LAUSR

Prescribing medications has been one of the core functions of a physician’s craft, and advances in medicine have permitted an ever-increasing ability to manage, but not necessarily cure, common human ailments. Individual prescriber and system-level factors have been implicated in the phenomenon of potentially inappropriate polypharmacy (PIP).1 The practice of “deprescribing,” or the process of reassessment and discontinuation of ineffective or harmful medications, has received increasing attention in the fields of geriatric medicine2 and, most recently, psychiatry.3 Deprescribing is a necessary and proactive approach to reducing PIP; it compliments preventative approaches, such as prescriber and patient education about PIP, and reactive measures, such as prior authorizations and peer reviews. Inappropriate prescribing and PIP are prevalent in child and adolescent psychiatry, with evidence for increasing use of psychotropic medications,4 particularly antipsychotics.5 The increase in PIP in child psychiatry, without a clear improvement in functioning, is only one reason to focus on and foster the practice of thoughtful deprescribing.6 A number of characteristics unique to the field of child psychiatry make deprescribing urgently needed. First, the patients are a particularly vulnerable population, with limited capacity to participate in treatment decisions due to cognitive immaturity, caregiver factors, and, in no small measure, illnesses that impair emotional and executive functioning. Second, the medications commonly used in child psychiatry are often only modestly effective, with common, and at times, serious side effects. Third, most evidence for effectiveness of psychotropics is based on short-term trials (6–8 weeks), whereas the treatment often involves longer-term prescribing. Fourth, the impact of adding psychoactive agents to a still developing brain is largely unknown. Finally, for all pediatric psychiatric disorders, the medications, while most readily available, are only a part of a complete treatment plan necessary for recovery.