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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2019.00717

Hypnotic discontinuation using a blinded (masked) tapering approach: a case series

 Constance H. Fung1, 2*,  Jennifer L. Martin1, 2,  Cathy Alessi1, 2, Joseph M. Dzierzewski3, Ian Cook4, 5, Alison Moore6,  Austin Grinberg1, 2, Michelle Zeidler1, 2 and  Lara Kierlin7
  • 1VA Greater Los Angeles Healthcare System, United States
  • 2UCLA David Geffen School of Medicine, United States
  • 3Virginia Commonwealth University, United States
  • 4UCLA Semel Institute for Neuroscience and Human Behavior, United States
  • 5Other, United States
  • 6University of California, San Diego, United States
  • 7Other, United States

Chronic use of hypnotic medications such as benzodiazepines is associated with adverse consequences including increased risk of falls. Efforts to help patients discontinue these medications have had varying levels of success. We developed a blinded (masked) tapering protocol to help patients taper off hypnotics. In this blinded protocol, patients consented to a drug taper but agreed to forego knowledge about the specific tapering schedule or the actual dose each night until the end of the taper. Blinded tapering aims to reduce negative expectancies for withdrawal effects that may impair a patient’s successful discontinuation of hypnotics. In preparation for a randomized trial, we tested the feasibility of adding a blinded tapering component to current best evidence practice (supervised hypnotic taper combined with cognitive behavioral therapy for insomnia [CBTI]) in 5 adult patients recruited from an outpatient mental health practice in Oregon. A compounding pharmacy prepared the blinded capsules for each patient. During the gradual blinded taper, each participant completed CBTI. Measures collected included feasibility/process (e.g., recruitment barriers), hypnotic use, the Dysfunctional Beliefs and Attitudes about Sleep Scale, Insomnia Severity Index, Epworth Sleepiness Scale, and Patient Health Questionnaire-9 (depressive symptoms). The intervention was feasible, and participants reported high satisfaction with the protocol and willingness to follow the same treatment again. All five participants successfully discontinued their hypnotic medication use post-treatment. Dysfunctional beliefs/attitudes about sleep and insomnia severity improved. Blinded tapering is a promising new method for improving hypnotic discontinuation among patients treated with a combination of hypnotic tapering plus CBTI.

Keywords: Benzodiazepine discontinuation, Cognitive behavioral therapy for insomnia, placebo effect., insomnia, medication taper

Received: 25 Jun 2019; Accepted: 09 Sep 2019.

Copyright: © 2019 Fung, Martin, Alessi, Dzierzewski, Cook, Moore, Grinberg, Zeidler and Kierlin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Constance H. Fung, VA Greater Los Angeles Healthcare System, Los Angeles, United States, constance.fung@va.gov