Chapter 23: Medication Discontinuation

The primary focus is on the tapering process, which involves gradually reducing medication dosages to minimize withdrawal symptoms and prevent relapse of underlying psychiatric conditions. Different medication classes present distinct discontinuation challenges that clinicians must understand and manage carefully. Antidepressant discontinuation can trigger a discontinuation syndrome characterized by physical and emotional symptoms resulting from sudden serotonin level changes. Benzodiazepines require particularly cautious withdrawal protocols because abrupt cessation carries the serious risk of seizures and severe rebound anxiety that may exceed the original anxiety disorder. Mood stabilizers present the danger of precipitating manic episodes when discontinued too rapidly, while antipsychotic medications can lead to withdrawal dyskinesias and psychotic relapse if stopped improperly. The chapter also addresses the clinical indicators that signal a need for medication reevaluation, including treatment resistance when patients show inadequate response to standard therapeutic doses, unexplained relapse suggesting either medication ineffectiveness or adherence problems, and emerging side effects that compromise quality of life or medical safety. Additional red flags for treatment adjustment include new medical conditions that interact with current medications, dosage-related concerns where symptoms persist despite adequate dosing, and situations where therapeutic benefits plateau or diminish over time. Clinicians must distinguish between genuine treatment failure and discontinuation effects, requiring careful assessment of symptom timing and medication history. The chapter emphasizes that discontinuation decisions demand individualized planning that considers the specific medication class, duration of treatment, patient symptom severity, social supports, and preferences. Proper tapering schedules vary significantly across drug categories and individual patient factors, making clinical judgment essential for safe deprescribing while maintaining therapeutic stability.