What Is Deprescribing? How Medication Regimen Optimization Can Improve Your Health

If you or someone you love takes five or more medications every day, you're in the majority — not the minority. Polypharmacy (the use of multiple medications simultaneously) is one of the most common and under-discussed challenges in modern healthcare. And while each medication may have been prescribed for a good reason, the combination of them can sometimes cause more harm than good.

That's where deprescribing comes in. It's not about stopping medications carelessly. It's about a thoughtful, evidence-based process of reviewing, reducing, and optimizing the medications you take so that each one is genuinely working for you — not against you.

This post breaks down what deprescribing is, why medication regimen optimization matters, who it's most relevant for, and how to start the conversation with your healthcare provider.

What Is Deprescribing?

Deprescribing is the supervised process of tapering, stopping, or replacing medications that may no longer be necessary, effective, or safe. The key word is supervised — deprescribing isn't about going off your medications without medical guidance. It's a collaborative process between you and your prescriber.

The goal isn't to minimize treatment. The goal is to make sure every medication in your regimen has a clear, current purpose — and that the benefits outweigh the risks for you, right now, at this point in your health journey.

Key Terms to Know

• Polypharmacy — taking 5+ medications concurrently; associated with increased adverse effects, interactions, and falls
• Deprescribing — tapering or stopping unnecessary meds; supports fewer side effects, better adherence, and lower cost
• Regimen optimization — the right drug, dose, timing, and duration for improved outcomes and quality of life
• Medication review — a systematic assessment of all medications that identifies redundancies and risks

Why Do So Many People End Up on Too Many Medications?

Polypharmacy isn't usually the result of careless prescribing. It develops gradually, often across multiple providers, over many years. Here's how it commonly happens:

• You see multiple specialists who each prescribe independently — without full visibility into what the others have prescribed
• A medication is started for one condition, causes a side effect, and a second medication is added to manage that side effect (a 'prescribing cascade')
• Medications started for short-term problems (like sleep aids, antacids, or pain medications) become long-term habits
• Life circumstances change — weight loss, aging, improved health — but medication doses don't get re-evaluated
• Transitions of care (like hospital discharge) sometimes result in new medications being added without the old ones being reviewed

None of this reflects failure on anyone's part. It reflects a healthcare system where prescribing new medications is often easier than stopping old ones.

The Risks of Polypharmacy

Taking multiple medications isn't inherently dangerous — but it does increase the likelihood of problems, including drug-drug interactions, drug-disease interactions, reduced adherence, and higher rates of falls, cognitive decline, and hospitalization.

When two or more medications interact, they can reduce each other's effectiveness or amplify side effects. The risk grows non-linearly: someone on 5 medications has dozens of potential two-drug interaction pairs. Some medications are also problematic for people with certain unrelated health conditions — for example, some sleep medications worsen cognitive function in older adults, and some antihistamines increase fall risk.

The more medications someone takes, the harder it is to take them consistently and correctly. Complex regimens — multiple pills, different times of day, food interactions — are a major driver of medication non-adherence. Research also consistently links polypharmacy, particularly in older adults, with increased rates of falls, delirium, cognitive impairment, and hospital readmission. The Beers Criteria, published by the American Geriatrics Society, specifically identifies medications that are potentially inappropriate in older adults for this reason.

Did You Know?

• Studies suggest that for patients on 5 or more medications, up to 25–30% of medications may have no current indication
• Adverse drug reactions are responsible for a significant percentage of hospitalizations in adults over 65
• Some common 'symptoms of aging' — fatigue, cognitive fog, dizziness, appetite loss — may actually be medication side effects

What Does Medication Regimen Optimization Look Like?

Medication regimen optimization is the broader process of making sure every aspect of a patient's medication plan — the right drugs, doses, timing, and duration — is aligned with their current health status and goals. Deprescribing is one tool within that process.

A comprehensive medication review typically includes:

• A full inventory of every medication being taken, including over-the-counter drugs, supplements, vitamins, and herbal remedies
• A review of why each medication was originally prescribed and whether that indication still exists
• An assessment of each medication's effectiveness — is it actually doing what it was meant to do?
• A check for interactions, duplications, and dosing issues
• A conversation about the patient's goals, values, and quality of life priorities
• A prioritized plan: which medications to continue, adjust, or taper — with a clear monitoring plan

This is often carried out by a pharmacist (particularly a clinical pharmacist or one with medication therapy management training), a geriatrician, a primary care physician, or an interdisciplinary team.

Who Is Deprescribing Most Relevant For?

While anyone taking multiple medications can benefit from a periodic medication review, deprescribing is especially relevant for:

• Older adults (65+): aging changes how the body processes medications — kidneys and liver slow down, body composition shifts, and the brain becomes more sensitive to certain drugs
• People managing multiple chronic conditions: diabetes, hypertension, heart disease, depression, and chronic pain often co-occur, leading to complex regimens
• Anyone who has recently experienced a major health change: significant weight change, a hospitalization, a new diagnosis, or recovery from a serious illness
• People experiencing unexplained symptoms: fatigue, brain fog, dizziness, falls, or GI problems that can't be explained by a known condition may be medication side effects
• Caregivers managing medications for a loved one — caregivers often have a unique view into how medications are (or aren't) being tolerated

How to Start the Conversation With Your Provider

Many patients feel uncomfortable questioning their medications — especially ones prescribed by specialists or taken for a long time. But asking questions about your medications is not only appropriate, it's encouraged.

Before your appointment, write down every single thing you take: prescription medications with doses and timing, over-the-counter medications, vitamins, supplements, and herbal products. Bring the physical bottles if it's easier.

Then ask these questions:

• 'What is this medication treating, and is that condition still active?'
• 'Are there any medications I'm taking that might be causing [symptom]?'
• 'Are there any medications on my list that might be duplicating each other?'
• 'Is there a medication here that I might be able to stop or take at a lower dose?'
• 'Can I request a full medication review with a clinical pharmacist?'

Your provider may not have the bandwidth for a comprehensive review in a routine appointment. Asking to schedule a dedicated medication review visit — or asking for a referral to a clinical pharmacist for medication therapy management (MTM) — is completely reasonable, and often covered by insurance.

Important Safety Note

Never stop or reduce a prescription medication without guidance from your prescriber. Some medications — including antidepressants, blood pressure medications, corticosteroids, and benzodiazepines — require gradual tapering to avoid withdrawal or rebound effects. Deprescribing is a medically supervised process. This article is for informational purposes only and is not a substitute for personalized medical advice.

The Connection Between Medication and Mental Health

For people managing mental health conditions, medication regimen optimization has a particular layer of complexity — and importance. Psychiatric medications (antidepressants, antipsychotics, anxiolytics, mood stabilizers) are sometimes prescribed during acute episodes and continued indefinitely without regular re-evaluation. They can also interact with medications prescribed by other providers who may not have full visibility into the psychiatric history.

Many psychiatric medications have side effects — weight gain, sedation, sexual dysfunction, cognitive effects — that can gradually erode quality of life and treatment adherence. A thoughtful medication review in a mental health context might explore:

• Whether the original indication (e.g., a depressive episode) is still clinically active
• Whether the current dose remains appropriate given weight or life changes
• Whether simpler regimens (fewer medications, lower doses) might achieve the same therapeutic goals
• Whether non-pharmacological approaches (therapy, lifestyle changes) might support dose reduction

This kind of conversation is best held with a psychiatrist or a mental health-informed prescriber — and ideally in conjunction with therapy.

What the Research Says

Deprescribing is a growing field, and the evidence is building. Structured deprescribing interventions have been shown to reduce medication burden without worsening clinical outcomes, lower rates of falls and fall-related injuries in older adults, improve patient-reported quality of life, reduce healthcare costs, and improve adherence to the medications that do remain — because a simpler regimen is easier to follow.

Organizations including the World Health Organization, the American Geriatrics Society, and the Canadian Deprescribing Network have called for more systematic approaches to medication review across healthcare settings.

The Bottom Line

More medications doesn't always mean better health. In many cases, a carefully curated, regularly reviewed medication regimen — one where every drug has a clear purpose and the benefits genuinely outweigh the risks — leads to better outcomes, fewer side effects, and a higher quality of life.

Deprescribing isn't about taking away treatment. It's about making treatment work better for you, as you are right now. If you're managing multiple medications and haven't had a comprehensive review in a while, it's worth asking your care team about it.

Ready to take a closer look at your medications? If you're navigating complex medication decisions — especially at the intersection of mental and physical health — working with a provider who collaborates with your medical team can make a real difference. Schedule a consultation or call (702) 608-7750. Telehealth available in California and Nevada.