Clinicians often struggle to strike a balance between prescribing multiple medications to address various medical problems and the risks that use of multiple medications may create, especially for older Veterans. Deprescribing is a comprehensive process of drug review, decreasing dose, or discontinuation that aims to reduce medication risk in the context of patients' co-morbidities, functional status, preferences, goals, and life expectancy. Deprescribing requires trust, communication, coordination, and patience. The following story, based on in-depth interviews of a Veteran, clinician and pharmacist describes the process of tapering off of a benzodiazepine from multiple perspectives.

Mr. Holland has been on clonazepam for over twenty years, but his main concern is having trouble with sleep. Currently, Mr. Holland takes 12 medications daily. A lengthy medication list and multiple comorbidities are not uncommon among Veterans. That is why the deprescribing process can be complex and often require a team approach. For psychiatrists like Dr. Hansen, the motivations for using a particular treatment approach can be different from those of the patient.

Veterans like Mr. Holland who take benzodiazepines such as clonazepam may experience withdrawal when missing doses or when trying to reduce the dose. Withdrawal effects can seem very much like anxiety – the symptom that clonazepam is supposed to treat. Patients often fear that their symptoms may return if benzodiazepines are reduced or discontinued. In Mr. Holland's situation, Dr. Hansen must take into account multiple factors including the age of his patient, the patient's preferences, and the possibility of withdrawal symptoms that might arise as the patient tapers off the benzodiazepine.

Decision-making between doctor and patient should include clear messages about possible reactions to tapering the medication, agreement on the frequency of check-ins and desired outcome, and an emphasis on the importance of patience and trust while walking through the deprescribing process.

Doctors and pharmacists are aware that each patient will require a unique deprescribing plan. Communication is key. By including the patient in the process, the deprescribing process is more likely to reach a satisfactory outcome. Sometimes patients and clinicians don't agree on the optimal outcome, but working together, an acceptable compromise may be achieved. Some patients may prefer to stay on the same medication, but at a lower dose, which may be acceptable to the clinician.

Sometimes it is challenging for a clinician and patient to reach full agreement on a treatment approach or outcome. Bringing in another team member, such as a pharmacist, can help. Though pharmacists cannot prescribe some scheduled drugs like clonazepam, their knowledge of medications and their effects on the body is extensive.

A successful deprescribing process often requires sustained follow up. Each member of the triad plays their part so that the Veteran does not feel alone in the process. Although Mr. Holland resumed taking clonazepam, in the end, the dose was reduced; further attempts at reducing the dose are anticipated.