Exploring Rational Polypharmacy and Judicious Prescribing at the 2025 PA Institute

During their session at the 2025 Psych Congress PA Institute, “Polypharmacy in Psychiatry: When to Add, When to Deprescribe,” co-presenters Kathryn Werner, MPAS, PA-C, CAQ, and Steering Committee Consultant Brittany Albright, MD, MPH, offered attendees a comprehensive overview of evidence-based strategies for thoughtful prescribing and deprescribing of psychotropic medications.

“Rational polypharmacy definitely has a place in our practice,” said Werner, who noted that 60% of outpatients in psychiatry take at least 2 psychotropic medications. 

But concerns arise when patients have been prescribed more medications than are clinically appropriate in the context of their comorbidities. 

The presenters highlighted several mechanisms driving polypharmacy, including prescribing cascades, fragmented care, symptom-driven add-ons, and lack of medication reassessment. They also underscored the importance of distinguishing rational polypharmacy, which involves goal-driven, evidence-based combinations, from unnecessary or harmful regimens. 

To employ judicious prescribing, Werner and Dr Albright encouraged clinicians to evaluate regimen appropriateness by reviewing medication indication, benefit–risk ratio, drug–drug interactions, and focusing treatment planning on patient-centered outcomes.

Werner also urged clinicians to pause and think, “Is there anything wrong with this medicine?” before automatically refilling prescriptions for patients.

The presenters then shifted focus to deprescribing, defined as the intentional, supervised reduction of medications when harm outweighs benefit. “Deprescribing is just as important as prescribing,” Werner said. “It’s an active process that we want to be mindful of.”

The clinicians emphasized that safely deprescribing requires careful timing, shared decision-making, and psychoeducation to avoid destabilization, focusing on 1 medication at time. They also stressed that patient beliefs strongly influence readiness to deprescribe, encouraging audience members to “gently introduce the idea of deprescribing” and get patient feedback before initiating the process. 

After initiation, the presenters recommend careful monitoring of symptom recurrence, withdrawal effects, and functional improvement or decline to gauge whether adjustments to the deprescription plan are necessary. 

In addition to highlighting the role of pharmacokinetics in anticipating side effects and optimizing taper schedules, the clinicians also recommended that providers complement all prescribing and deprescribing decisions with non-pharmacologic and lifestyle interventions, like the WILD 5 wellness program.

As they wrapped up their session, Dr Albright and Werner reinforced the idea that deprescribing is not “doing less,” but delivering safer, more intentional care for patients, highlighting both thoughtful prescribing and deprescribing as essential competencies in psychiatric practice. 

For more updates from the Psych Congress PA Institute, visit the meeting newsroom.