The new federal push for deprescribing reflects a broader MAHA concern about psychiatric overprescribing. There is a reasonable point here. On inpatient units, we often inherit long medication lists, unclear indications, duplicative psychotropics, and side effects that can look like new symptoms. Thoughtful deprescribing can reduce sedation, falls, metabolic burden, anticholinergic load, and drug interactions. But the approach also has risks. “Deprescribing” can be misread as a political mandate to stop psychiatric medications rather than a careful clinical process that weighs relapse, withdrawal, and clinical destabilization. Many of our patients are acutely psychotic, manic, suicidal, withdrawing, delirious, or medically unstable, so abrupt reductions can be dangerous. And as we discuss in this issue, once an antidepressant is stopped, restarting it may not bring back the original response. The goal should not be deprescribing for its own sake, but a safer, cleaner, better-justified regimen at discharge.

Victoria Hendrick, MD
vhendric@ucla.edu