Welcome to Back from the Abyss. I'm Dr. Craig Hecock.

Today I'm doing a solo episode.

This is the art of deprescribing.

One of the main consequences of having a psychiatric healthcare system largely based on the brief med management visit is that patients tend to end up on more and more medications

the longer they stay in the system

and the more clinicians they see. Again, when all you have is a hammer, everything looks like a nail,

and the medication management mindset is that both psychiatric and psychological symptoms can

and should be primarily treated with medication adjustments and additions.

Add to this the fact that so much of what we call treatment-resistant anxiety

or treatment-resistant depression is actually either a primary or secondary consequence of trauma.

And as you have all heard me discuss in a number of episodes, most psych meds do little to nothing for trauma.

Thus, the most complicated, the most symptomatic of our patients often end up on a long list of psych meds,

many of which are almost surely doing nothing, positive at least, and may well be causing significant side effects

and or withdrawal symptoms if their dosing schedule is altered. And so, this is the situation in tens

of thousands of psychiatrists and psych and pee offices across the country. A patient shows up with

some chronic, difficult to treat depression or anxiety of some unknown

etiology.

They bring this huge list of meds that they've tried or either don't work, have caused side effects,

and or they already are on a long list of meds that they don't think are helping.

So today I'm presenting here six guidelines and ways to think about the challenging,

but ultimately super rewarding task of trying to simplify, pare down,

and sometimes even totally eliminate these handfuls of pills that so many people are taking daily.

...