The American society of clinical psychopharmacology (ASCP) task force on the deprescribing of psychotropic medications for mood disorders: Delphi expert consensus
File(s)
Accepted version
Author(s)
Goldberg, Joseph
Young, Allan
Swartz, Holly
McIntyre, Roger S
Mago, Rajnish
Type
Journal Article
Abstract
The American Society of Clinical Psychopharmacology (ASCP) convened a 45-member international expert task force to identify circumstances supporting the deprescribing of core psychotropic medications for major depressive disorder (MDD) and bipolar disorders. Three Delphi survey rounds plus a selective literature review identified points of consensus (predefined as >75% agreement) about when antidepressant, antipsychotic, mood stabilizer, and sedative-hypnotic deprescribing is warranted. Twenty of 32 statements (63%) achieved consensus across 7 thematic areas. In MDD, panelists favored discontinuing antidepressants when mechanisms of action are duplicative, adequate trials produce <25% improvement, or loss of prior efficacy cannot be regained through dose increases or augmentations. Indefinite antidepressant maintenance in MDD was favored after >3 lifetime episodes. In bipolar disorder, antidepressant deprescribing was favored in the setting of rapid cycling, mixed features, or emerging mania/hypomania symptoms; and discouraged if prior antidepressant cessation led to relapse. In nonpsychotic mood disorders, panelists favored deprescribing antipsychotics that caused significant weight gain or tardive dyskinesia over adding pharmacological antidotes. Deprescribing to achieve an eventual medication-free status was considered inappropriate in bipolar I but not necessarily bipolar II disorder. While individualized circumstances necessarily inform psychopharmacology management, clinical presentations that misalign with existing pharmacotherapies may signal the desirability of cautious deprescribing.
Date Acceptance
2026-01-23
Citation
The British journal of psychiatry. Supplement
ISSN
0960-5371
Publisher
Cambridge University Press
Journal / Book Title
The British journal of psychiatry. Supplement
Copyright Statement
Copyright © TheAuthor(s), 2026. Published by Cambridge University Press on behalf of Royal College of Psychiatrists. This is the author’s accepted manuscript made available under a CC-BY licence in accordance with Imperial’s Research Publications Open Access policy (www.imperial.ac.uk/oa-policy)
License URL
Publication Status
Accepted