Effectiveness and safety of long-term benzodiazepine use in anxiety disorders

Shinfuku, Masaki; Kishimoto, Toshifumi; Uchida, Hiroyuki; Suzuki, Takefumi; Mimura, Masaru; Kikuchi, Toshiaki

doi:10.1097/yic.0000000000000276

Cited by 37 publications

(25 citation statements)

References 36 publications

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“…If impairments reported in long‐term BZRA users are attributable to residual acute effects or acquired functional deficits due to prolonged exposure, cessation or limitation of BZRA use would be advised. However, if clinical complaints account for the observed impairments, continuation could be the best decision (Shinfuku et al., 2019 ). Also, for the individual assessment of the fitness to drive of long‐term BZRA users, it is important to elucidate which factors might impair driving performance to allow for efficient screening.…”

Section: Introductionmentioning

confidence: 99%

An explorative approach to understanding individual differences in driving performance and neurocognition in long‐term benzodiazepine users

Vinckenbosch

Vermeeren

Vuurman

et al. 2021

Human Psychopharmacology

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Objective Previous research reported cognitive and psychomotor impairments in long‐term users of benzodiazepine receptor agonists (BZRAs). This article explores the role of acute intoxication and clinical complaints. Methods Neurocognitive and on‐road driving performance of 19 long‐term (≥6 months) regular (≥twice weekly) BZRA users with estimated plasma concentrations, based on self‐reported use, exceeding the therapeutic threshold (CBZRA+), and 31 long‐term regular BZRA users below (CBZRA−), was compared to that of 76 controls. Results BZRA users performed worse on tasks of response speed, processing speed, and sustained attention. Age, but not CBZRA or self‐reported clinical complaints, was a significant covariate. Road‐tracking performance was explained by CBZRA only. The CBZRA + group exhibited increased mean standard deviation of lateral position comparable to that at blood‐alcohol concentrations of 0.5 g/L. Conclusions Functional impairments in long‐term BZRA users are not attributable to self‐reported clinical complaints or estimated BZRA concentrations, except for road‐tracking, which was impaired in CBZRA + users. Limitations to address are the lack of assessment of objective clinical complaints, acute task related stress, and actual BZRA plasma concentrations. In conclusion, the results confirm previous findings that demonstrate inferior performance across several psychomotor and neurocognitive domains in long‐term BZRA users.

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Section: Introductionmentioning

confidence: 99%

An explorative approach to understanding individual differences in driving performance and neurocognition in long‐term benzodiazepine users

Vinckenbosch

Vermeeren

Vuurman

et al. 2021

Human Psychopharmacology

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“…Benzodiazepines, even though they should be avoided in long-term therapy of insomnia, are frequently used and can cause constipation [33,34]. In our study, calcium-channel blockers and diuretics were associated with an increased prevalence of deteriorated sleep quality.…”

Section: Discussionmentioning

confidence: 44%

Associations between constipation symptoms and the sleep quality in non-dialysis chronic kidney disease patients: a cross-sectional study

Ruszkowski¹,

Heleniak²,

Król³

et al. 2021

Polish Archives of Internal Medicine

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“…Critics of benzodiazepines cite their being prescribed as first-line treatments for anxiety in primary care settings before SSRIs, potential risks of tolerance, dependence, abuse or misuse, and concerns about falls in the elderly (45). However, there is a lack of strong evidence that SSRIs and other first-line treatments are superior to, or better-tolerated than, benzodiazepines for anxiety disorders, in particular GAD (46), especially for short-term treatment (44,47), and possibly beyond 8 weeks as well (48). Benzodiazepines, which act as GABA-A agonists, are highly versatile medications that can be prescribed for a wide range of conditions including alcohol withdrawal, agitation or aggression, anesthesia, catatonia, mania, insomnia, muscle spasms, epilepsy or seizures, and REM sleep behavior and movement disorders (44).…”

Section: Current Treatments For Anxiety Disordersmentioning

confidence: 99%

Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options

Garakani¹,

Murrough²,

Freire³

et al. 2021

FOC

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Anxiety disorders are the most prevalent psychiatric disorders and a leading cause of disability. While there continues to be expansive research in posttraumatic stress disorder (PTSD), depression and schizophrenia, there is a relative dearth of novel medications under investigation for anxiety disorders. This review's first aim is to summarize current pharmacological treatments (both approved and off-label) for panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and specific phobias (SP), including selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), azapirones (e.g., buspirone), mixed antidepressants (e.g., mirtazapine), antipsychotics, antihistamines (e.g., hydroxyzine), alpha-and beta-adrenergic medications (e.g., propranolol, clonidine), and GABAergic medications (benzodiazepines, pregabalin, and gabapentin). Posttraumatic stress disorder and obsessive-compulsive disorder are excluded from this review. Second, we will review novel pharmacotherapeutic agents under investigation for the treatment of anxiety disorders in adults. The pathways and neurotransmitters reviewed include serotonergic agents, glutamate modulators, GABAergic medications, neuropeptides, neurosteroids, alpha-and beta-adrenergic agents, cannabinoids, and natural remedies. The outcome of the review reveals a lack of randomized double-blind placebocontrolled trials for anxiety disorders and few studies comparing novel treatments to existing anxiolytic agents. Although there are some recent randomized controlled trials for novel agents including neuropeptides, glutamatergic agents (such as ketamine and d-cycloserine), and cannabinoids (including cannabidiol) primarily in GAD or SAD, these trials have largely been negative, with only some promise for kava and PH94B (an inhaled neurosteroid). Overall, the progression of current and future psychopharmacology research in anxiety disorders suggests that there needs to be further expansion in research of these novel pathways and largerscale studies of promising agents with positive results from smaller trials.

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Effectiveness and safety of long-term benzodiazepine use in anxiety disorders

Cited by 37 publications

References 36 publications

An explorative approach to understanding individual differences in driving performance and neurocognition in long‐term benzodiazepine users

An explorative approach to understanding individual differences in driving performance and neurocognition in long‐term benzodiazepine users

Associations between constipation symptoms and the sleep quality in non-dialysis chronic kidney disease patients: a cross-sectional study

Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options

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