The Art of Deprescribing: How Fewer Medications Can Mean Better Health

The Art of Deprescribing: How Fewer Medications Can Mean Better Health

She came in carrying a list.

Not a list of symptoms or questions, though she had those too. It was a list of medications — eleven of them — printed neatly on a folded piece of paper she had clearly prepared before our appointment. She placed it on the desk between us with the quiet exhaustion of someone who had been managing something complicated for a very long time.

She was fifty-three years old. She had seen multiple specialists over the past decade. Each visit, she told me, had ended with either a new prescription or a higher dose of an existing one. One medication for blood pressure. Another for the side effects of that medication. A sleep aid that had become less effective over time but impossible to discontinue without help. A statin, an antidepressant, a proton pump inhibitor she had been told to take indefinitely after a brief period of acid reflux years ago.

She was not dramatically unwell. But she was not well either. She was tired in a way that sleep did not fix. Her thinking felt slower than it once had. Her digestion was unpredictable. She had gained weight despite no significant change in her habits. And somewhere along the way, she had started to wonder whether the medications meant to help her might also be contributing to how she felt.

She was right to wonder.

When More Becomes Less

There is a cultural assumption embedded in modern medicine — one that patients absorb without realizing it — that more treatment equals better care. More tests. More interventions. More prescriptions. Each one feels like progress, like evidence that something is being done.

But medicine has a quieter, more uncomfortable truth: medications interact with one another. They deplete nutrients. They alter hormones. They affect the gut microbiome, liver function, cognitive processing, and energy metabolism. And when multiple medications accumulate over years — a phenomenon known as polypharmacy — the cumulative effect on a patient's wellbeing can be profound and deeply underappreciated.

Studies suggest that patients taking five or more medications face significantly elevated risks of adverse drug reactions, falls, cognitive decline, and hospitalizations. Yet in routine clinical practice, the question of whether a medication is still necessary is asked far less often than the question of whether a new one should be added.

This is the gap that deprescribing addresses.

What Deprescribing Actually Means

Deprescribing is not simply stopping medications. That distinction matters enormously. It is a deliberate, evidence-informed, physician-guided process of identifying which medications in a patient's regimen may no longer be serving them — and thoughtfully reducing or discontinuing those agents in a way that is safe, gradual, and closely monitored.

It requires time. It requires a willingness to ask uncomfortable questions. And it requires a physician who understands not only pharmacology but also the patient sitting across from them — their history, their biology, their goals, and what feeling genuinely well actually looks like for them.

In my practice, deprescribing is not a last resort. It is a first question. When a new patient arrives with a long medication list, one of the most important things I can do is look at that list with fresh eyes and ask: what is earning its place here, and what might we be ready to reconsider?

The Medications Most Often Worth Revisiting

Not every medication on a list is a candidate for deprescribing. Some are essential, well-tolerated, and clearly beneficial. But there are certain classes of medications that appear with striking frequency in patients who have been in the traditional medical system for many years — and that deserve particularly careful examination.

Proton Pump Inhibitors. Originally designed for short-term use, proton pump inhibitors are among the most commonly prescribed medications in the country and among the most routinely continued far beyond their intended duration. Long-term use is associated with magnesium depletion, impaired B12 absorption, increased risk of gut dysbiosis, and emerging concerns around kidney and bone health. Many patients taking them daily have never had a conversation about whether they still need them.

Sleep Medications and Benzodiazepines. These medications can be genuinely helpful in short-term or crisis situations. But they were never designed for indefinite use, and yet indefinite use is extraordinarily common. Over time, they alter sleep architecture, impair memory consolidation, and in older patients, meaningfully increase fall and cognitive risk. Discontinuing them requires a careful, gradual taper — but for many patients, the improvement in clarity and sleep quality on the other side is remarkable.

Certain Blood Pressure Medications. Hypertension management is nuanced. But some patients find that as their lifestyle improves — with weight loss, reduced stress, optimized sleep, and dietary changes — their blood pressure normalizes in ways their medications have not yet caught up with. Continuing a medication whose indication has resolved is not neutral. It carries its own risks.

Antidepressants and Mood Stabilizers. These medications play an important role in mental health care, and I want to be clear that deprescribing in this category must be approached with particular sensitivity and collaboration. But there are patients who began an antidepressant during a specific life circumstance years ago, never had a thoughtful conversation about discontinuation, and have continued taking it by inertia rather than intention. For some, that is the right choice. For others, exploring what lies underneath — including hormonal imbalances, nutritional deficiencies, thyroid dysfunction, or chronic inflammation — opens entirely different treatment possibilities.

Statins in Lower-Risk Patients. Statins have genuine value for patients with established cardiovascular disease or very high risk profiles. But they are also frequently prescribed to individuals whose absolute risk reduction may be modest while their side effect burden — fatigue, muscle pain, cognitive fog, and CoQ10 depletion — is very real. This is a conversation worth having, ideally alongside a fuller picture of cardiovascular risk informed by advanced lipid testing and genetic insight.

What Deprescribing Looks Like in Practice

When I sat with my patient and her list of eleven medications, we did not begin by cutting anything. We began by understanding.

I reviewed her complete history — not just the diagnoses that had generated each prescription, but the timeline, the context, the original intention. I ordered labs she had never had, including a comprehensive metabolic panel, nutrient levels, inflammatory markers, and hormonal testing. I asked her what symptoms had improved on each medication, and which she was uncertain about. I asked how she had felt before some of these prescriptions existed in her life.

Over the following months, we worked through her regimen carefully and collaboratively. The proton pump inhibitor, which she had been taking for six years after a brief episode of reflux during a period of high stress, was gradually tapered with dietary support and a gut healing protocol. Her magnesium levels, which had been low, began to normalize. Her sleep — which she had attributed to age — improved noticeably.

The sleep medication came next, replaced over time with a combination of targeted hormone optimization, sleep hygiene support, and magnesium supplementation. It took patience. But she did it.

By the end of our first year together, she was taking four medications — all of them genuinely indicated, all of them tolerated well, all of them chosen intentionally. She told me she felt more like herself than she had in a decade. Not because she was on less medication, exactly. But because her care had finally become thoughtful.

The Connection to Precision Medicine

One of the reasons deprescribing works so powerfully within a precision medicine framework is that it does not happen in isolation. When we are simultaneously looking at a patient's genetics, hormonal status, nutritional profile, gut health, and inflammatory markers, we gain a far more complete picture of why certain symptoms exist — and whether a medication is truly addressing a root cause or simply managing a downstream effect.

Many patients who have spent years on antidepressants, for example, have never had their MTHFR status assessed or their methylation capacity evaluated. Many patients on sleep aids have never had a thorough hormonal evaluation. Many patients on multiple blood pressure medications have never had a detailed conversation about stress physiology, cortisol patterns, or dietary sodium sensitivity in the context of their genetics.

This is not a criticism of the physicians who prescribed those medications. It is simply the reality of what standard care is designed to do — and what integrative precision medicine is designed to do differently.

A Different Kind of Courage

There is something counterintuitive about deprescribing that I want to acknowledge directly. In medicine, adding a treatment feels like action. Removing one can feel like risk — even when the evidence supports it, even when the patient is ready, even when the goal is clearly greater wellbeing.

But I have come to believe that knowing when to step back is one of the most sophisticated clinical skills a physician can develop. It requires a different kind of confidence. Not the confidence of doing more, but the confidence of doing what is right.

My patients who have gone through a thoughtful deprescribing process consistently describe the experience the same way. They feel clearer. They feel lighter. They feel, as one patient put it, like the static has been turned down.

That is not a small thing. That is medicine working the way it was always meant to.

Is This Conversation Right for You?

If you are managing multiple medications and have ever wondered whether all of them are still serving you — or whether some of your symptoms might actually be medication-related rather than disease-related — that instinct deserves to be taken seriously.

Deprescribing is not appropriate for everyone, and it is never something to attempt alone. But for the right patient, approached with the right level of care, it can be genuinely life-changing.

At Modern Human MD, this is the kind of conversation I welcome. Not because fewer medications is always better, but because intentional, evidence-based, individualized care always is.

If you would like to explore what a comprehensive medication review might look like as part of your care, I would be honored to be part of that process.