Self-reported attitudes and strategies of physicians towards medication reduction and discontinuation

With increasing prescriptions, harmful side effects and controversial effectiveness of both antidepressant (AD) and antipsychotic (AP) medications, the reduction in and discontinuation of these drugs will become increasingly important. Outpatient physicians play a pivotal role in this process. This paper aims to explore the self-reported attitudes, expectations, expertise, and challenges of physicians regarding the reduction and discontinuation of AD and AP.

A survey containing 49 questions was sent to 607 mental health professionals in Berlin and Brandenburg, in this article 41 questions are displayed. Descriptive analyses and comparisons between answers were performed via established statistical methods, and some responses were grouped to make graphic display simpler.

A total of 103 physicians with different backgrounds participated in the survey. Most physicians have claimed to minimize doses of AP and AD. They indicated that patients should be supported in reducing both drugs but were less likely to support the discontinuation of AP than AD. Physicians rated their expertise in tapering both drugs as adequate or high but felt more confident with AD. Concerns, discomfort, and risks perceived by physicians were greater for AP than for AD discontinuation and for discontinuation versus dose reduction overall.

Despite self-reported competence and patients' needs and desires, the systematic deprescription of AD or AP has not been established a standard practice yet. Physicians' fear of clinical deterioration, responsibility for their role and concerns often take precedence over supporting the discontinuation of both drugs, particularly in the case of APs.