• Palliative Care
• Depression
• Terminal care
• Clinical decisions
• Advance Care Planning
• Quality of life

In palliative care, we can often predict that a patient is entering a deteriorating phase and the prognosis is limited. We can also anticipate a shift from the oral route to the parental route using continuous subcutaneous infusion (CSCI) as this deterioration progresses. However, how should we appropriately manage medications such as antidepressants that are not amenable to administration by CSCI? Should we proactively deprescribe or dose-reduce such medications to minimise well-recognised issues associated with their abrupt cessation?

Deprescribing describes the systematic process of tapering and discontinuing medications when existing or potential harm outweighs existing or potential benefits.1 Knowing when and how to deprescribe medications can be associated with significant challenges.2 Several deprescribing guidelines are available to guide clinical decision-making: ‘deprescribing.org’ provides guidance on a variety of medications including antihyperglycemic and antipsychotic agents, and the ‘OncPal deprescribing guideline’ provides guidance on the deprescribing of aspirin, lipid-lowering medications, antihypertensives, as well as vitamins, minerals and complementary therapies for cancer patients with a limited life expectancy. While these guidelines are invaluable, guidance is not provided on the appropriate deprescribing of many medications, including antidepressants. Antidepressant medications are commonly prescribed to palliative care patients. According to a recent retrospective study, 30% of hospice patients were prescribed at least one antidepressant medication for the management of symptoms including depression, anxiety, pain, sleep …