The Importance of an Exit Plan: Deprescribing in Psychiatry

In this video from the 2023 Psych Congress NP Institute, Rakesh Jain, MD, MPH, a distinguished member of the Psych Congress steering committee, details the concept of de-prescribing in psychiatry. Whether preparing for the possible need to adjust medication regimes, or helping patients stop treatment that is no longer needed, “Never, ever enter a war or a battle without an exit plan,” says Dr Jain.

Don't miss these other clinical pearls from Dr. Jain:

>>Approaching Psychedelics for Depression With Both Caution and Optimism

>>Comparing Treatments for Tardive Dyskinesia

Read the Transcript

Psych Congress Network: Could you explain why mindful deprescribing is just as important as effective prescribing?

Rakesh Jain, MD, MPH: Hello my dear friends and colleagues. I'm Rakesh Jain, and I'm a proud member of the Psych Congress Steering Committee.

Today I want to talk about a grossly underdiscussed topic: de-prescribing. Yes, I did say de-prescribing. You and I have spent our entire careers learning how to prescribe medications, but really, is that enough? Should we not have an exit strategy in place when we start medications? Sure, some patients may need medications for a long time, but the truth of the matter is most patients either need to switch medications or hopefully the need for the medication has dissipated. So, this field of de-prescribing, it's time to talk about it. The more we talk about it, I think the better off we might be.

I do have some suggestions for you. Never, ever enter a war or a battle without an exit plan. I think some famous general in a wartime setting must have said that, but I think that applies to you and I as well. Every time we enter the battlefield of fighting a patient's psychiatric illness with the weaponry of a psychiatric tool, know how to get out of it with grace, without harming the patient. There is simply no doubt a biopsychosocial approach is the ideal approach to take when you're considering de-prescribing. Without a doubt, having the patient as your educated ally—them understanding why you want to decrease a medication, why is that important, why they need not be too afraid, how you will be with them every step of the way, and the actual process we'll be utilizing to help our patient—are critical elements.

Here at Psych Congress, we are exceptional at education on prescribing, and we are exceptional at understanding the need for de-prescribing with grace. Remember, again, biopsychosocial approaches to take. With that in mind, there's simply no doubt in my mind that your de-prescribing habits will rise to the same level as your prescribing habits.

Thank you very much for hearing my thoughts, and I wish you and your patients the very best.

Rakesh Jain, MD, MPH, attended medical school at the University of Calcutta in India. He then attended graduate school at the University of Texas School of Public Health in Houston, where he was awarded a “National Institute/Center for Disease Control Competitive Traineeship”. His research thesis focused on the impact of substance abuse. He graduated from the School of Public Health in 1987 with a Masters of Public Health (MPH) degree.

Dr Jain served a 3-year residency in Psychiatry at the Department of Psychiatry and Behavioral Sciences at the University of Texas Medical School at Houston. He followed that by obtaining further specialty training, by undergoing a 2-year fellowship in Child and Adolescent Psychiatry. In addition, Dr Jain completed a postdoctoral fellowship in Research Psychiatry at the University of Texas Mental Sciences Institute, in Houston. He was awarded the “National Research Service Award” for the support of this postdoctoral fellowship.