BackgroundIncreasing psychotropic prescribing has raised concerns about long-term safety and regimen complexity in mental health care. Although psychotherapy is an established treatment, its role in medication optimization and psychotropic medication reduction in real-world practice across patient subgroups remains insufficiently characterized.ObjectiveTo evaluate whether initiation of psychotherapy is associated with short-term changes in psychotropic medication exposure and regimen complexity, and to examine differences by sex, age, and diagnostic category. Methods: A retrospective cohort study was conducted using anonymized pharmacy dispensing data from the Mental Health Service of Hospital Marina Baixa (Alicante, Spain) between 2014 and 2024. Patients with at least one active prescription for a benzodiazepine or antidepressant within 90 days before psychotherapy initiation were included. Psychotropic exposure was compared in symmetric 90-day pre- and post-therapy windows using number of active agents, total Defined Daily Doses, and prevalence of benzodiazepine and antidepressant use, with stratified analyses by sex, age group, and diagnosis.ResultsThe cohort comprised 86,502 patients and 20.76 million dispensations. The median number of psychotropic medications decreased from 5 to 2 (p < 0.001), while total dose remained stable (median Defined Daily Dose ≈ 21.7; p = 0.999). Benzodiazepine use declined from 87.6% to 67.5% and antidepressant use from 81.8% to 68.8% (both p < 0.001). Men were more likely than women to discontinue benzodiazepines (odds ratio 1.27, 95% confidence interval 1.13–1.43), and simplification increased with age (median reduction −1 in <18 years to −4 in ≥65 years). The largest benzodiazepine reductions occurred in depressive, personality, and episodic mood disorders (−23 to −27 percentage points).ConclusionsIn routine public mental health care, psychotherapy initiation is associated with substantial simplification of psychotropic treatment regimens without increasing overall medication dose, supporting a potential role in facilitating rational medication simplification.
Radically different