Initiation and long‐term use of benzodiazepines and Z‐drugs in bipolar disorder

Wingård, Louise; Taipale, Heidi; Reutfors, Johan; Westerlund, Anna; Bodén, Robert; Tiihonen, Jari; Tanskanen, Antti; Andersen, Morten

doi:10.1111/bdi.12626

Cited by 27 publications

(32 citation statements)

References 57 publications

(124 reference statements)

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“… 20 Previous studies have mainly assessed long-term BZDR use in prevalent users, whereas this study population included only incident BZDR users. Previous studies assessing new BZDR users have found that the incidence of long-term use is 11.8% in the general population, 33 9% among working-aged persons (requiring longer use periods of ≥8 months without gaps), 34 26% among older adults, 35 22% among persons with bipolar disorder, 29 and 30% among older persons with Alzheimer disease. 36 All of these estimates are lower than the 39.4% incidence reported in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Clonazepam was associated with a higher risk for development of long-term use, which is consistent with previous prevalence studies. 28 , 29 Clonazepam is a high-potency benzodiazepine with a long elimination half-life, 42 and it was used mainly for nonepilepsy indications in this study. However, its high potency may be associated with escalated development of tolerance and related adverse events.…”

Section: Discussionmentioning

confidence: 99%

“… 20 , 26 , 27 Some studies point toward problems focused on specific substances, including alprazolam and clonazepam. 28 , 29 , 30 Concerns have also been raised about the increasing use of benzodiazepine-related drugs, often called Z-drugs, specifically, zolpidem. 28 , 30 , 31 …”

Section: Introductionmentioning

confidence: 99%

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Incidence of and Characteristics Associated With Long-term Benzodiazepine Use in Finland

et al. 2020

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Incidence of and Characteristics Associated With Long-term Benzodiazepine Use in Finland

et al. 2020

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“…Benzodiazepines and benzodiazepine related drugs (BZRD), taken by 30% to 60% of individuals with schizophrenia or bipolar disorder, are other concerns. [33][34][35][36] Neutropenia and its extreme form agranulocytosis can occur with a variety of antipsychotics and mood-stabilisers, particularly with clozapine and carbamazepine. 37 Some of the agents used to treat COVID-19 infection such as chloroquine, hydroxychloroquine, azithromycin, and lopinavir can also cause neutropenia.…”

Section: Other Risk Factors Which May Specifically Associated With Sementioning

confidence: 99%

Death associated with coronavirus (COVID-19) infection in individuals with severe mental disorders in Sweden during the early months of the outbreak – a exploratory cross-sectional analysis of a population-based register study

Maripuu

Bendix

Öhlund

et al. 2020

Preprint

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Background: Individuals with severe mental disorder (SMD) have a higher risk of somatic comorbidity and mortality than the rest of the population. We set up a population-based study to assess whether individuals with SMD had a higher risk of death associated with a COVID-19 infection (COVID-19 associated death) than individuals without SMD. Methods: Exploratory analysis with a cross-sectional design in the framework of a population-based register study covering the entire Swedish population. The Swedish Board for Health and Welfare (Socialstyrelsen) provided anonymised tabulated summary data for further analysis. We compared numbers of COVID-19 associated death in individuals with SMD (cases) and without SMD (controls). We calculated the odds ratio (OR) for the whole sample and by age group and four potential risk factors, namely diabetes, cardiovascular disease, hypertension, chronic lung disease. Results: The sample comprised of 7,923,859 individuals, 103,999 with SMD and 7,819,860 controls. There were 130 (0.1%) COVID-19 associated deaths in the SMD group and 4945 (0.06%) in the control group, corresponding to an OR of 1.98 (CI 1.66-2.35; p < 0.001). The odds were fourfold in the age group between 60 and 79 years. Cardiovascular diseases increased the odds by 50%. Individuals with SMD without any of the risk factors under study had three-folds odds of COVID-19 associated death. Conclusion: Our preliminary results suggest that individuals with SMD are a further group at increased risk of COVID-19 associated death. The factors contributing to this increased mortality risk require clarification.

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“…These include the baseline level of polypharmacy seen in BD generally (Greil, Haberle, Haueis, Grohmann, & Russmann, ) and the propensity for substance misuse in this population (Gold et al, ). Indeed, a recent cohort study identified a high risk of long‐term (i.e., potentially iatrogenic) use of benzodiazepines or Z‐drugs when they are initiated in BD: Clonazepam and alprazolam were particularly linked to long‐term use, as was use of more than one benzodiazepine/Z‐drug (Wingard et al, ).…”

Section: Behavioural Strategies In the Context Of Collaborative Care mentioning

confidence: 99%

Assessment and treatment of sleep problems in bipolar disorder—A guide for psychologists and clinically focused review

Morton

Murray

2020

Clin Psychology and Psychoth

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Sleep problems are highly prevalent in bipolar disorder (BD) and constitute an important therapeutic focus in this population: They are highly impairing and distressing, are an area of subjective importance to consumers, and likely play a role in predicting/triggering mood episodes. The aim of this review is to orient psychologists and psychotherapists to current research relevant to their clinical practice with people with BD, including (a) the prevalence and presentation of sleep problems, (b) the impacts and correlates of impaired sleep, and (c) the relationship between sleep problems and mood symptoms (including the predictive/triggering role of sleep in BD mood relapses). Detailed recommendations for assessment and cognitivebehavioural intervention strategies for use in BD are described. It will be concluded that although some sleep problems and comorbidities require interdisciplinary collaboration, a range of evidence-informed strategies can be effectively and appropriately applied by clinical psychologists and psychotherapists. K E Y W O R D Sbipolar disorder, circadian, mood disorder, psychiatric disorder, self-management, sleep

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Initiation and long‐term use of benzodiazepines and Z‐drugs in bipolar disorder

Abstract: The incidence of subsequent long-term use among bipolar benzodiazepine initiators is high. Patients on clonazepam, alprazolam or benzodiazepine/Z-drug polytherapy have the highest risk of becoming long-term users, suggesting that these treatments should be used restrictively.

Cited by 27 publications

References 57 publications

Incidence of and Characteristics Associated With Long-term Benzodiazepine Use in Finland

Incidence of and Characteristics Associated With Long-term Benzodiazepine Use in Finland

Death associated with coronavirus (COVID-19) infection in individuals with severe mental disorders in Sweden during the early months of the outbreak – a exploratory cross-sectional analysis of a population-based register study

Assessment and treatment of sleep problems in bipolar disorder—A guide for psychologists and clinically focused review

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