A deprescribing consensus asks clinicians to find out what the patient expects
- A consensus statement from a 45-member task force of the American Society of Clinical Psychopharmacology on deprescribing psychotropic medications, built on a Delphi survey and a focused literature review between January and May 2025; consensus was defined as 75% or more concordance among panelists.
- Round 1 had 91 items in two sections; this publication reports the first section, 39 statements, with consensus on 34 (87%). Across round 1 and round 2, consensus was reached on 44 of 50 questions (88%).
- In the section on the psychological context, the authors call it essential for clinicians to query and appreciate patients' anticipated outcomes after deprescribing, and name psychoeducation, collaborative tapering plans, adjunctive coping skills and regular supportive monitoring as imperative.
- A Table 3 statement, that clear communication with patients about the rationale for deprescribing may help allay patient fears, reached 98% agreement and was rated with high confidence by 34 of 44 panelists (77%).
Most of this consensus statement is pharmacology: when a drug is redundant, how to review risk and benefit, what to monitor. One short passage concerns the conversation with the patient, and it is the part a psychotherapist can use directly.
Expectation as a topic of its own
The authors write that it is essential for clinicians to query and appreciate patients' anticipated outcomes after deprescribing. With some medications, such as benzodiazepines, the prospect of discontinuation alone can prompt emotional discomfort and expectations of intensified suffering. The same paragraph lists psychoeducation, collaborative tapering plans, adjunctive coping skills and regular supportive monitoring. A related statement, that clear communication about the rationale may help allay patient fears, reached 98% agreement.
My reading: the sentence about anticipated outcomes makes the patient's expectation a subject of the conversation, something the clinician asks about instead of assuming. The document does not present that question as a stand-alone intervention. It sits inside a set of measures, and it costs a therapist nothing to ask it.
In practice, when a client says a prescriber is reviewing or reducing a medication, ask what they expect to happen and note the answer in their words. With the client's consent, pass it to the prescriber, who owns the decision and any schedule.
The statement treats the patient's expectation of what deprescribing will bring as something clinicians should ask about directly.
This is a consensus statement of a 45-member panel, not a trial, and the authors say the recommendations should not be misconstrued as a standard of care. Respondents noted that some psychological recommendations, such as formal cognitive therapy during deprescribing, have not been tested in empirical trials.