[Tapering of antidementia drugs, antidepressants and antipsychotics in elderly patients : When possible, when not?]

BACKGROUND: Antidementia drugs, antidepressants and antipsychotics are among the most frequently prescribed medication in old and multimorbid patients. Due to side effects (e. g. prolonged QTc interval) in emergency medicine/intensive care unit or patients' wishes the question is often raised whether these drugs can be stopped and how this may be done. ANTIDEMENTIA DRUGS: If the cognition is stable under antidementia drugs or if the patient is in favour of the medication, it should be continued. After stopping antidementia drugs there may be a deterioration of cognitive function in the following 2-3 months. This should be discussed with the patient and the relatives/caregiver. ANTIDEPRESSANTS: In case of only slight or reactive depressive mood antidepressants should be tapered. The dose should be reduced over a period of at least 4 weeks. A sudden stop may cause a withdrawal syndrome with flu-like symptoms, fatigue, tremor, insomnia, anxiety or confusion. In severe depressive episodes there is a high risk of relapse; therefore deprescribing should only be done after a stable remission of 4-9 months. ANTIPSYCHOTICS: Antipsychotics in dementia or nursing home patients as well as in cases of delirium should be tapered, whereby confusion may increase again. When antipsychotics were prescribed because of hallucinations or severe psychosis, they should not be reduced or only with great caution.