Benzodiazepine and antidepressant use in elderly patients with anxiety disorders: A survey of 796 outpatients in Japan

Uchida, Hiroyuki; Suzuki, Takefumi; Mamo, David C.; Mulsant, Benoit H.; Kikuchi, Toshiaki; Takeuchi, Hiroyoshi; Tomita, Masayuki; Watanabe, Koichiro; Yagi, Gohei; Kashima, Haruo

doi:10.1016/j.janxdis.2008.10.003

Cited by 41 publications

(34 citation statements)

References 31 publications

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“…In addition, the ratios of patients treated with antidepressant combinations and concomitant anxiolytic/hypnotic drugs were 23.4-35.9 and 60.3-73.0%, respectively, [11][12][13] showing that our results were comparable. Given that there are several other equivalency scales, further investigation is required to compare them with this existing data to see if there are any differences.…”

Section: )mentioning

confidence: 74%

“…In addition, it is known that inter-individual differences exist in the daily dosing requirements for antidepressants. [11][12][13] Regarding these differences in therapeutic needs, many investigators have considered the association between the daily dose and synergism among antidepressants and patient characteristics, including genetic polymorphisms. However, many of these studies on genetic polymorphisms have focused on the effects on antidepressant pharmacokinetics.…”

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confidence: 99%

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Influence of Genetic Polymorphisms and Concomitant Anxiolytic Doses on Antidepressant Maintenance Doses in Japanese Patients with Depression

Inoue

Murofushi

Nagaoka

et al. 2016

Biological & Pharmaceutical Bulletin

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To prevent recurrent depression, patients should ideally continue treatment for >6 months with the antidepressant dose that effectively suppressed acute depressive symptoms. However, there are inter-individual differences in the antidepressant doses required to achieve response and maintenance. Therefore, this study was conducted to examine the role of clinical features, including genetic polymorphisms, on the antidepressant dose required for maintenance therapy in 82 Japanese patients with depression. We calculated the antidepressant dose using the imipramine equivalent scale and the dose of concomitant anxiolytics and hypnotics using the diazepam equivalent scale. The 82 participants were classified into two groups based on the median imipramine equivalent dose, and we examined the influence of patient characteristics and the presence of genetic polymorphisms of brain-derived neurotropic factor (BDNF; rs6265) and cyclic adenosine monophosphate responsive element-binding protein 1 (CREB1; rs2253306, rs4675690, rs769963) on the antidepressant maintenance dose. Using a multivariate logistic regression analysis, we found that the concomitant diazepam equivalent dose and presence of the CREB1 rs4675690 polymorphism were significantly associated with the antidepressant maintenance dose. We concluded that these factors influenced the antidepressant dose in maintenance therapy among Japanese patients with depression. However, further research is required in large cohorts.Key words antidepressant; maintenance dose; depressive disorder; polymorphism; brain-derived neurotrophic factor; cyclic AMP responsive element binding protein 1 Depressive disorder is a common psychiatric disorder, with approximately 350 million people being affected worldwide. 1)Moreover, it is associated with a high rate of recurrence and chronicity, with 12-35% of all cases becoming chronic and 13.2% experiencing recurrence within 5 years.2-5) When starting antidepressant therapy, the dose of antidepressant is low and is slowly increased, and careful attention is paid to the development of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and mania, the so-called "activation syndrome." The target dose is the lowest dose that adequately suppresses depressive symptoms with tolerable side effects. After achieving remission, the therapeutic dose acutely required is continued as maintenance therapy for >6 months to prevent recurrence. 6,7)Several reports suggest that when an antidepressant is ineffective in suppressing depressive symptoms, combination therapy with another antidepressant or anxiolytic or hypnotic drugs is more effective than increasing the dose of the preexisting antidepressant. [8][9][10] In studies on Japanese patients with depression, 23.4-35.9% of cases were treated with antidepressant combination therapy and 60.3-73.0% were treated with concomitant anxiolytic or hypnotic drugs. In addition, it is known that inter-individual differences exist in the daily dosing ...

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confidence: 74%

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confidence: 99%

Influence of Genetic Polymorphisms and Concomitant Anxiolytic Doses on Antidepressant Maintenance Doses in Japanese Patients with Depression

Inoue

Murofushi

Nagaoka

et al. 2016

Biological & Pharmaceutical Bulletin

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“…However, the type of brief, evidence-based psychological intervention that we have reported, when added to comprehensive pulmonary rehabilitation programmes, can help COPD patients to self-manage their own care more effectively [5], treat panic attacks when already present and prevent the development of panic attacks or panic disorder. A more extended psychological intervention will be required for patients who have fully developed panic disorder [3], but without the inherent risks of benzodiazepine medications in the elderly: dependence, cognitive impairment and falls [6]. …”

Section: From the Authorsmentioning

confidence: 99%

From the authors:

Livermore¹,

Sharpe²,

Mckenzie³

2010

Eur Respir J

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“…This difference may be due to the fact that prescription behaviours are likely to be subject to physician training as well as to direct and indirect influence of local standard of care. [1][2][3] The statement 'the massive use of anxiolytics is one of the characteristics of Japanese medicine' by Dr Toda may give an incorrect impression. In fact, the prevalent use of benzodiazepines has also been reported outside Japan, and its frequent use without any rationale is apparently not a local issue.…”

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confidence: 99%

“…In fact, the prevalent use of benzodiazepines has also been reported outside Japan, and its frequent use without any rationale is apparently not a local issue. 1,3,4 This is critically important especially for senior people, given the increased drug sensitivity in this population. 5 Further investigations are warranted to pursue not only effective treatments for new patients, but also safe methods of discontinuing (at least tapering) those potentially toxic medications for already medicated patients, 6 irrespective of country.…”

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confidence: 99%

Strict use of terminology: Reply to Dr Toda

Uchida¹,

Suzuki²

2009

Psychiatry Clin Neurosci

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The symptoms of visual alteration described here, are compatible with those of PPA reported in the literature.1,2 The present case supports the hypothesis that PPA is an antipsychotic side-effect, rather than a schizophrenia symptom. The present patient experienced PPA at a very low dose of risperidone, suggesting that mood disorder patients may be more susceptible to this side-effect, similar to the recent finding in extrapyramidal side-effects. 4 Given the widespread use of antipsychotics for various psychiatric disorders, more careful attention should be paid to this potentially serious side-effect, irrespective of diagnosis. Antipsychotic-induced extrapyramidal side effects in bipolar disorder and schizophrenia: A systematic review. REFERENCES

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Benzodiazepine and antidepressant use in elderly patients with anxiety disorders: A survey of 796 outpatients in Japan

Cited by 41 publications

References 31 publications

Influence of Genetic Polymorphisms and Concomitant Anxiolytic Doses on Antidepressant Maintenance Doses in Japanese Patients with Depression

Influence of Genetic Polymorphisms and Concomitant Anxiolytic Doses on Antidepressant Maintenance Doses in Japanese Patients with Depression

From the authors:

Strict use of terminology: Reply to Dr Toda

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