# 144 - Reduction schedules

# Reduction schedules

470
The Maudsley® Prescribing Guidelines in Psychiatry
CHAPTER 3
11. Horowitz M, et al. The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-­drugs. Oxford: Wiley-­
Blackwell; 2024.
12. Horowitz MA, et al. Addiction and physical dependence are not the same thing. Lancet Psychiatry 2023; 10:e23.
13. Guina J, et al. Benzodiazepines I: upping the care on downers: the evidence of risks, benefits and alternatives. J Clin Med 2018; 7:17.
14. Gutierrez MA, et al. Paradoxical reactions to benzodiazepines. Am J Nurs 2001; 101:34–40.
15. Crowe SF, et  al. The residual medium and long-­term cognitive effects of benzodiazepine use: an updated meta-­analysis. Arch Clin 
Neuropsychol 2017; 33:901–911.
16. Brandt J, et al. Benzodiazepines and z-­drugs: an updated review of major adverse outcomes reported on in epidemiologic research. Drugs R 
D 2017; 17:493–507.
17. Donnelly K, et al. Benzodiazepines, z-­drugs and the risk of hip fracture: a systematic review and meta-­analysis. PLoS One 2017; 12:e0174730.
18. Golombok S, et al. Cognitive impairment in long-­term benzodiazepine users. Psychol Med 1988; 18:365–374.
19. Finkle WD, et al. Risk of fractures requiring hospitalization after an initial prescription for zolpidem, alprazolam, lorazepam, or diazepam in 
older adults. J Am Geriatr Soc 2011; 59:1883–1890.
20. Molero Y, et al. Associations between gabapentinoids and suicidal behaviour, unintentional overdoses, injuries, road traffic incidents, and 
violent crime: population based cohort study in Sweden. BMJ 2019; 365:l2147.
21. Schweizer E, et al. Long-­term therapeutic use of benzodiazepines. II. Effects of gradual taper. Arch Gen Psychiatry 1990; 47:908–915.
22. Schweizer E, et al. Benzodiazepine dependence and withdrawal: a review of the syndrome and its clinical management. Acta Psychiatr Scand 
1998; 98 Suppl 393:95–101.
23. Uhlenhuth EH, et al. International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: 
IV. Therapeutic dose dependence and abuse liability of benzodiazepines in the long-­term treatment of anxiety disorders. J Clin 
Psychopharmacol 1999; 19:23S–29S.
24. Ashton H. The diagnosis and management of benzodiazepine dependence. Curr Opin Psychiatry 2005; 18:249–255.
25. Ashton H. Benzodiazepine withdrawal: outcome in 50 patients. Br J Addict 1987; 82:665–671.
26. US Food and Drug Administration. FDA requiring boxed warning updated to improve safe use of benzodiazepine drug class: includes potential for abuse, addiction, and other serious risks 2020 (last accessed July 2024); https://www.fda.gov/drugs/drug-­safety-­and-­availability/ 
fda-­requiring-­boxed-­warning-­updated-­improve-­safe-­use-­benzodiazepine-­drug-­class#:~:text=FDA.
27. Ashton H. Protracted withdrawal from benzodiazepines: the post-­withdrawal syndrome. Psychiatr Ann 1995; 1:174–179.
28. Ritvo AD, et al. Long-­term consequences of benzodiazepine-­induced neurological dysfunction: a survey. PLoS One 2023; 18:e0285584.
29. Soyka M. Treatment of benzodiazepine dependence. N Engl J Med 2017; 376:1147–1157.
30. Petursson H. The benzodiazepine withdrawal syndrome. Addiction 1994; 89:1455–1459.
31. Tannenbaum C, et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the 
EMPOWER cluster randomized trial. JAMA Intern Med 2014; 174:890–898.
32. Guy. A, et al. Guidance for Psychological Therapists: Enabling Conversations with Clients Taking or Withdrawing from Prescribed Psychiatric 
Drugs. London: APPG for Prescribed Drug Dependence; 2019.
33. Parr JM, et  al. Effectiveness of current treatment approaches for benzodiazepine discontinuation: a meta-­analysis. Addiction 2009; 
104:13–24.
34. Denis C, et al. Pharmacological interventions for benzodiazepine mono-­dependence management in outpatient settings. Cochrane Database 
Syst Rev 2006; (3):CD005194.
35. Ashton H. Benzodiazepines: How They Work and How to Withdraw. 2002 (last accessed February 2025); http://www.benzo.org.uk/manual/
bzcha01.htm.
36. Ashton H. Benzodiazepine dependence. Adverse syndromes and psychiatric drugs. In: Adverse Syndromes and Psychiatric Drugs: A Clinical 
Guide. Oxford: Oxford University Press; 2004:239–260.
37. Brouillet E, et al. In vivo bidirectional modulatory effect of benzodiazepine receptor ligands on GABAergic transmission evaluated by positron emission tomography in non-­human primates. Brain Res 1991; 557:167–176.
38. Inner Compass Initiative Inc. The Withdrawal Project. 2024; https://withdrawal.theinnercompass.org.
39. Pollmann AS, et al. Deprescribing benzodiazepines and Z-­drugs in community-­dwelling adults: a scoping review. BMC Pharmacol Toxicol 
2015; 16:19.
40. Kales A, et al. Rebound insomnia after only brief and intermittent use of rapidly eliminated benzodiazepines. Clin Pharmacol Ther 1991; 
49:468–476.