Medication Strategies: Switching, Tapering, Cross-Over, Overmedication, Drug-Drug Interactions, and Discontinuation Syndromes

  • Elizabeth Kozyra
  • Timothy LauEmail author


Psychotropic medications are known to cause a heightened risk of significant adverse effects in the geriatric population, including falls, hip fractures, delirium, and over-sedation. Geriatric patients may experience these and other adverse effects due to altered pharmacokinetics and pharmacodynamics, which must be considered when prescribing or changing regimens. The aged are also more likely to be prescribed multiple medications due to concurrent illnesses, with a higher risk of medication-related problems. Strategies are offered for switching, tapering, and cross-tapering of psychotropics to enhance efficacy and to minimize discontinuation syndromes and other adverse effects.


Psychotropic medications Pharmacokinetic Pharmacodynamic Drug-drug interactions Overmedication Switching and tapering medications Discontinuation syndromes 


  1. 1.
    Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent patterns of medication use in the ambulatory adult population of the United States. The Slone survey. JAMA. 2002;287:337–44.CrossRefGoogle Scholar
  2. 2.
    Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalization for adverse drug events in older Americans. NEJM. 2011;365(21):2002–12.CrossRefGoogle Scholar
  3. 3.
    Masoon N, Shakib S, Kalisch L, Caughey G. Systemic review of polypharmacy definition, assessment tools, and association with clinical outcomes. Res Social Adm Pharm. 2017;13(4):E28–29.4.CrossRefGoogle Scholar
  4. 4.
    American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American geriatrics society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63:2227–46.CrossRefGoogle Scholar
  5. 5.
    Correll CU. Switching and combining antipsychotics. CNS Spectrums. 2010;15(56):8–11.CrossRefGoogle Scholar
  6. 6.
    DSM-5. American Psychiatric Association. DSM-5 Arlington (Va): APA, 2013.Google Scholar
  7. 7.
    Bhat V, Kenndey S. Recognition and management of antidepressant discontinuation syndrome. J Psychiatry Neurosci. 2017;42(4):E7–8.CrossRefGoogle Scholar
  8. 8.
    Fava GA, Gatti A, Belaise C, et al. Withdrawal symptoms after selective serotonin reuptake inhibitor discontinuation: a systematic review. Psychother Psychosom. 2015;84:72–81.CrossRefGoogle Scholar
  9. 9.
    Keks N, Hope J, Keogh S. Switching and stopping antidepressants. Aust Prescr. 2016;39:76–83.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Wilson E, Lader M. A review of the management of antidepressant discontinuation symptoms. Ther Adv Psychopharmacol. 2015;5(6):357–68.CrossRefGoogle Scholar
  11. 11.
    Takeuchi H, Kantor N, Uchida H, Suzuki T, Remington G. Immediate vs. gradual discontinuation in antipsychotic switch: a systematic review and meta-analysis. Schizoph Bull. 2017;43(4):862–71.PubMedGoogle Scholar
  12. 12.
    Olfson M, King M, Schoenbaum M. Benzodiazepine use in the united states. JAMA Psychiatry. 2015;72(2):136–42.CrossRefGoogle Scholar
  13. 13.
    Cunningham CM, Hanely GE, Morgan S. Patterns of use of benzodiazepines in British Columbia: examining the impact of increasing research and guideline cautions against long-term use. Health Policy. 2010;97:122–9.CrossRefGoogle Scholar
  14. 14.
    National Institute of Health. Despite risks, Benzodiazepine use highest in older people. December 2014. Available from
  15. 15.
    Brett J, Murnion B. Management of benzodiazepine misuse and dependence. Aust Prescriber. 2015;38(5):152–5.CrossRefGoogle Scholar
  16. 16.
    Gould RL, Coulson MC, Howard RJ. Cognitive behavioral therapy for depression in older people: a meta-analysis and meta-regression of randomized controlled trials. J Am Geriatr Soc. 2012;60(10):1817–30.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Royal Ottawa Mental Health CentreOttawaCanada
  2. 2.Faculty of Medicine, University of Ottawa, Department of Psychiatry, Geriatric Psychiatry Inpatient Unit, The RoyalOttawaCanada

Personalised recommendations