One of the most common challenges psych nurse practitioners face is deprescribing—knowing when and how to safely reduce or discontinue medications. Implementing effective deprescribing tips is essential to optimize patient medication management and improve outcomes. This delicate balancing act requires careful clinical reasoning to ensure patients stay on the minimum effective medication regimen without unnecessary polypharmacy.
I want to share some clinical pearls from an expert session held in our Mental Health Mastermind community with psych NP Kirby Williams on “The Art of Deprescribing.” Her insights are practical and immediately applicable.
5 Deprescribing Tips to Implement in Your Practice
1. Reframe How You Think About Deprescribing
Deprescribing isn’t about eliminating all meds. Instead, it’s finding the minimum effective medication management through collaborative conversations with patients. Remember, the minimum effective dose looks different for every patient, even if they share the same diagnosis.
2. Start With Diagnostic Clarity
Before reducing medications, ensure your diagnosis is accurate. This may take multiple appointments — which is completely normal. Delve deeper into symptom patterns, frequency, and duration. Tools like the Harvard Bipolarity Index, which is 90% sensitive and specific for bipolar disorder, can help.
3. Make Deprescribing a Routine Assessment
Regularly review each medication’s necessity with your patients. Ask: “How do you feel about this medication? Is it still helpful? Are there side effects?” These questions open crucial conversations that guide medication adjustments.
4. Create a “Pause for the Cause” Habit
When symptoms worsen, pause before adding new medications. Consider: How long have symptoms lasted? Is the patient adherent? Could substance use or diagnostic errors be factors? If you add a new med, consider whether something else can be reduced.
5. Involve Patients in Decision-Making
During her lecture, Kirby shared a decision-making grid where patients list risks, benefits, preferences, and planned interventions related to medication changes. This tool empowers patients and increases engagement in deprescribing.
Deprescribing is a marathon, not a sprint. For patients on multiple meds, optimal medication management may take 2–3 years—and that timeline is perfectly okay.
Want the Full Deprescribing Deep-Dive?
If you are a part of the Mental Health Mastermind community, you can access the replay of this expert session in the Mental Health Mastermind community on Skool, under “Guest Speakers.” Kirby covers detailed tapering guidance for antidepressants, antipsychotics, benzodiazepines, Z-drugs, and psychostimulants.
If you don’t have the Mental Disorders Crash Course yet but want to deepen your skills and confidence, consider enrolling. The course offers 13+ hours of AANP-accredited continuing education credits (3.05 of which count towards pharmacology).
Learn More About the Mental Disorders Crash Course
Further Reading
- Psychiatric Deprescribing: Where Do You Start?
- NP Qualification: How Psych NPs Compare to Psychiatrists
