Deprescribing
Coming off medication deserves the same care as starting it.
Deprescribing is the planned, supervised reduction or stopping of a medication that has done its job, or whose costs now outweigh its benefits. It is a named service here because it is real clinical work: done slowly, paced by your symptoms, with a prescriber watching the same measures we used to start the medication in the first place. Not a cold stop, not a white-knuckle experiment, and not a lifetime sentence in the other direction either.
PsychMed Care is the medication management practice of Solutions Psychiatry. If you are looking for therapy, or therapy and medication together, the full practice is at psych.us.
Why people ask
Five honest reasons this page exists
Feeling flat
The crisis passed, the medication worked, and somewhere along the way the color went out of things. Emotional blunting is a known cost of long-term treatment, and it is a legitimate reason to revisit the plan.
Side effects that outstayed the emergency
Weight, sleep, libido, energy: costs that were worth paying in a hard season may not be worth paying forever. A fair review asks whether they still are.
Years past the original reason
A medication started for a divorce, a death, a brutal job, a postpartum year. Life moved on. Nobody ever scheduled the conversation about whether the prescription should move on too.
A list that grew by accretion
One medication added to treat the side effect of another, across prescribers and years, until nobody alive can say what the original plan was. Untangling that is deprescribing too.
Wanting to know the baseline
Who are you, now, without it? That is a clinical question with a safe way to answer it: gradually, measured, reversible, with support in the room.
The first conversation about tapering covers ground a refill never touches: what each medication was started for and when, what has been tried before, what your life looks like this season, and what a bad month would cost you right now. Some seasons are wrong for tapering: a fresh crisis, a major transition mid-flight, a history that says this medication is load-bearing. When that is the honest read, I will say so, and we revisit later instead of forcing a milestone.
The usual candidates
Medications people most often ask about
Antidepressants
The most common tapering work here. SSRIs and SNRIs differ in how they let go: some clear the body in a day, others linger for weeks, and the schedule respects that chemistry rather than a generic calendar. Short-half-life agents usually need the smallest, slowest final steps.
Sleep medications
Prescription sleep aids often outlive the insomnia that justified them, and tolerance quietly raises the dose over the years. A taper here pairs the dose cuts with rebuilding the sleep itself, so the landing has somewhere to happen.
Anti-anxiety medications
Benzodiazepines ask for the most patience of any class on this page. The nervous system adapts to them deeply, so reductions are small, the timeline is long, and rushing is the one strategy that reliably fails. It is slow because slow works.
The supporting cast
Agents added along the way to patch side effects, boost a flagging response, or quiet a symptom that has since moved out. Each gets the same question: what is your job now, and is anybody still benefiting from it?
What does a taper actually feel like? Honest answer: uneven. Dose cuts are often followed by a few rough days, a settling, then a stretch of feeling surprisingly like yourself, sometimes clearer than you have felt in a long while. Symptoms tend to arrive in waves rather than as a steady line, which is why pacing by response beats marching by calendar, and why a hard week after a cut is information to adjust the pace, not proof that you cannot do this. People also regularly report the inverse surprise: a feared cut that turns out to be a non-event, because the dose being removed was contributing less than everyone assumed. Either direction, we find out together, in small steps, with the option to pause built into the design.
Your other clinicians stay in the loop. If you have a therapist, a primary care physician, or another prescriber, tapering decisions get shared with them with your permission, because a medication list is a team document even when this practice manages it. And if the taper surfaces something outside medication, a grief that was being muted, a sleep problem with its own physics, that gets named and routed to the right kind of care rather than medicated back into silence.
Practicalities, briefly. A taper does not require a special program, a leave from work, or an announcement to anyone. It runs inside ordinary follow-up care, on video, at the visit lengths this practice already uses, and the cost structure is the same one published on the homepage: no taper package, no premium tier, no penalty for pausing. The only special requirement is patience, and that one is shared: yours for the process, mine for the schedule your nervous system actually sets.
How a taper is built
Slow on purpose, in four moves
Review the whole list
Every medication, its origin story, its current job. We choose which one moves first, and usually it is the one with the least left to prove.
One medication at a time
Tapering two agents at once scrambles the signal. One change, observed honestly, beats a brave overhaul nobody can interpret.
Smaller cuts as the dose falls
Reductions shrink as the dose gets lower, because the last stretch of a dose carries disproportionate weight. Equal steps look tidy on paper and feel terrible in a body.
Pacing set by symptoms
The schedule bends around your response. Pauses are part of the method, not a failure of it, and any step can be revisited without drama.
The support structure matters as much as the arithmetic. Follow-ups during a taper run on the same 30-minute standard as all follow-ups here, with measures tracked at each step and brief focused support inside the visit aimed at exactly what tapering stirs up. That pairing is not decoration. In a Lancet Psychiatry meta-analysis of 76 randomized trials and 17,379 participants, tapering slowly while receiving psychological support prevented relapse in about one in five patients, an effect large enough to change how this service is built.
Safety, stated plainly
Three rules that do not bend
Never stop suddenly
Some psychiatric medications are genuinely rough to quit cold: discontinuation symptoms can mimic the original illness, or worse. If you take nothing else from this page, take that. Any stop worth doing is worth planning.
Withdrawal is not relapse
Early symptoms after a dose cut are often the nervous system recalibrating, not the illness returning. Telling the two apart, by timing and by character, is the clinical heart of a good taper.
Staying on is also success
Some people taper and discover the medication was quietly holding a great deal. Going back up is data, not defeat, and long-term treatment chosen on purpose is a good outcome too.
The taper guide
The myth this page answers, and the attitude behind the service, explained in the taper guide.
Tapering visits
How follow-ups are structured while a taper runs: measures, pacing, and support at every step.
The full service
Deprescribing is one direction inside medication management; the other direction lives here too.
“A medication that has done its job deserves a careful goodbye, not an indefinite renewal.”
Thinking about less medication? Start with a full review of your list