A quiet shift in prescribing

Across the world, healthcare is waking up to a neglected truth: starting a medicine is easy, but stopping one safely is hard. For decades, systems have focused on initiating treatment, with little guidance on how to discontinue. This gap has left many older adults and long-term psychiatric patients on drugs far beyond their intended use — often experiencing withdrawal, side effects, or functional decline.

Enter taper clinics: specialized services designed to support patients in reducing or discontinuing long-term medications in a structured, supervised way.

What is a taper clinic?

A taper clinic is a service — usually outpatient, sometimes virtual — that provides:

• Comprehensive medication review: evaluating each drug’s current indication, risks, and benefits.

• Structured taper plans: gradual dose reductions, often using “hyperbolic tapering” (smaller cuts as the dose lowers) to minimize withdrawal.

• Close monitoring: regular follow-up to distinguish withdrawal symptoms from relapse.

• Multidisciplinary input: often involving pharmacists, psychiatrists, geriatricians, and nurses.

The focus is often on psychiatric medications (antidepressants, benzodiazepines, antipsychotics, gabapentinoids), but taper clinics also manage opioids, sleep medicines, and polypharmacy in frail older adults.

Why are taper clinics becoming popular?

1. Growing awareness of withdrawal syndromes

   • Antidepressant and benzodiazepine withdrawal are increasingly recognized as underdiagnosed problems.

   • Patients often report withdrawal being mistaken for relapse, leading to unnecessary lifelong treatment.

2. Public demand and patient advocacy

   • Online communities and patient groups have highlighted struggles with tapering unsupported, driving demand for specialized services.

   • Transparency about risks of long-term use (e.g., sleeping pills and dementia risk, benzodiazepines and falls) fuels interest.

3. Policy and safety priorities

   • National guidelines now recommend medication review and deprescribing for older adults and those on high-risk medications.

   • Healthcare systems are under pressure to reduce avoidable harms, admissions, and costs linked to polypharmacy.

4. Evidence base catching up

   • Studies show deprescribing interventions reduce polypharmacy and PIMs, with very low rates of serious adverse outcomes.

   • Taper clinics operationalize this evidence, offering a safe framework to do what guidelines recommend.

The clinic model in action

Different countries are experimenting with models:

• UK & Europe: community taper clinics, often pharmacist-led, focusing on antidepressant withdrawal and psychotropic polypharmacy.

• North America: hospital-linked deprescribing services, integrated into geriatric medicine and pain management.

• Telehealth taper support: virtual taper clinics emerging in response to patient demand, especially post-COVID.

Common threads: personalized taper plans, slow reductions, and emphasis on patient education and empowerment.

Challenges and criticisms

• Resource intensive: requires time, frequent follow-up, and trained staff.

• Not universally available: patchy access depending on region.

• Fear of relapse: both patients and clinicians may hesitate, especially with severe psychiatric illness.

• Limited research: while deprescribing is safe in general, more evidence is needed on long-term outcomes of structured taper clinics.

The bigger picture

Taper clinics represent a cultural change in medicine: shifting from “prescribe and continue” to “prescribe, review, and when safe, stop.”

For patients, they offer reassurance that stopping a medication is not abandonment but active care.
For clinicians, they provide structured support to navigate the complexities of withdrawal and relapse prevention.

The rising popularity of taper clinics signals a recognition that safe stopping is as important as safe starting — and that patients deserve specialized support at both ends of the treatment journey.

Local support: tapering with guidance

If you or a loved one are considering reducing long-term psychiatric or sleep medicines, the process is safest when supervised. Taper clinics are designed exactly for this — structured plans, gradual reductions, and close monitoring to avoid withdrawal or relapse.

In Chennai, this service is available through:

Dr. Srinivas Rajkumar T
Consultant Psychiatrist
Apollo Clinic, Velachery, Chennai
📞 85951 55808