Psychiatric medications are often started through a decision. They are continued through momentum.
That is not an accusation. It is how most health care systems work. A prescription has refills. A follow-up visit is short. The immediate question becomes, “Should we renew this?” rather than, “What problem is this medication solving now, and at what cost?”
A 2026 consensus statement from the American Society of Clinical Psychopharmacology put periodic reassessment at the center of psychiatric prescribing. Its task force unanimously agreed that the usefulness of each psychotropic medication should be reviewed at least annually. That sounds straightforward. It isn’t. ([doi.org](https://doi.org/10.1001/jamanetworkopen.2026.0043))
The refill question is too small
A refill is an administrative event. A medication decision is a clinical and personal one.
Those are not the same thing.
Consider how much can change after a medication is started. The original symptoms may have improved. Life circumstances may be different. Other medications may have been added. A side effect that seemed tolerable at first may have become more consequential over time. The medication may still be beneficial, partially beneficial, no longer beneficial, or beneficial in one area while creating a burden somewhere else.
None of that can be answered by the fact that the prescription has been filled before.
Here is the part worth looking at: continuing a medication is an active choice, even when it feels passive. It deserves the same basic clarity that starting it was supposed to receive.
What should be revisited?
The 2026 consensus statement is useful because it does not frame deprescribing as the opposite of good care. It frames prescribing, renewing, and selectively discontinuing medications as parts of one ongoing process. It also acknowledges a major limitation: much of the guidance reflects expert consensus, and more empirical research on how deprescribing protocols work in practice is still needed. ([doi.org](https://doi.org/10.1001/jamanetworkopen.2026.0043?utm_source=openai))
That distinction matters. Consensus can organize good questions. It does not settle every answer.
A meaningful medication review should make the original decision visible again:
- What symptoms, risks, or functional problems led to the medication being prescribed?
- What changed after it was started, including after dose changes?
- What benefit is still noticeable now?
- What burdens have emerged, including physical, cognitive, sexual, sleep-related, emotional, metabolic, or financial burdens?
- Have other medications, substances, medical conditions, or life circumstances changed the equation?
- What was the intended endpoint when treatment began, if there was one?
This is not a checklist designed to produce one outcome. A review could reasonably support continuation. It could identify a medication that still has a clear role. It could also reveal duplication, a weak benefit-harm balance, an unaddressed adverse effect, or a medication that was never revisited after the immediate crisis passed.
Benefit is not the only variable
People often assume the relevant question is whether a medication “works.” But that phrase can conceal more than it reveals.
Does it work compared with the period before treatment? Does it work compared with what the person experiences at a different dose? Does it work for one symptom while worsening another? Is the apparent benefit coming from the medication, from changes in sleep, work, relationships, substance use, therapy, time, or several factors at once?
Sometimes we know. Sometimes we are making a reasonable inference. Sometimes the answer is simply uncertain.
Side effects and adverse effects also deserve more precision than they usually get. A side effect is not automatically minor just because it is listed in prescribing information. An adverse effect is not automatically proof that a medication was inappropriate. The relevant issue is the lived tradeoff: magnitude, duration, reversibility, alternatives, and what the person values most.
Long-term use adds another layer. Evidence that a medication helps during an acute episode is not identical to evidence about its benefits and burdens after years of exposure. That does not mean long-term treatment lacks value. It means the original evidence question may not fully answer the current decision question.
When symptoms change, labels can mislead
This becomes especially important if a medication is being reconsidered and symptoms emerge after a change.
Anxiety, insomnia, low mood, agitation, panic, emotional instability, and physical discomfort can reflect withdrawal, rebound, the return of previous symptoms, recurrence of a condition, medication effects, life circumstances, or more than one of these at once. Familiar symptoms are not automatically evidence of relapse. Unfamiliar symptoms are not automatically proof of withdrawal.
Timing matters. Pattern matters. What existed before medication matters. What happened after prior dose changes matters. So does the course over time.
Physical dependence is relevant here, but it should not be confused with addiction. A person can develop physiological adaptation to a psychiatric medication without compulsive drug-seeking behavior. Withdrawal after a medication change may reflect that adaptation. It does not, by itself, prove the medication must be continued indefinitely. It also does not prove the medication was harmful or wrongly prescribed.
Annual review is not an annual push to stop
There is a temptation to turn every new conversation about deprescribing into a slogan: fewer medications are always better, or continued treatment is always safer.
Neither claim survives much scrutiny.
Some medications remain clearly useful over time. Some do not. Some situations are too complex to reduce to a simple benefit-versus-risk calculation because the evidence is incomplete and the stakes are real. The goal is not to create pressure to stop. It is to prevent inertia from masquerading as informed consent.
A refill may be appropriate. But it should not be mistaken for a decision simply because it is familiar.
The better question is quieter and more demanding: If this medication were not already part of the picture, what would we need to know before deciding to continue it now?
Written for Dr. Teralyn Sell, PhD
Psychology · Brain Health · Human Behavior