You are looking for a deprescribing specialist because you want to take fewer psychiatric medications, or none at all, and you cannot find a doctor willing to help. Maybe one prescription became two, then four, and no one can explain anymore what each one is for.
Psychiatric medication deprescribing is the medical process of carefully reducing and stopping medications that may no longer be helping. It deserves the same skill and attention as prescribing, and it almost never gets it.
Mark Leeds, D.O. is an osteopathic physician who provides deprescribing care through private telemedicine. He serves on the medical advisory board of the Benzodiazepine Information Coalition, and he has guided patients off medications that other doctors said they would take for life.
What is deprescribing, and why does it need a specialist?
Deprescribing and tapering mean the same thing, and this page uses the two words interchangeably. Both describe a planned, gradual, medically supervised reduction of a medication, paced by how your body responds.
Starting a psychiatric medication takes a prescription pad and a fifteen minute visit. Stopping one safely can take a year of careful, responsive adjustments. That gap is exactly where a specialist matters.
Your nervous system adapts to these medications over months and years. Reduce the dose too quickly and the body protests with withdrawal symptoms, which are easily mistaken for relapse. A doctor who cannot tell withdrawal from relapse will raise the dose again and call it proof that you need the drug forever.
One thing should be said plainly at the start. If your body has adapted to a medication your doctor prescribed, that is physical dependence, and physical dependence is not addiction. It is a normal biological response to long-term treatment, and the answer to it is a gradual medical taper, not addiction recovery programming.
Which psychiatric medications can be deprescribed?
Dr. Leeds helps patients taper medications across the major psychiatric classes:
- Benzodiazepines, including Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam), and Valium (diazepam), along with z-drugs such as Ambien (zolpidem)
- Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), and Lexapro (escitalopram)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs)
- Gabapentinoids, meaning gabapentin (Neurontin) and pregabalin (Lyrica)
- Antipsychotics, including Abilify (aripiprazole), Seroquel (quetiapine), and Zyprexa (olanzapine)
Seroquel and Zyprexa deserve special mention. These are powerful antipsychotic medications that are frequently prescribed inappropriately for sleep, and many people who took them for simple insomnia now carry a serious dependence they never agreed to.
Benzodiazepine tapering is its own discipline with its own withdrawal syndrome, covered in depth on the benzodiazepine tapering page. Antidepressant tapering follows the same core principles, with different tools and timing.
The same principles guide every taper.
Across every medication class, three ideas anchor this work.
The first is hyperbolic tapering. Dose reductions become progressively smaller as the total dose gets lower, because the relationship between dose and effect in the brain is not a straight line. The final milligrams do a surprising amount of work, so the final cuts must be the gentlest.
The second is published guidance. The Maudsley Deprescribing Guidelines, written by psychiatrists at King’s College London, provide detailed tapering protocols across the psychiatric medication classes. For benzodiazepines, the Ashton Manual remains the foundational reference.
The third is precise dosing. Standard tablets do not come in the small steps a slow taper requires. Compound pharmacies can prepare liquid formulations and precisely dosed capsules, allowing reductions as small as a fraction of a milligram.
Every prescription should come with an exit plan.
Here is a hard truth about modern psychiatry: it is quick to add and slow to subtract. Medications get layered on, year after year, often without any strategy for coming off.
A psychiatric medication can be like scaffolding on a building. It may hold things steady through a hard season. But scaffolding is meant to come down when the repair is done, and no one should be told to live inside it forever.
None of this means your medications were a mistake, or that you were wrong to take them. It means the second half of the job was never finished. Deprescribing is the second half of the job.
You set the pace.
There is no standard schedule in this practice, because there is no standard patient. Dr. Leeds builds each taper around your medications, your history, and your nervous system’s response, then adjusts it week by week.
If symptoms flare after a reduction, that is information, not failure. The plan slows down, or holds at the current dose, until you feel steady again. You are never pushed to keep cutting on a schedule your body has already voted against.
Appointments are weekly, by video or audio, and can run up to an hour. Between visits, patients have 24/7 text access to Dr. Leeds for urgent questions. Patient-led pacing only works when the physician actually knows how last week went.
Care also goes beyond dose numbers. Dr. Leeds coaches patients on reconnecting with meaningful activities during the taper, because a life worth waking up for is part of how the nervous system heals. You are treated as a partner in the plan, not a recipient of it.
How to begin
The first step is the contact form on drleeds.com. From there, most people schedule an initial consultation with Dr. Leeds to review their medication list and their goals.
Medical management and prescribing are available to patients located in Florida. Consultations are paid sessions, by audio or video, up to one hour, and they are available to anyone, anywhere. A consultation can cover any topic, but it is not a medical visit and it does not establish a physician-patient relationship.
If you have been waiting for a doctor to bring up an exit plan, you can stop waiting. You are allowed to bring it up first.
Psychiatric medication deprescribing FAQ
What does psychiatric medication deprescribing mean?
Psychiatric medication deprescribing is the planned, medically supervised reduction of psychiatric medications such as benzodiazepines, antidepressants, gabapentinoids, and antipsychotics. The goal is the lowest dose that truly serves you, which for many patients means stopping completely. It is done gradually, with a physician adjusting the plan based on your response.
Is deprescribing the same as tapering?
Yes. Deprescribing emphasizes the decision to reduce or stop a medication, while tapering emphasizes the gradual method used to do it safely. In practice they are one process, and Dr. Leeds uses the words interchangeably.
Can Seroquel or Zyprexa prescribed for sleep be deprescribed?
Yes. Seroquel (quetiapine) and Zyprexa (olanzapine) are antipsychotic medications frequently prescribed inappropriately for insomnia, and long-term use creates real physical dependence. Dr. Leeds helps patients taper these medications gradually while addressing sleep as part of the overall plan.
How long does psychiatric medication deprescribing take?
It depends on the medication, how long you have taken it, and how your nervous system responds. Some tapers finish within months, while benzodiazepine tapers often take a year or longer. The timeline adapts to you, never the other way around.
I take several psychiatric medications. Can they all be deprescribed?
Often yes, but not all at once. Tapering usually proceeds one medication at a time, in a deliberate order, so your body faces one change at a time and symptoms can be read clearly. Dr. Leeds plans that sequence with you based on your full medication list and history.
About the physician
Mark Leeds, D.O. is an osteopathic physician providing concierge telemedicine care focused on benzodiazepine and z-drug tapering, psychiatric medication deprescribing, opioid dependence treatment, and alcohol use disorder. Dr. Leeds works directly with each patient, with weekly appointments and 24/7 text access between visits. He serves on the medical advisory board of the Benzodiazepine Information Coalition and hosts The Rehab Podcast on the Mental Health News Radio Network. Medical management is available for patients in Florida; consultations are available more broadly.