To BDZ or not to BDZ? That is the question! Is there reliable scientific evidence for or against using benzodiazepines in the aftermath of potentially traumatic events for the prevention of PTSD? A systematic review and meta-analysis

Abstract

Background: Most international guidelines suggest that benzodiazepines (BDZs) may be inefficient or iatrogenic in the aftermath of a potentially traumatic event (PTE). The goal of this study was to assess the strength of the evidence on whether the use of BDZs in the aftermath of a PTE negatively affects the incidence and severity of post-traumatic stress disorder (PTSD). Methods: We systematically scrutinized the ISI Web of Knowledge, MEDLINE, SCOPUS, and PTSDpubs electronic databases in addition to citation searching. We included original studies providing data about the development of PTSD in adults after BDZ administration in the aftermath of a PTE. We screened 387 abstracts and selected eight studies for the qualitative synthesis and seven for the meta-analysis. We performed two separate meta-analyses, one for randomized clinical trials (RCTs) and the other for cohort studies. Heterogeneity between studies was evaluated with Higgins I² statistic and tested using the χ². This study was registered at PROSPERO (number 127170). Results: The meta-analysis of the cohort studies showed an increased risk of PTSD in patients who received BDZs compared to those who did not (risk ratio (RR) = 1.53; 95% confidence interval (CI): 1.05–2.23) with a modest heterogeneity among studies ( I2 = 41.8, p = 0.143). Regarding the RCTs, the combined measure revealed a tendency toward an increased severity of the PTSD symptoms (standardized mean difference (SMD): 0.24; 95% CI: 0.32–0.79). Conclusion: The studies reviewed showed a possible harmful effect of BDZs when used immediately after a PTE. However, these conclusions were based on a small number of studies of poor to moderate methodological quality.

Interaction of Val66Met BDNF and 5-HTTLPR polymorphisms with prevalence of post-earthquake 27-F PTSD in Chilean population

“…After the earthquake, the prevalence of post-earthquake PTSD was found to be 11.06% (11.6% and 9.0% in women and men, respectively), with no significant difference from the literature’s reported prevalence of PTSD (9 to 11%) for those who have been exposed to a traumatic event ( Abeldaño et al, 2014 ; Campos et al, 2022 ). Before the earthquake, in Chile in 2009, a prevalence of 4.4% was identified in the population over 15 years of age, which was considered a reference value ( Benítez et al, 2009 ).…”

Prescribing and deprescribing guidance for benzodiazepine and benzodiazepine receptor agonist use in adults with depression, anxiety, and insomnia: an international scoping review

“…Furthermore, the use of BZD in PTSD has been controversial and frequently ill-advised based on their proposed propensity to interfere with fear extinction in exposure therapy as well as potentiate the development of ongoing stress symptomatology in the aftermath of a traumatic event. 155 , 156 , 157 , 158 …”

Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review

“…Its use is empirical; its evidence base for PTSD includes one veteran survey, case reports, a small open study, and a trial of trazodone as an adjunct to fluoxetine in adolescents for insomnia [ 269 - 272 ]. Benzodiazepines are often prescribed in the context of PTSD to quell anxiety, but they are generally discouraged due to: a) evidence of a 150% increased risk of PTSD development when given in the aftermath of trauma [ 273 ], b) lack of efficacy for PTSD and c) increased risk of benzodiazepine abuse. Despite the small effect sizes, limited evidence base, significant relapse after discontinuation, and potential for adverse effects from currently prescribed PTSD pharmacotherapy, it is recognized that many of these treatments can be useful to treat PTSD comorbidities or individual PTSD symptoms, such as depression, anxiety, hyperarousal, and insomnia.…”