References
Deprescribing in mental health care
Abstract
Deprescribing has mostly developed in older adult care as a strategy to reverse the potential harm to older adults of receiving too many inappropriate medicines. There are many studies in older adult care that show that by deprescribing medicines, prescribers are able to improve patient function, generate a higher quality of life, and reduce bothersome signs and symptoms. However, there have been few comparable studies in mental health. Overprescribing or inappropriate prescribing has also become an issue for mental health care. However, it commonly relates to psychotropic medicines and, in particular, to antidepressants, benzodiazepines, z hypnotics, antiepileptics, such as pregabalin, and to multiple psychotropic prescribing. In other areas of therapy associated with physical health, the concerns have generally been those of under prescribing. This paper discusses how relevant deprescribing is to mental health care and some of the issues to consider.
Polypharmacy is one of the three categories mandated by the World Health Organization (WHO, 2017) third global patient safety challenge for action. Through the Medication Without Harm challenge, the WHO aims to ‘reduce severe avoidable medicine related harm globally by 50% in the next 5 years'. Donaldson et al (2017) highlighted the commitment of all health services to the challenge. This will be achieved by encouraging countries and key stakeholders to focus on early action priorities, as well as developmental programmes to improve practice and health systems. In the UK, a short life working group on reducing medication harm was established and reported in February 2018 (Department of Health and Social Care, 2018). Deprescribing is a part of the programme to address excessive polypharmacy and unnecessary prescribing.
There are a number of definitions of the term deprescribing. At its core are facets of the medicines optimisation movement and concerns about polypharmacy, particularly in older adult care.
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