<p>Cognitive Behavioral Therapy Reduces Benzodiazepine Anxiolytics Use in Japanese Patients with Mood and Anxiety Disorders: A Retrospective Observational Study</p>

Abstract

Purpose Benzodiazepines (BZDs) are prescribed to treat psychiatric diseases. However, many guidelines recommend limiting the use of BZDs because of side effects and lack of evidence regarding long-term efficacy. Moreover, reducing BZDs’ use is difficult because of dependency and the severity of withdrawal symptoms. The efficacy of cognitive behavioral therapy (CBT) for mood and anxiety disorders has been demonstrated. However, there is scant evidence that CBT has effectively reduced BZDs use, especially in Japan, where the BZDs prescription rate is high. Therefore, we sought to examine the impact of CBT on reducing BZDs use in a Japanese psychiatric setting. Patients and Methods Participants were outpatients with mood and anxiety disorders who were prescribed BZD anxiolytics. We retrospectively reviewed changes in BZD anxiolytics prescription dosages during CBT (66 patients; mean number of CBT sessions, 14.6) from our hospital record between April 2015 and September 2017. We checked prescriptions at four time points: at first interview for judging adaptation of CBT (baseline), at the first CBT session, at the last CBT session, and 3 months after the last CBT session. Results A total of 13 of 66 patients discontinued BZD anxiolytics during CBT, and 21 of 66 reduced their prescribed dosage by 50%. The association between discontinuation and dose-reduction and assessment period was modeled simultaneously using Bayesian hierarchical hurdle model. Results from the modeling showed a significant discontinuation at post-CBT and at 3 months post-CBT session compared to baseline (estimated median odds ratio [OR] post-CBT = 9.79 [95% CI: 4.65–20.45]; OR at 3 months post-CBT = 11.53 [95% CI: 6.06–22.33]). Moreover, a significant dose reduction was observed post-intervention (estimated median relative risk = 0.845 [95% CI: 0.729–0.982]), with a median reduction of 1.7 mg (diazepam conversion) in BZD use. Conclusion Our results suggest that CBT possibly aids in reducing and discontinuing BZD anxiolytics use for Japanese patients.

Impact of the COVID-19 pandemic on patients with mental health problems and the differences among diagnostic categories

“…The association between symptom deterioration and increase in drug dosage was higher in F 4 than in other diagnostic categories. It might be partially reflected in the high risk of benzodiazepine dependence in the pharmacological treatment of anxiety (O’Brien, 2005), and in the limitation of cognitive behavioral therapy in Japan, which may be a challenge for the future (Nakajima et al, 2020). New physical symptoms were seen in F 2.…”

Trends in the Prescription of Benzodiazepine Receptor Agonists from 2009 to 2020: A Retrospective Study Using Electronic Healthcare Record Data of a University Hospital in Japan

“…Therefore, it is considered that these guidelines are effective in changing the prescription trend, and publishing a method for reducing dosages and number of drugs for BZRAs in these guidelines would help in changing prescription trends. As methods for reducing prescription amount of BZRAs, psychological therapy or education, such as cognitive behavioral therapy are used [ 25 , 26 , 27 ], and a method of reducing BZRAs prescriptions in clinical practice is required. Otherwise, it will be effective to launch medical fee revisions concerning the prescribed number of BZRAs to reduce the number of BZRAs.…”

Characteristics of patients with anxiety disorder without selective serotonin reuptake inhibitor prescription over a two‐year period of pharmacotherapy

“…There can be several reasons for BZ monotherapy without SSRIs in the treatment of patients with anxiety disorders. First, the prescription rate of BZ anxiolytics is higher in Japan than in other countries 5 . Such regional characteristics may contribute to BZ monotherapy without SSRIs.…”

“…First, the prescription rate of BZ anxiolytics is higher in Japan than in other countries. 5 Such regional characteristics may contribute to BZ monotherapy without SSRIs. Second, previous studies have reported that there was sex difference in the prescription of BZ anxiolytics.…”