Taper and attempt to discontinue any drugs that may be contributing to this unwanted sedation. If the drugs are important to continue for other reasons, see if any less sedating substitutes can be found. Persistent sedation is one of the "disabling side effects" [Van Putten] that often escapes the notice of physicians because it may not be objectively obvious. It is now recognized to be a major cause of subjective discomfort and inability to function.
If the patient is on two or more antipsychotics, and you have eliminated the other causes of sedation, the cause of the unwanted sedation may be focused here. See if some of the antipsychotics can be reduced or eliminated, particularly those more associated with sedation such as low potency neuroleptics, quetiapine, and olanzapine. Sometimes, the antipsychotics should be reduced first, that is, before reducing the ancillary sedating agents. For example, if the patient is on a benzodiazepine and the clinician is concerned with precipitating increased anxiety or withdrawal symptoms (or return of antipsychotic side effects such as akathisia that are being treated with the benzodiazepine), it may be better to reduce the antipsychotics first.
Recommendation #01
