacy[1]
- Deprescribing is generally defined as the systematic process of identifying and reducing or stopping medications when their potential risks outweigh the benefits or the benefits are unclear[3]
- Estimates of how often people experience discontinuation symptoms after stopping an antidepressant vary widely by medication, duration of use, and study method; a large 2024 meta-analysis found symptoms in about 31% of people stopping an antidepressant compared with 17% stopping placebo. A more gradual taper is generally recommended[5]
- A minority of people who stop long-term benzodiazepines may experience a protracted course of withdrawal symptoms, which is why slow, individualized tapering is generally recommended[6]
Overview
Deprescribing is a structured, collaborative process in which you and a clinician revisit an existing medication regimen and decide whether any drugs can be safely reduced or stopped. It may be considered when the balance of benefit and harm has shifted over time – for example, when side effects have accumulated, several medications interact, or a medication has continued long after the situation that prompted it has resolved.
In psychiatry, the process starts with a comprehensive review of why each medication was prescribed, how long you have taken it, your current symptoms, and your goals and preferences. The aim is not simply to reduce the number of pills. It is to arrive at a regimen that matches your current needs while limiting avoidable burden.
The brain adapts to medication taken over time, and reducing it too quickly can cause withdrawal or rebound symptoms. An individualized taper is therefore central to deprescribing. For antidepressants and benzodiazepines, this often involves gradual, proportional dose reductions, sometimes called a hyperbolic taper, with regular check-ins to assess your response and distinguish temporary discontinuation symptoms from a genuine return of the underlying condition.
Deprescribing is a shared decision that weighs the possible benefit of reducing medication against the risk of relapse. It is not appropriate in every situation. For some conditions, maintenance treatment remains the safer course, and the question of tapering can be revisited rather than assumed from the start.
What to Expect
- Comprehensive medication review, including the reason for each medication, how long it has been taken, current symptoms, side effects, other prescriptions, and your goals.
- Collaborative discussion of whether deprescribing is appropriate, weighing the potential benefits of reducing medication against the risk of relapse for the specific condition.
- Shared decision-making and informed consent, covering what to expect, the difference between withdrawal and relapse, and the importance of not stopping abruptly on your own.
- Selection of which medication to address first when several are involved, typically one at a time, prioritizing the agent whose harms or burden are most likely to outweigh its benefit.
- Design of an individualized taper schedule, often using gradual, proportional (hyperbolic) dose reductions for antidepressants and benzodiazepines rather than fixed equal steps.
- Implementation of the first dose reduction, with clear guidance on what symptoms to watch for and how to stay in contact between appointments.
- Regular monitoring visits to assess tolerability, distinguish discontinuation symptoms from relapse, and decide whether to continue, slow, pause, or temporarily reverse the taper.
- Provision of psychotherapy or other support during the taper to help manage symptoms and reinforce coping strategies.
- Reassessment at the end of the process to confirm stability, document the outcome, and agree on a plan for follow-up or, if needed, reinstatement.
How does Deprescribing work?
- Deprescribing carefully reverses adaptations that the brain and body make to long-term medication. It is not a single drug action. The process depends on a comprehensive review, an individualized series of dose reductions, and close monitoring over time.
- The medication review maps each drug to its original purpose, how long it has been taken, and its current balance of benefit and harm. Clinicians may also use structured criteria for potentially inappropriate medications to identify drugs that are commonly considered for reduction in certain populations.
- Many psychiatric medications are tapered gradually and proportionally. The reductions become smaller as the dose gets lower, an approach sometimes called a hyperbolic taper, so the size of the change the body has to absorb remains roughly even at each step. This approach is often used with antidepressants and benzodiazepines to reduce the severity of withdrawal.
- Monitoring focuses on two different possibilities. Discontinuation symptoms tend to appear soon after a dose reduction and ease over time. A relapse is a genuine return of the underlying condition. The distinction helps determine whether the taper continues, slows, pauses, or is adjusted.
- Clinical judgment is combined with your goals, values, and lived experience throughout the process. Psychotherapy or other support often runs alongside the taper to help manage symptoms and reinforce coping strategies. Here, I provide the prescribing and psychotherapy in the same appointment. A dose reduction and the related work on sleep, anxiety, or coping are planned together and adjusted together when either needs to change.
- A second opinion is also a normal reason to start. You may still be seeing the prescriber who began the medication and want another psychiatrist to review the full regimen before you make a decision. The review has value on its own, and asking for it is not a decision to taper.
- The medications I taper most often include antidepressants such as SSRIs, benzodiazepines, stimulants, antipsychotics, and prescription sleep aids. Before the first reduction, we settle two questions: which medications still earn their place and where each taper is intended to end. The dose goals are explicit, and the timeline is agreed with you.
When It's Recommended
- Polypharmacy or overmedication, where a person is taking multiple medications and the overall burden or interaction risk may outweigh benefit
- Adverse effects, side effects, or drug interactions that are affecting quality of life
- Medications continued past their original indication, such as a treatment kept long after the episode that prompted it has resolved
- Sustained remission or stability where a clinician and patient wish to explore whether a medication can be reduced
- A patient's informed preference to take fewer medications, explored within a supervised plan
- Medications with limited or unclear ongoing benefit relative to their risks
Have questions about this treatment?
Reach out to learn more from Mario A. Benitez-Lopez.
Recovery & Aftercare
- Deprescribing is typically a gradual process that unfolds over weeks to many months, and sometimes longer for medications taken over long periods
- Temporary withdrawal symptoms, when they occur, often emerge soon after a dose reduction and tend to ease over the following days to weeks
- The pace is individualized and may be slowed, paused, or partially reversed based on how a person responds, rather than following a fixed timeline
- Regular follow-up continues throughout and after the taper to confirm stability and to respond quickly if symptoms return
- For some people, the outcome is a reduced regimen rather than full discontinuation, and for others continuing the medication remains the most appropriate choice
Alternative Treatments
- Continuing the current medication regimen with ongoing monitoring, when its benefits still outweigh its burden
- Dose optimization or switching to a different medication rather than stopping, when side effects are the main concern
- Psychotherapy and other non-medication supports, which may be introduced or expanded during or in place of tapering
- Lifestyle approaches such as sleep, exercise, and stress management as part of a broader treatment plan
Frequently Asked Questions
- Deprescribing is the planned, physician-supervised process of reducing or stopping medications whose current harms or burden may outweigh their benefit. It begins with a comprehensive medication review, followed when appropriate by an individualized taper and close monitoring. It is gradual and collaborative, not an abrupt stop.
- Deprescribing involves appointments and no physical procedure. A dose reduction can sometimes cause temporary discontinuation symptoms such as dizziness, sleep changes, or irritability. These symptoms often ease over the following days to weeks. A slower, more gradual taper is generally used to keep discomfort as mild as possible.
- Deprescribing is generally considered safe when a qualified clinician plans and supervises it using a gradual taper and regular monitoring. It is not appropriate in every situation, and medication is not stopped abruptly or without medical supervision. The specific risks and situations in which deprescribing may not be appropriate are listed in the safety sections above.
- The timeline depends on the medication, how long you have taken it, and how you respond to each reduction. A single tapering step may span weeks. A full plan often takes several months and sometimes longer, with follow-up visits typically becoming more frequent during active tapering.
- The first step is a comprehensive review of your medication regimen and a shared decision about whether tapering is appropriate. If it is, an individualized, gradual taper is designed. Your response is monitored closely to distinguish temporary withdrawal symptoms from a return of the underlying condition, and the pace is adjusted as needed.
- Deprescribing may not be appropriate during active, severe, or unstable illness or after a recent relapse. Long-term maintenance treatment is often indicated for bipolar disorder, recurrent or severe depression, and psychotic disorders, and continuing medication is often the safer course in those situations. A thorough evaluation determines whether deprescribing is appropriate for an individual patient.
- That disagreement is common, and it is reasonable to ask a second psychiatrist to review the decision. I will examine why each medication was started, how long it has been taken, and its current balance of benefit and harm. I will also tell you if I think continuing is safer, because some regimens should remain unchanged. The review is meant to give you a clinical answer you can act on, not to guarantee a taper.
- Not here. Deprescribing works better when psychotherapy runs alongside it, and I provide both. The taper schedule and the therapy can be adjusted against each other within the same appointment. If you already have a therapist you want to keep, I am glad to coordinate with them.
- Yes. I am comfortable supervising benzodiazepine and stimulant tapers, including when a controlled substance is part of a regimen that also contains an antidepressant you want to stop.
What are the risks of Deprescribing?
Who should avoid this
- Active, severe, or unstable psychiatric illness, or a recent relapse, where continuing effective treatment is generally the priority
- High relapse-risk conditions where long-term maintenance is often indicated – such as bipolar disorder, recurrent or severe major depression, and psychotic disorders including schizophrenia and schizoaffective disorder – where deprescribing may be inappropriate
- Abrupt discontinuation is never appropriate for benzodiazepines, antidepressants, or mood stabilizers, because sudden cessation can cause withdrawal, rebound, or with some agents more serious effects
- Recent suicidal ideation, self-harm risk, or other instability that could be worsened by changing an effective regimen
- Situations where a medication continues to provide clear benefit that outweighs its burden
- Absence of a monitoring plan or an inability to attend follow-up, since deprescribing requires supervision
Possible risks
- Discontinuation (withdrawal) symptoms such as dizziness, flu-like sensations, insomnia, irritability, or sensory disturbances, which vary by medication and taper speed
- Rebound symptoms, in which the original symptoms return, sometimes more intensely than before treatment
- Relapse of the underlying condition, which can be difficult to distinguish from temporary withdrawal
- Protracted withdrawal, a prolonged course of symptoms that a minority of people may experience after stopping long-term benzodiazepine or antidepressant use
- With certain medications, abrupt or overly rapid reduction can cause serious effects, which is why supervised, gradual tapering is used
- This is not an exhaustive list of potential risks; discuss any medication change with your prescribing clinician before making it
Your practitioner
Mario A. Benitez-Lopez, MD
I am a board-certified adult psychiatrist and the founder of San Francisco Concierge Psychiatry. I completed my psychiatry residency at the University of Washington and hold a master's in clinical research from Stanford. I offer bilingual (English and Spanish) care in a concierge model built around small panels and longer sessions, spanning medication management, deprescribing, and evidence-based individual and couples therapy.
Sources & references
This article draws on 7 sources, including government health agencies, peer-reviewed research.
Government & research
- National Institute on Aging – The Dangers of Polypharmacy and the Case for Deprescribing in Older Adults
- National Institute on Aging – Taking Medicines Safely as You Age
- StatPearls (NCBI Bookshelf) – Strategies to Reduce Polypharmacy in Older Adults
- Therapeutics Letter (NCBI Bookshelf) – How to Stop Antidepressants
- Deprescribing Benzodiazepines and Z-drugs in Community-Dwelling Adults: A Scoping Review (PMC)
- Deprescribing: Practical Ways to Support Person-Centred, Evidence-Based Deprescribing (PMC)
Medically reviewed by Mario A. Benitez-Lopez, MD · Last reviewed: 2026-08-31