Deprescribing psychiatric medications in youth: A feasibility study

Background and objective: Rates of psychiatric medication use among U.S. youth have increased substantially and stakeholders are increasingly concerned. We tested the feasibility of a novel intervention that combines shared decision making and a structured deprescribing protocol during routine outpatient care with youth. Methods: Five clinicians delivered the intervention to youth 6 to 17 years old receiving three or more psychiatric medications or an off-label antipsychotic. Families completed assessments at baseline, 18- and 30-weeks. We collected data via surveys, medical records, and qualitative interviews. Results: We enrolled 31 youth, 29 received the intervention, and 13 of the 29 (45%) chose to deprescribe. Eleven of those 13 reduced their dose or stopped completely; 2 returned to their original dose. Of the 13, the mean dose-weighted medication use reduced from 3.9 (SD=1.38) to 2.9 (SD=1.41), and the mean number of medication reactions reduced from 1.3 (SD=2.21) to 0.3 (SD=0.48). In the 16 participants who chose not to deprescribe, the mean dose-weighted medication use and medication reactions reduced from 3.4 (SD=0.89) to 3.2 (SD=1.32) and 0.6 (SD=0.89) to 0.0 (SD=0.0), respectively. Youth functioning remained similar across groups. There were no study-related serious adverse events. Clinicians and caregivers considered the intervention feasible, valuable, and effective. Conclusions: Our intervention and procedures were feasible in real-world community settings. The intervention shows promising findings related to safety and effectiveness. Trial registration: Our study was retrospectively registered with ClinicalTrials.gov. NCT # pending.