Patterns of benzodiazepines use in primary care adults with anxiety disorders

Abstract

BackgroundBenzodiazepines are among the most commonly prescribed drugs for anxiety disorders. While they are indicated as adjunctive treatment for short-term use according to clinical practice guidelines, previous studies have shown patterns of long-term use of benzodiazepines, which is problematic due to side effects, dependence and potential of abuse. The aims of this study were to examine among a large sample of primary care adults suffering from anxiety disorders: 1) benzodiazepine use patterns; and 2) correlates of long-term benzodiazepine use.MethodsData were drawn from the “Dialogue” project, a large primary care study conducted in 64 primary care clinics in the province of Quebec, Canada. Following a mental health screening in waiting rooms, patients at risk of anxiety or depression completed the Composite International Diagnostic Interview-Simplified (CIDIS). A sample of 740 adults meeting DSM-IV criteria for Generalized Anxiety Disorder, Panic Disorder or Social Anxiety Disorder in the past 12 months took part in this study.ResultsBenzodiazepines were used by 22.6% of participants with anxiety disorders in our primary care sample. A large majority of benzodiazepine users (88.4%) met our indicator of long-term use, as defined by utilization for more than 12 weeks including regular and as-needed use. Based on a logistic regression model, individual correlates associated with long-term benzodiazepine use included: being 30 years or older, having a comorbid physical illness, meeting criteria for comorbid agoraphobia, reporting the use of sleep-aids, and concurrent SSRI utilization.LimitationData collection with self-reported questionnaires may be subject to information bias.ConclusionsDespite knowledge of the risks of long-term use of benzodiazepines, this remains a pervasive problem. Clinicians need to be mindful of patterns and risk factors leading to long-term use of benzodiazepines in patients with anxiety disorders. Results of this study should raise awareness regarding appropriate prescription practices for benzodiazepines, including decision-making in initiation, duration of prescription, and use of strategies for discontinuation in current long-term benzodiazepine users.

Does cognitive behavioral therapy for anxiety disorders assist the discontinuation of benzodiazepines among patients with anxiety disorders? A systematic review and meta‐analysis

“…Most of the studies identified by the literature search involved patients with anxiety disorders who were not taking BZD. Although long‐term use of BZD has been reported in several countries, 20, 21 few studies have examined the effects of CBT for BZD discontinuation. Second, because we included different anxiety disorders, it would have been best to conduct a subgroup analysis for each anxiety disorder.…”

“…In clinical practice, however, BZD anxiolytics are often used for the long‐term treatment of anxiety disorders 20, 21 . An observational study in a Canadian primary‐care setting found that 22.6% of patients with an anxiety disorder used BZD and that 79.6% were long‐term BZD users, over the course of 180 days 20 .…”

“…In clinical practice, however, BZD anxiolytics are often used for the long‐term treatment of anxiety disorders 20, 21 . An observational study in a Canadian primary‐care setting found that 22.6% of patients with an anxiety disorder used BZD and that 79.6% were long‐term BZD users, over the course of 180 days 20 . Another observational study conducted at clinical treatment facilities in the USA that followed patients with anxiety disorders for 12 years showed that 55.7% of patients with generalized anxiety disorder, 47.4% of patients with social anxiety disorder, and 57.9% of patients with panic disorder continued taking BZD throughout the study period 21, 22 .…”

<p>Medication Profile and Treatment Cost Estimation Among Outpatients with Schizophrenia, Bipolar Disorder, Depression, and Anxiety Disorders in Indonesia</p>

“…However, benzodiazepines are not recommended for long-term treatment owing to side effects and potential addiction. 53 Benzodiazepines are usually administered for severe anxiety disorders and are administered at night to overcome insomnia. 54,55 In our study, the estimated annual treatment cost for outpatients with schizophrenia from a healthcare perspective was USD 236 per patient.…”

Benzodiazepínicos

“…No tratamento de transtorno de ansiedade estes medicamentos são adotados como uma opção adjunta aos antidepressivos, em dosagem regular e a curto prazo, com o objetivo de atenuar os sintomas do paciente, até que antidepressivos promovam o efeito desejado. A duração máxima recomendada para o tratamento com BZDs deve ser de 2 a 8 semanas, preferencialmente não excedendo 12 semanas 6 .…”