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Dr. Bryan Atkinson opened the class with a story fromhospice that set the tone: at the end of life, simply stopping non-essentialmedications often helped patients wake up, eat, and live more fully for weekslonger than expected. The point was plain—medications deserve ongoing scrutiny,not automatic renewal. With that, he introduced Katherine “Kathy Z.” Zbodula,an Adult Nurse Practitioner with more than 25 years in adult and geriatricprimary care and over three decades in healthcare overall, including cardiacICU nursing and, currently, addiction medicine.

What Deprescribing Means—and What It Doesn’t

Katherine framed deprescribing as a deliberate, supervisedprocess of reducing or discontinuing medicines that no longer help—or may becausing harm. It is not “stopping everything.” The work includesover-the-counter products, too, because they can meaningfully affect safety andoutcomes. The mindset is patient-centered: weigh real benefits against realrisks, use the lowest effective doses, taper when needed, monitor closely, andmake decisions together.

Why It Matters

Polypharmacy is common. Katherine cited figures showing thatabout 40% of older adults take five or more medications, and an estimated20–50% of prescriptions may be inappropriate in some way. Thoughtfuldeprescribing aims to reduce the medication load, improve function and qualityof life, cut adverse drug events, and—often—lower costs. She noted that simplyremoving burdensome drugs can start a gentle detoxification process, allowingthe body’s own healing capacity to re-emerge.

How Healthcare Changed—and Why Reassessment Is Needed

Drawing on 38 years of practice, Katherine described shiftsfrom paper charts to electronic records, DRG-driven early discharges andreadmissions, and a culture that too often rushed to match diagnoses with drugswhile overlooking root causes. She recalled nontraditional therapies oncedismissed out of hand. The pandemic, she argued, intensified vulnerability andfear, forcing clinicians to choose between protocol and prudence. Hertouchstones remain steady: first, do no harm; prioritize prevention; use medicationswisely and not as a permanent bandage; teach patients so they can helpthemselves.

Practical Alternatives: When “Less” Starts to Work

Katherine surveyed evidence-informed options that maysupport a lighter medication plan, always within a supervised taper whensomeone is already on prescriptions.

For blood pressure, some patients—especially early in thediagnosis—may benefit from botanicals such as hibiscus or olive leaf, whilelong-time users of multiple antihypertensives require gradual, individualizedadjustments. For mood, saffron has data comparable to certain antidepressants;lavender oil and passionflower can help reduce anxiety by supporting GABAactivity. For inflammation, curcumin and white willow bark may offer NSAID-likeeffects.

On cholesterol, the first lever is lifestyle: lowerinflammation, improve diet quality, reduce triglycerides, and address insulinresistance. Short-term options can include red yeast rice, but only if theproduct is verified to contain monacolin K and is free of citrinin; even then,it is not universally safe and isn’t Katherine’s “first line.” Other supportiveoptions include berberine, plant sterols (from foods such as nuts, seeds,legumes, avocados, and crucifers), omega-3s, garlic, CoQ10, beets, and antioxidant-richnutrients. Berberine and fish oil together can be helpful in certain cases.

Regarding reflux, Katherine cautioned against indefiniteproton pump inhibitor (PPI) use when not truly needed because of associationswith kidney and cardiovascular issues, nutrient deficiencies, fractures, andpossible cancer risk. Gentle alternatives include aloe vera syrup (sugar-freefor those with diabetes), alginate from seaweed that forms a protective “raft,”and DGL licorice for mucosal support—alongside fundamentals such as weight losswhere needed, trigger-food avoidance, head-of-bed elevation, and smaller meals.

Safety First: Tapers, Timelines, and Red Flags

Stopping antidepressants or benzodiazepines abruptly isunsafe. Katherine emphasized slow, supervised tapers to avoid withdrawalsymptoms like “brain zaps,” dizziness, or—especially withbenzodiazepines—seizures. Monitoring cadence depends on the drug class andclinical picture: some cases call for follow-up in 1–2 weeks, others in 1–6months. She recommends symptom diaries, clear written instructions, andagreed-upon “call us” thresholds. If a trial reduction fails—say, bloodpressure rises after removing an ACE inhibitor—the medication is restarted atthe best dose and reconsidered later if lifestyle changes take hold.

Certain supplements interact with common drugs. St. John’swort can reduce the effectiveness of oral contraceptives, warfarin, and someHIV therapies. Garlic can increase bleeding risk. Ashwagandha may interact withdiabetes and blood pressure medications. Kava poses sedation and liver concerns(especially with alcohol). Licorice can lower potassium and raise arrhythmiarisk when combined with diuretics or digoxin. Ginkgo may increase bleeding riskwith NSAIDs, aspirin, or warfarin. Pregnancy, breastfeeding, liver and kidneydisease, autoimmune conditions, and pediatric use demand extra caution—oravoidance.

Quality control matters. Look for USP or NSF markings,third-party testing, and GMP compliance. Be wary of “proprietary blends” thathide exact amounts, miracle-cure claims, and unknown manufacturers withoutclear contact information.

A Clear Process Patients Can Understand

Katherine outlined a five-step flow: review all medications;prioritize which help and which harm; decide together where to start; tapergradually with monitoring; reassess and adjust. She also shared a simple T-P-Rlens: is a medicine treating something active, preventing something plausible,or under evaluation? High-priority targets for removal include drugs without avalid indication, those causing adverse effects, and preventive agents unlikelyto confer benefit over a person’s remaining lifespan. Throughout, shareddecision-making keeps plans aligned with personal values, beliefs, andgoals—even when those beliefs come from family history or habit.

Thyroid Questions, Realistic Answers

In the Q&A, a question about thyroid medicationsprompted a measured reply. Decisions depend on diagnosis (hypo vs. hyper),duration of use, and a full thyroid panel beyond TSH alone (including T3, T4,and antibodies). In some cases, a careful, slow reduction with close monitoringcan be appropriate; in others, continued therapy remains warranted. The mainpoint: this is involved work and should be undertaken with qualified guidance.

Broader Traditions and Non-Drug Strategies

A guest contributor, Dr. Anthony James, highlightedlongstanding non-drug systems such as Ayurveda and manual or yoga-basedtherapies with published research in their home countries. He underscored thateffective reduction of unnecessary medication often includes lifestyle,physical medicine, and mind-body methods—not only herbs or supplements. Theclass closed by acknowledging the value of grounded, rational strategies thattreat medication as a tool, not a default.

The Takeaway

Deprescribing is a careful, collaborative craft. It respectsthe good that medicines can do while recognizing the harm they can cause whenstacked, prolonged, or never re-evaluated. Done thoughtfully—with tapering,monitoring, and honest conversation—it can lift side effects, simplify care,and let the body regain its footing.