Depression following withdrawal from long-term benzodiazepine use: a report of four cases

Olajide, Dele; Lader, Malcolm

doi:10.1017/s0033291700019899

Cited by 67 publications

(19 citation statements)

References 13 publications

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“…A recent prospective cohort study has reported an elevated risk of incident depressive symp toms in association with new, short-term, exposure to sed ative hypnotics among medical inpatients [65], In this study, none of the subjects were exposed long term, and none exceeded standard dosages. This finding reflects ear lier observations that depression may occur as a 'paradox ical reaction' in some subjects [127,128], Depressive symptoms may also occur during withdrawal from benzo diazepines [129]. Lader [130] offered two possible inter pretations for this latter finding.…”

Section: Sedative Hypnotic Drugssupporting

confidence: 54%

Drug-Induced Depression

Patten

Love

1997

Psychother Psychosom

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Background: Certain drugs may contribute to the etiology of depressive symptoms and depressive disorders. The objective of this review is to critically appraise the literature concerned with these potential etiological associations. Method: The review was based on papers uncovered in electronic literature searches using Medline, Psychlit and Psychological Abstracts. Statistical power calculations were used to assist in the interpretation of negative results. Results: A large number of publications were uncovered, but most of these were case reports. There were relatively few empirical studies. Corticosteroids, certain calcium channel blockers and digoxin have been associated with depression by replicated, well conducted studies. Psychostimulant withdrawal is also associated with prominent depressive symptoms. Preliminary evidence suggests that antihyperlipidemic agents, angiotensin converting enzyme inhibitors, sedative hypnotics, psychostimulants and certain hormonal agents may also cause depression. Despite an extensive literature, the potential association between β-blockers and depressive symptoms remains controversial. There is no substantial evidence that l-dopa or histamine-2-receptor blockers cause depression and the literature is relatively conclusive in determining that thiazide diuretics are not associated with depressive symptoms. Conclusions: A small, but growing, literature confirms that certain drug exposures can contribute to the biopsychosocial etiology of depressive symptoms and disorders. Current beliefs and diagnostic conventions classify drug-induced depression into a distinct category (Substance-Induced Mood Disorder): but this approach is not specifically supported by the existing literature.

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Section: Sedative Hypnotic Drugssupporting

confidence: 54%

Drug-Induced Depression

Patten

Love

1997

Psychother Psychosom

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“…Clinical experience suggests that antidepressants are the most important since depressive symptoms, sometimes amounting to major depression, are common after withdrawal (Olajide & Lader, 1984;Ashton, 1987). Several drugs have been tested for their ability to alleviate benzodiazepine withdrawal symptoms; none have been shown to be generally effective.…”

Section: Dosage Reductionmentioning

confidence: 99%

The treatment of benzodiazepine dependence

Ashton

1994

Addiction

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Withdrawal of benzodiazepines is currently advised for long-term benzodiazepine users because of doubts about continued efficacy, risks of adverse effects, including dependence and neuropsychological impairment and socio-economic costs. About half a million people in the UK may need advice on withdrawal. Successful withdrawal strategies should combine gradual dosage reduction and psychological support. The benzodiazepine dosage should be tapered at an individually titrated rate which should usually be under the patient's control. The whole process may take weeks or months. Withdrawal from diazepam is convenient because of available dosage strengths, but can be carried out directly from other benzodiazepine. Adjuvant medication may occasionally be required (antidepressants, propranolol) but no drugs have been proved to be of general utility in alleviating withdrawal-related symptoms. Psychological support should be available both during dosage reduction and for some months after cessation of drug use. Such support should include the provision of information about benzodiazepines, general encouragement, and measures to reduce anxiety and promote the learning of non-pharmacological ways of coping with stress. For many patients the degree of support required is minimal; a minority may need counselling or formal psychological therapy. Unwilling patients should not be forced to withdraw. With these methods, success rates of withdrawal are high and are unaffected by duration of usage, dosage or type of benzodiazepine, rate of withdrawal, symptom severity, psychiatric history or personality disorder. Longer-term outcome is less clear; a considerable proportion of patients may temporarily take benzodiazepines again and some need other psychotropic medication. However, the outcome may be improved by careful pharmacological and psychological handling of withdrawal and post-withdrawal phases.

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“…These medications were shown to have undesirable effects including amnesia, ataxia, tiredness, nausea, hypotension, leucopenia, hostility, confusion and depression [34], tolerance and dependence [35,36]. Benzodiazepines are still in use today for the treatment of insomnia.…”

Section: Introductionmentioning

confidence: 99%

Effects of a Bovine Alpha S1-Casein Tryptic Hydrolysate (CTH) on Sleep Disorder in Japanese General Population

Saint-Hilaire¹,

Messaoudi²,

Desor³

et al. 2009

TOSLPJ

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This study describes the effect of bovine alpha-S1 casein tryptic hydrolysate (CTH) in a representative sample of day-time workers from the general population of Japan with the occurrence of insomnia during the preceding six months. To investigate this issue, 32 subjects, aged between 25 and 40 years, were examined for the subjective sleep quality using the Japanese Pittsburg Sleep Quality Index (PSQI-J).CTH significantly improves the PSQI total score of the treated subjects. It particularly improves the sleep quality after two weeks of treatment, decreases the sleep latency and the daytime dysfunction after four weeks of treatment.Given the antistress properties of CTH, it seems possible to relate the detected improvement of sleep aspects to a reduction of stress following its' chronic administration.In conclusion, being given its beneficial effects and its absence of negative side effects, it would be advantageous to use the CTH to improve chronic insomnia in the Japanese general population. However, further studies will be necessary in order to clarify the essential aspect of CTH properties in the sleep problems.

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Depression following withdrawal from long-term benzodiazepine use: a report of four cases

Cited by 67 publications

References 13 publications

Drug-Induced Depression

Drug-Induced Depression

The treatment of benzodiazepine dependence

Effects of a Bovine Alpha S1-Casein Tryptic Hydrolysate (CTH) on Sleep Disorder in Japanese General Population

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