Benzodiazepines With Antidepressants May Spark Long-Term Use

June 14, 2017

By David Douglas

NEW YORK—Simultaneous benzodiazepine treatment doesn’t make newly prescribed antidepressants more effective, but a sizeable minority of patients showed signs of dependence in a large observational study.

"We found new simultaneous antidepressant and benzodiazepine use to be relatively common in adults beginning antidepressant treatment for depression," Greta A. Bushnell told Reuters Health by email.

"While the majority had only one benzodiazepine prescription fill," she added, "a subset demonstrated long-term benzodiazepine use, highlighting the need for ongoing consideration of the potential benefit and harm of benzodiazepine prescribing in this setting."

In a June 7 online paper in JAMA Psychiatry, Bushnell of the University of North Carolina Gillings School of Global Public Health, Chapel Hill, and colleagues note that a benzodiazepine may be added to new antidepressant therapy to speed the reduction of symptoms such as anxiety and insomnia.

However, because of the risk of dependence, only short-term use of a benzodiazepine is advised. For example, UK guidelines caution against using such agents for more than two weeks.

To gain further information, the team examined insurance data on more than 765,000 patients (median age, 39) who initiated antidepressant treatment between 2001 and 2014. Of these, 10.6% also initiated benzodiazepine treatment.

There was an initial annual increase in benzodiazepine use, rising from 6.1% in 2001 to 12.5% in 2012. However, the level stabilized at 11.5% through 2014.

Antidepressant treatment length was similar between benzodiazepine and non-benzodiazepine groups with the researchers observing "no clinically meaningful difference."

But while 64% of the benzodiazepine group filled their prescription only once, 14.8% had four or more refills and 12.3% used benzodiazepines for at least six months. In fact, at six months, 2.4% had dropped their antidepressant use and continued with benzodiazepines.

The investigators conclude, "When prescribed carefully in appropriate patients, benzodiazepines are considered to be useful medications." However, given these findings, "More emphasis on short-term use may be needed for some patients, including patients treated by non–mental health specialists."

Commenting by email, Dr. Nicholas Moore of the University of Bordeaux, France, told Reuters Health there were "fewer initiations of benzodiazepines . . . at the onset of antidepressant treatment than I would have expected, showing most patients seem treated properly and cautiously."

Dr. Moore, who is Professor of Clinical Pharmacology, added, "The risks of persistent treatment suggesting dependency was related to long initial prescription (even though the effects of 'benzos' only last a few weeks) and use of long half-life drugs. There was no change in the outcome of depression whether benzos were used or not."

"This," he concluded, "underlines the caution with which these highly addictive drugs need to be used in depressive patients: at best, not at all. If really needed, prescription of short half-life drugs for only a few days, not more than six weeks might be tested, with caution."


JAMA Psychiatry 2017.

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