Friday, June 9, 2017

Benzodiazepine Use May Become Long Term When Combined With Antidepressants

The clinician’s decision to start a patient on antidepressants and benzodiazepines at the same time in treating depression should be considered carefully because of potential long-term use and risks associated with benzodiazepines, according to a study published online June 7 by JAMA Psychiatry.

The study found that among adults who started taking an antidepressant simultaneously with benzodiazepine therapy for treatment of depression, 12.3% of new, consistent users (22% of new, sporadic users) became long-term benzodiazepine users, defined as 6 months or longer of continuous use. This outcome was more common among patients with an initial prescription for a longer benzodiazepine days’ supply or long-acting benzodiazepine and recent prescription opioid fills.

Patients with an initial days’ supply of 8 to 15 days, 22 to 35 days, and more than 35 days were more likely to become long-term users than were patients with 1 to 7 days’ supply, the study found. Older adults, patients initiating long-acting benzodiazepines, and patients diagnosed by a psychiatrist compared with a family practitioner also were more likely to become long-time users. The researchers speculated that this type of therapy may be used more with severe depression, but did not measure depression severity in the study.

The researchers used a 2001-2014 claims database of commercially insured adults (aged 18-64 years) with a recent depression diagnosis who began antidepressant therapy and had not used antidepressants or benzodiazepines in the prior year. Of the study’s 765,130 adults (median age, 39 years), 10.6% received the simultaneous antidepressant-benzodiazepine therapy; the proportion of these patients increased from 6.1% in 2001 and peaked at 12.5% in 2012.

An anxiety diagnosis was found to be the strongest determinant of simultaneous use of benzodiazepines with antidepressants—this was true for 24% of new users with a recent unspecified anxiety diagnosis and 39% with a recent panic disorder diagnosis.

“Despite cautions and concerns, benzodiazepines are commonly prescribed during antidepressant treatment … but less is known about the specific practice of simultaneously beginning benzodiazepine therapy with antidepressant therapy,” wrote the authors.

(Image: simarik /iStock)


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