{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T23:27:21Z","timestamp":1790638041537,"version":"4.1.0"},"reference-count":56,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T00:00:00Z","timestamp":1678838400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Roehampton Strategic Priorities Fund"},{"name":"Mr Stefan Hearst"},{"name":"University of Roehampton Strategic Priorities Fund"},{"name":"University of Roehampton Strategic Priorities Fund"},{"name":"University of Roehampton Strategic Priorities Fund"},{"name":"University of Roehampton Strategic Priorities Fund"},{"name":"University of Roehampton Strategic Priorities Fund"},{"name":"Mr Stefan Hearst"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nPublic Health England recently called for the establishment of services to help people to safely stop prescribed drugs associated with dependence and withdrawal, including benzodiazepines, z-drugs, antidepressants, gabapentinoids and opioids. NICE identified a lack of knowledge about the best model for such service delivery. Therefore, we performed a global survey of existing deprescribing services to identify common practices and inform service development.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nWe identified existing deprescribing services and interviewed key personnel in these services using an interview co-produced with researchers with lived experience of withdrawal. We summarised the common practices of the services and analysed the interviews using a rapid form of qualitative framework analysis.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nThirteen deprescribing services were included (8 UK, 5 from other countries). The common practices in the services were: gradual tapering of medications often over more than a year, and reductions made in a broadly hyperbolic manner (smaller reductions as total dose became lower). Reductions were individualised so that withdrawal symptoms remained tolerable, with the patient leading this decision-making in most services. Support and reassurance were provided throughout the process, sometimes by means of telephone support lines. Psychosocial support for the management of underlying conditions (e.g. CBT, counselling) were provided by the service or through referral. Lived experience was often embedded in services through founders, hiring criteria, peer support and sources of information to guide tapering.<\/jats:p>\n<\/jats:sec>\n\nConclusion<\/jats:title>\nWe found many common practices across existing deprescribing services around the world. We suggest that these ingredients are included in commissioning guidance of future services and suggest directions for further research to clarify best practice.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0282988","type":"journal-article","created":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T17:37:17Z","timestamp":1678901837000},"page":"e0282988","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":23,"title":["\u201cStabilise-reduce, stabilise-reduce\u201d: A survey of the common practices of deprescribing services and recommendations for future services"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9735-4731","authenticated-orcid":true,"given":"Ruth E.","family":"Cooper","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4195-0208","authenticated-orcid":true,"given":"Michael","family":"Ashman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo","family":"Lomani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Moncrieff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Guy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Davies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Morant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1318-2029","authenticated-orcid":true,"given":"Mark","family":"Horowitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,3,15]]},"reference":[{"key":"pone.0282988.ref001","unstructured":"Public Health England. 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Network Contract Directed Enhanced Service: Structured medication reviews and medicines optimisation: guidance. 2022; 66\u201367."},{"key":"pone.0282988.ref021","unstructured":"NICE. Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults. 2022. Available: https:\/\/www.nice.org.uk\/guidance\/ng215\/chapter\/recommendations#identifying-and-managing-withdrawal-symptoms"},{"key":"pone.0282988.ref022","doi-asserted-by":"crossref","DOI":"10.1177\/2045125320932452","article-title":"How user knowledge of psychotropic drug withdrawal resulted in the development of person-specific tapering medication","volume":"10","author":"PC Groot","year":"2020","journal-title":"Ther Adv Psychopharmacol"},{"key":"pone.0282988.ref023","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/bmj.g1687","article-title":"Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide","volume":"348","author":"TC Hoffmann","year":"2014","journal-title":"BMJ"},{"key":"pone.0282988.ref024","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a","volume":"19","author":"A Tong","year":"2007","journal-title":"Int J Qual Heal Care"},{"key":"pone.0282988.ref025","unstructured":"All Party Parliamentary Group for Prescribed Drug Dependence. 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Bryman","year":"2012","edition":"4"},{"key":"pone.0282988.ref027","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2288-13-117","article-title":"Using the framework method for the analysis of qualitative data in multi-disciplinary health research","volume":"13","author":"N Gale","year":"2013","journal-title":"BMC Med Res Methodol"},{"key":"pone.0282988.ref028","doi-asserted-by":"crossref","first-page":"2192","DOI":"10.1177\/1049732320951526","article-title":"Carrying Out Rapid Qualitative Research During a Pandemic: Emerging Lessons From COVID-19","volume":"30","author":"C Vindrola-Padros","year":"2020","journal-title":"Qual Health Res"},{"key":"pone.0282988.ref029","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1177\/1049732312448541","article-title":"Patient and public involvement in the coproduction of knowledge: Reflection on the analysis of qualitative data in a mental health study","volume":"22","author":"S Gillard","year":"2012","journal-title":"Qual Health Res"},{"key":"pone.0282988.ref030","author":"P. Armstrong","year":"2010","journal-title":"Council for Information on Tranquilisers and Antidepressants (CITA)"},{"key":"pone.0282988.ref031","author":"H. Ashton","year":"2002","journal-title":"Benzodiazepines: how they work and how to withdraw (aka The Ashton Manual)"},{"key":"pone.0282988.ref032","first-page":"1","article-title":"A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse","author":"MA Horowitz","year":"2021","journal-title":"Schizophr Bull"},{"key":"pone.0282988.ref033","unstructured":"The Icarus Project and Freedom Center. Harm Reduction Guide to Coming Off Psychiatric Drugs. 2012. Available: www.freedom-center.org"},{"key":"pone.0282988.ref034","doi-asserted-by":"crossref","DOI":"10.1177\/20451253211067656","article-title":"Clinical practice guideline recommendations on tapering and discontinuing antidepressants for depression: a systematic review","volume":"12","author":"A S\u00f8rensen","year":"2022","journal-title":"Ther Adv Psychopharmacol"},{"key":"pone.0282988.ref035","volume-title":"Pharmaceutical Journal","author":"C. Burns","year":"2022"},{"key":"pone.0282988.ref036","first-page":"1","article-title":"Withdrawal of unnecessary antidepressant medication: A randomised controlled trial in primary care","volume":"1","author":"R Eveleigh","year":"2017","journal-title":"BJGP Open"},{"key":"pone.0282988.ref037","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1370\/afm.2336","article-title":"Managing antidepressant discontinuation: A systematic review","volume":"17","author":"E Maund","year":"2019","journal-title":"Ann Fam Med"},{"key":"pone.0282988.ref038","author":"C Ford","year":"2014","journal-title":"Guidance for the use and reduction of misuse of benzodiazepines and other hypnotics and anxiolytics in general practice"},{"key":"pone.0282988.ref039","doi-asserted-by":"crossref","first-page":"152","DOI":"10.18773\/austprescr.2015.055","article-title":"Management of benzodiazepine misuse and dependence","volume":"38","author":"J Brett","year":"2015","journal-title":"Aust Prescr"},{"key":"pone.0282988.ref040","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.1001\/jama.2019.16409","article-title":"Patient-Centered Reduction or Discontinuation of Long-term Opioid Analgesics: The HHS Guide for Clinicians","volume":"322","author":"D Dowell","year":"2019","journal-title":"JAMA"},{"key":"pone.0282988.ref041","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.euroneuro.2021.10.001","article-title":"How to reduce and stop psychiatric medication","volume":"55","author":"MA Horowitz","year":"2022","journal-title":"Eur Neuropsychopharmacol"},{"key":"pone.0282988.ref042","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1111\/j.1360-0443.2008.02364.x","article-title":"Effectiveness of current treatment approaches for benzodiazepine discontinuation: A meta-analysis","volume":"104","author":"JM Parr","year":"2009","journal-title":"Addiction"},{"key":"pone.0282988.ref043","article-title":"Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults","volume":"2021","author":"E Van Leeuwen","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0282988.ref044","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13063-020-04338-7","article-title":"REDUCE (Reviewing long-term antidepressant use by careful monitoring in everyday practice) internet and telephone support to people coming off long-term antidepressants: Protocol for a randomised controlled trial","volume":"21","author":"T Kendrick","year":"2020","journal-title":"Trials"},{"key":"pone.0282988.ref045","unstructured":"$39 million for research partnerships to improve delivery of healthcare. 2022. Available: https:\/\/www.nhmrc.gov.au\/about-us\/news-centre\/39-million-research-partnerships-improve-delivery-healthcare"},{"key":"pone.0282988.ref046","unstructured":"NICE. NICE. National Institute for Health and Care excellence: Shared Decision Making; NICE guideline [NG197]. 2021. Available: https:\/\/www.nice.org.uk\/guidance\/ng197"},{"key":"pone.0282988.ref047","first-page":"1015","article-title":"Discontinuation of benzodiazepines among older insomniac adults treated with cognitive-behavioural therapy combined with gradual tapering: A randomized trial","volume":"169","author":"L Baillargeon","year":"2003","journal-title":"Cmaj"},{"key":"pone.0282988.ref048","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1159\/000489498","article-title":"The efficacy of a group CBT relapse prevention program for remitted anxiety disorder patients who discontinue antidepressant medication: A randomized controlled trial","volume":"87","author":"WD Scholten","year":"2018","journal-title":"Psychother Psychosom"},{"key":"pone.0282988.ref049","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1192\/bjp.2019.269","article-title":"Selective serotonin reuptake inhibitor \u201cdiscontinuation syndrome\u201d or withdrawal","volume":"218","author":"I Massabki","year":"2021","journal-title":"Br J Psychiatry"},{"key":"pone.0282988.ref050","doi-asserted-by":"crossref","first-page":"l6103","DOI":"10.1136\/bmj.l6103","article-title":"NICE updates antidepressant guidelines to reflect severity and length of withdrawal symptoms","volume":"367","author":"G. Iacobucci","year":"2019","journal-title":"BMJ"},{"key":"pone.0282988.ref051","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.jad.2018.10.107","article-title":"Barriers and facilitators to discontinuing antidepressant use: A systematic review and thematic synthesis","volume":"245","author":"E Maund","year":"2019","journal-title":"J Affect Disord"},{"key":"pone.0282988.ref052","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1371\/journal.pmed.0020392","article-title":"Serotonin and depression: A disconnect between the advertisements and the scientific literature","volume":"2","author":"JR Lacasse","year":"2005","journal-title":"PLoS Med"},{"key":"pone.0282988.ref053","first-page":"1","article-title":"The serotonin theory of depression: a systematic umbrella review of the evidence","author":"J Moncrieff","year":"2022","journal-title":"Mol Psychiatry"},{"key":"pone.0282988.ref054","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1177\/1098214014536601","article-title":"Expediting the Analysis of Qualitative Data in Evaluation: A Procedure for the Rapid Identification of Themes From Audio Recordings (RITA)","volume":"36","author":"JW Neal","year":"2015","journal-title":"Am J Eval"},{"key":"pone.0282988.ref055","volume-title":"Guidance for Psychological Therapists Enabling conversations with clients taking or withdrawing from prescribed psychiatric drugs","author":"A. 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