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The American Society of Clinical Psychopharmacology (ASCP) task force on the deprescribing of psychotropic medications for mood disorders: Delphi expert consensus

Published online by Cambridge University Press:  25 March 2026

Joseph F. Goldberg*
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Holly A. Swartz
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
Roger S. McIntyre
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Rajnish Mago
Affiliation:
Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, USA Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Gin S. Malhi
Affiliation:
Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia CADE Clinic and Mood-T, Royal North Shore Hospital, St. Leonards, New South Wales, Australia Department of Psychiatry, University of Oxford, Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
Manish K. Jha
Affiliation:
Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and the Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
Michael Berk
Affiliation:
Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia Mental Health, Drugs and Alcohol Service, Barwon Health, Geelong, Victoria, Australia
Siegfried Kasper
Affiliation:
Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria Center for Brain Research, Department of Molecular Neuroscience, Medical University of Vienna, Vienna, Austria
Marlene P. Freeman
Affiliation:
Department of Psychiatry, Ammon-Pinizzotto Center for Women’s Mental Health at Massachusetts General Hospital, Boston, Massachusetts, USA Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
Michael J. Gitlin
Affiliation:
Department of Psychiatry, Geffen School of Medicine at UCLA, Los Angeles, California, USA
Martha Sajatovic
Affiliation:
Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
Michael J. Ostacher
Affiliation:
United States Department of Veterans Affairs, Palo Alto, Health Care System, Palo Alto, California, USA Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
Leslie Citrome
Affiliation:
Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
Dan V. Iosifescu
Affiliation:
Nathan Kline Institute, Orangeburg, New York, USA New York University Grossman School of Medicine, New York, New York, USA
Roy H. Perlis
Affiliation:
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA Center for Quantitative Health, Massachusetts General Hospital, Boston, Massachusetts, USA
Toshi A. Furukawa
Affiliation:
Office of Institutional Advancement and Communications, Kyoto University, Japan Graduate School of Medicine / School of Public Health, Kyoto University, Japan
Eduard Vieta
Affiliation:
Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Barcelona, Spain Institute of Neurosciences (UBNeuro), University of Barcelona, Barcelona, Spain Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Biomedical Research Networking Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
Michael E. Thase
Affiliation:
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
Allan H. Young
Affiliation:
Centre for Affective Disorders (CfAD), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
Mauricio Tohen
Affiliation:
Department of Psychiatry & Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico, USA
Andrew A. Nierenberg
Affiliation:
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Harvard Medical School, Boston, New Mexico, USA
Matt Macaluso
Affiliation:
Department of Psychiatry and Behavioral Neurobiology, The University of Alabama Heersink School of Medicine, Birmingham, Alabama, USA
Richard C. Shelton
Affiliation:
Department of Psychiatry and Behavioral Neurobiology, The University of Alabama Heersink School of Medicine, Birmingham, Alabama, USA
Christoph U. Correll
Affiliation:
The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
Scott T. Aaronson
Affiliation:
Institute for Advanced Diagnostics and Treatment, Sheppard Pratt Health System, Baltimore, Maryland, USA
Joshua D. Rosenblat
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
Philip Gorwood
Affiliation:
INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Université Paris Cité, Paris, France GHU Paris Psychiatrie et Neurosciences (CMME), Sainte-Anne Hospital, Paris, France
Arifulla Khan
Affiliation:
Northwest Clinical Research Center, Bellevue, Washington, USA
Ralph Kupka
Affiliation:
Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands
Lawrence J. Cohen
Affiliation:
Department of Pharmacotherapy, College of Pharmacy and Health Professions, University of North Texas Health, Fort Worth, Texas, USA Department of Pharmacy Practice, College of Pharmacy, Touro University, New York City, New York, USA
Philip B. Mitchell
Affiliation:
Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, New South Wales, Australia
Mark A. Frye
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
Gerard Sanacora
Affiliation:
Department of Psychiatry, Yale University, Yale-New Haven Hospital, New Haven, Connecticut, USA
John M. Kane
Affiliation:
The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, New York, USA
Jose M. Rubio-Lorente
Affiliation:
The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, New York, USA
David W. Goodman
Affiliation:
Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, USA Department of Psychiatry, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
Joseph Zohar
Affiliation:
Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
Lori Davis
Affiliation:
Department of Psychiatry and Behavioral Neurobiology, The University of Alabama Heersink School of Medicine, Birmingham, Alabama, USA
Swapnil Gupta
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA Castle Point VA Medical Center, Wappingers Falls, New York, USA
Sandra Steingard
Affiliation:
Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
Carlos A. Zarate
Affiliation:
Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
Anita H. Clayton
Affiliation:
Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
*
Correspondence: Joseph F. Goldberg. Email joseph.goldberg@mssm.edu

Summary

The American Society of Clinical Psychopharmacology convened a 45-member international expert task force to identify circumstances supporting the deprescribing of core psychotropic medications for major depressive disorder (MDD) and bipolar disorders. Three Delphi survey rounds plus a selective literature review identified points of consensus (predefined as ≥75% agreement) about when antidepressant, antipsychotic, mood stabiliser and sedative-hypnotic deprescribing is warranted. Twenty out of 32 statements (63%) achieved consensus across seven thematic areas. In MDD, panellists favoured discontinuing antidepressants when mechanisms of action are duplicative, adequate trials produce ≤25% improvement or loss of prior efficacy cannot be regained through dose increases or augmentations. Indefinite antidepressant maintenance in MDD was favoured after three or more lifetime episodes. In bipolar disorder, antidepressant deprescribing was favoured in the setting of rapid cycling, mixed features or emerging mania/hypomania symptoms; and discouraged if prior antidepressant cessation led to relapse. In nonpsychotic mood disorders, panellists favoured deprescribing antipsychotics that caused significant weight gain or tardive dyskinesia over adding pharmacological antidotes. Deprescribing to achieve an eventual medication-free status was considered inappropriate, in bipolar type 1, but not necessarily bipolar type 2 disorder. Although individualised circumstances necessarily inform psychopharmacology management, clinical presentations that misalign with existing pharmacotherapies may signal the desirability of cautious deprescribing.

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Copyright
© The Author(s), 2026. Published by Cambridge University Press on behalf of Royal College of Psychiatrists

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