Anita Clayton, MD, on Deprescribing and Treatment Optimization at APA

Anita Clayton, MD, shared current approaches to deprescribing in psychiatry and emphasized the importance of optimizing treatment, which she shared in her presentations at the American Psychiatric Association meeting.

Clayton described developing deprescribing strategies with colleagues using Delphi consensus expert panels focused on deprescribing in major depressive disorder, bipolar disorder, schizophrenia, and stimulant treatment. She explained that these initiatives, supported by the American Society of Clinical Psychopharmacology, were intended to provide clinicians with practical guidance for safely discontinuing or switching psychotropic medications.

Clayton stressed that psychiatrists should view deprescribing as an active component of evidence-based care rather than simply medication reduction. As she stated, “it’s not just about deprescribing, but it’s also about switching or optimizing patient care.” She noted that many patients remain on ineffective regimens despite only modest improvement, a practice she argued should be reconsidered. Clinicians should aim for full remission whenever possible, Clayton emphasized.

She also addressed recurrence risk across psychiatric disorders. Clayton explained that patients experiencing a first major depressive episode who remain symptom-free for 6 to 12 months may be appropriate candidates for medication discontinuation because many will not experience another episode.¹ In contrast, she emphasized that recurrent depression and schizophrenia require greater caution because relapse rates increase substantially over time.

Clayton highlighted schizophrenia as a particularly important area for careful treatment management. Referencing comments from John Kane, MD, she noted that recurrent psychotic episodes may contribute to worsening cognitive and functional outcomes. She explained that patients who do not respond adequately to an initial antipsychotic should be switched to another agent, and those failing 2 trials should be considered for clozapine treatment.² Clayton concluded that deprescribing decisions must remain individualized, balancing relapse prevention with minimizing unnecessary long-term medication exposure. She added, “we can’t just leave it at, ‘we tried that, you’re a little bit better’,” and not continue to optimize treatment.

Dr Clayton is chair of psychiatry and neurobehavioral sciences and professor of clinical obstetrics and gynecology at the University of Virginia. She is also current president of the American Society for Clinical Psychopharmacology.

References

1. Jung WY, Jang SH, Kim SG, et al. Times to discontinue antidepressants over 6 months in patients with major depressive disorder. Psychiatry Investig. 2016;13(4):440-6.

2. Barber S, Olotu U, Corsi M, et al. Clozapine combined with different antipsychotic drugs for treatment-resistant schizophrenia. Cochrane Database Syst Rev. 2017;3(3):CD006324.