ASCP Consensus Recommendations Aim to Define When and How to Consider Deprescribing Stimulants in ADHD Care

New expert consensus recommendations from the American Society of Clinical Psychopharmacology (ASCP) seek to provide clinicians with a standardized framework for prescribing and, when clinically appropriate, deprescribing stimulant medications.¹

In an interview with Psychiatric Times, David W. Goodman, MD, a co-author on the consensus guidelines and an adult psychiatrist specializing in ADHD and older adults, discussed the consensus recommendations and the rationale behind developing guidance for a topic that has increasingly become part of both clinical and public conversations.

“With the current controversy about the prescription of stimulant medications, and the questionable accuracy of psychiatric diagnoses for ADHD, it becomes very pertinent for all clinicians and prescribers to understand how to go about thoughtfully prescribing stimulants and then when to consider under what clinical circumstances to diminish the dose and perhaps take the patient off the medication,” Goodman told Psychiatric Times.

Why ASCP Developed Consensus Recommendations on Stimulant Deprescribing

According to Goodman, the publication emerged from a broader ASCP initiative focused on deprescribing psychotropic medications across multiple therapeutic areas. The stimulant guidance represents the third publication in that effort, following previously published work on psychotropic medication deprescribing in general and deprescribing in mood disorders. A separate manuscript addressing antipsychotic deprescribing is also in development.

To create the recommendations, ASCP convened nationally and internationally recognized psychopharmacology experts and employed a Delphi process (an iterative method of reviewing and refining clinical statements) to reach agreement on recommendations for practice.

“We reached consensus, which is a 75% or greater agreement,” Goodman explained, noting that the panel achieved strong or very strong agreement on 11 recommendations.

The primary goal, he said, was not to encourage indiscriminate discontinuation of stimulant treatment, but rather to establish a clear standard of care around both prescribing and reassessing stimulant use over time.

“The purpose of this exercise was to codify a certain approach, establishing a standard of care for the prescription and consideration for deprescribing stimulant medications,” Goodman said.

Importantly, he emphasized that the recommendations should not be conflated with broader public discussions questioning stimulant use.

“When I say deprescribing stimulant medications, this is not in line with the current public discourse about stopping medication,” Goodman said. “The deprescribing occurs in very specific clinical circumstances where a thoughtful prescriber is going to consider decreasing and stopping stimulant medications.”

Addressing Variability in ADHD Prescribing Practices

Goodman noted that a reviewer of the manuscript characterized many of the recommendations as reflecting what experienced clinicians already consider good medical practice. Although he agrees with that assessment, Goodman argued that formalizing those practices remains necessary because a substantial proportion of psychotropic medications are prescribed outside psychiatry.

“Our response to the reviewer was, yes, we agree,” he said. “But given that many and a lot of the psychotropic medications are now written by non-psychiatrists who have been inadequately trained in how to prescribe, how to diagnose, what kind of dosing to prescribe, the American Society for Clinical Psychopharmacologists decided this was necessary.”

The recommendations, he said, are intended to support clinicians in determining not only when stimulant treatment is appropriate but also when ongoing treatment should be reconsidered.

Goodman added that the guidance extends beyond ADHD alone, as stimulants may be prescribed in other psychiatric contexts where questions about duration of treatment and continued benefit can arise.

Reassessing Medication Burden and Treatment Necessity

A broader theme underlying the ASCP deprescribing initiative is the routine evaluation of whether all prescribed medications continue to provide meaningful benefit.

“The patient is on several medications,” Goodman said. “Are they all serving an effective benefit? And can the cocktail, if you will, be narrowed to those which are critical for stability and those which are no longer necessary in the treatment of the patient?”

Within ADHD treatment specifically, he also highlighted the expanding landscape of nonstimulant options. Goodman pointed to currently approved nonstimulant therapies, including atomoxetine and viloxazine, and noted the potential arrival of another nonstimulant option in the near future.

Historically, he said, nonstimulants have often been viewed as secondary choices because of the effectiveness and tolerability associated with stimulant medications. However, emerging literature is prompting renewed discussion about treatment sequencing.

“There are an increasing number of publications that are questioning that approach and perhaps maybe considering using non-stimulants, especially in the newly diagnosed who have not been prescribed stimulant medications,” Goodman said.

He noted that available evidence suggests treatment response may differ depending on when nonstimulants are introduced within the therapeutic sequence, underscoring the importance of individualized pharmacologic decision-making.

Beyond Clinical Practice: Implications for Education, Policy, and Standards of Care

Goodman stressed that expert consensus recommendations and clinical guidelines serve functions extending beyond day-to-day patient care. While acknowledging that expert consensus differs methodologically from formal clinical practice guidelines, he emphasized that both contribute to defining expectations for quality care.

“The purpose of publications of expert consensus and clinical practice guidelines is to advance patient care,” Goodman said. “It is the consolidation of the research and the clinical experience of people who have decades working with patients.”

He pointed to prescribing trends outside psychiatry as a key reason such guidance remains necessary.

“Almost 50% of all stimulants are written by non-psychiatrists,” Goodman said. “And these are folks who need clinical guidance. They don’t read the psychiatric research and literature.”

According to Goodman, consensus recommendations can influence multiple stakeholders, including clinicians, training programs, insurers, policymakers, and legal professionals. Educational programs may use updated recommendations to revise curricula, while insurers may incorporate evolving standards into reimbursement decisions. Expert recommendations can also be cited in medicolegal proceedings and help inform future health policy decisions.

“Putting this information out is really important to establishing and advancing standards of care,” Goodman said.

As stimulant prescribing remains a topic of heightened attention, Goodman framed the new ASCP recommendations as an effort to provide clinicians with a structured, evidence-informed approach to evaluating both the initiation and continuation of treatment—while keeping patient care at the center of decision-making.

Look for continued coverage of ASCP’s deprescribing initiatives, including an exclusive panel discussion with leading psychiatrists, as well as coverage of ASCP’s Annual Meeting, at Psychiatric Times.

Reference
1. Goodman DW, Mago R, Citrome L, et al. The American Society of Clinical Psychopharmacology task force consensus statement on the deprescribing of stimulant medications in adults with ADHD. Eur Neuropsychopharmacol. 2026;111:112863.