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Benzodiazepine use in the real world of psychiatric practice: low-dose, long-term drug taking and low rates of treatment discontinuation

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Objective

The present study was designed to (1) estimate the frequency of benzodiazepine use in psychiatric practice, (2) investigate factors associated with use, (3) establish whether a relationship exists between benzodiazepine dose and length of use, and (4) investigate factors associated with time to discontinuation.

Methods

This study was conducted in South Verona, Italy. All individuals who were exposed to benzodiazepines during 2005 were extracted from the local Psychiatric Case Register, and the longitudinal history of benzodiazepine exposure was retrospectively described.

Results

In 2005, a total of 1,771 individuals were in contact with at least one of the psychiatric facilities of the South Verona catchment area. Of these, 535 were benzodiazepine users, yielding a frequency of use of 30.2% [95% confidence intervals (CI) 28.0, 32.4]. In multivariate logistic regression analysis, lower level of education, diagnosis of affective illness, longer length of illness and higher service use were significantly associated with benzodiazepine exposure. An increase in dosages over time to maintain the drug’s effectiveness was not evident from the analysis of the relationship between daily dose and length of therapy. A total of 17.3% (93/535) of patients exposed to benzodiazepines discontinued treatment. Cox regression analysis revealed that age and length of illness were negatively associated with the probability of discontinuing therapy, while the concomitant use of antipsychotics and mood stabilisers was positively associated with discontinuing therapy.

Conclusion

The finding that in the great majority of psychiatric patients, low doses of benzodiazepines are routinely prescribed on a long-term basis suggests that, in this specific setting of care, treatment recommendations stating that use should be short term may not be applicable.

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References

  1. Divac N, Veljkovic S, Nesic Z, Stojanovic R, Bajcetic M, Vasiljevic Z, Prostran M, Samardzic R (2006) Pattern of utilization of benzodiazepines in patients with hypertension: a pilot study. Vojnosanit Pregl 63:370–375

    PubMed  Google Scholar 

  2. Gorgels WJ, Oude Voshaar RC, Mol AJ, van de Lisdonk EH, van Balkom AJ, Breteler MH, van den Hoogen HJ, Mulder J, Zitman FG (2006) Predictors of discontinuation of benzodiazepine prescription after sending a letter to long-term benzodiazepine users in family practice. Fam Pract 23:65–72

    Article  PubMed  CAS  Google Scholar 

  3. De las Cuevas C, Sanz E, De La Fuente JA, Cabrera C, Mateos A (1999) Prescribed daily doses and ‘risk factors’ associated with the use of benzodiazepines in primary care. Pharmacoepidemiol Drug Saf 8:207–216

    Article  PubMed  Google Scholar 

  4. van HR, Isacson D, Bakker A, Leufkens HG (2003) Comparing patterns of long-term benzodiazepine use between a Dutch and a Swedish community. Pharmacoepidemiol Drug Saf 12:49–53

    Article  Google Scholar 

  5. van HR, Leufkens HG, Bakker A (1998) Usage patterns of benzodiazepines in a Dutch community: a 10-year follow-up. Pharm World Sci 20:78–82

    Article  Google Scholar 

  6. Clark RE, Xie H, Brunette MF (2004) Benzodiazepine prescription practices and substance abuse in persons with severe mental illness. J Clin Psychiatry 65:151–155

    Article  PubMed  Google Scholar 

  7. Brunette MF, Noordsy DL, Xie H, Drake RE (2003) Benzodiazepine use and abuse among patients with severe mental illness and co-occurring substance use disorders. Psychiatr Serv 54:1395–1401

    Article  PubMed  Google Scholar 

  8. Tansella M, Amaddeo F, Burti L, Lasalvia A, Ruggeri M (2006) Evaluating a community-based mental health service focusing on severe mental illness. The Verona experience. Acta Psychiatr Scand Suppl 429:90–94

    Article  PubMed  Google Scholar 

  9. Tansella M, Burti L (2003) Integrating evaluative research and community-based mental health care in Verona, Italy. Br J Psychiatry 183:167–169

    Article  PubMed  Google Scholar 

  10. Amaddeo F, Beecham J, Bonizzato P, Fenyo A, Knapp M, Tansella M (1997) The use of a case register to evaluate the costs of psychiatric care. Acta Psychiatr Scand 95:189–198

    PubMed  CAS  Google Scholar 

  11. Barbui C, Nosè M, Rambaldelli G, Bonetto C, Levi D, Patten S, Tansella M (2005) Development of a registry for monitoring psychotropic drug prescriptions: aims, methods and implications for ordinary practice and research. Int J Methods Psych Res 14:151–157

    Article  Google Scholar 

  12. Lavik NJ (1983) Utilization of mental health services over a given period. Acta Psychiatr Scand 67:404–413

    PubMed  CAS  Google Scholar 

  13. Bonetto C, Nose M, Barbui C (2006) Generating drug exposure data from computer-based medical records. Comput Methods Programs Biomed 83:120–124

    Article  PubMed  Google Scholar 

  14. Roy-Byrne PP, Hommer D (1988) Benzodiazepine withdrawal: overview and implications for the treatment of anxiety. Am J Med 84:1041–1052

    Article  PubMed  CAS  Google Scholar 

  15. WHO Collaborating Centre for Drug Statistic Methodology (2003) Guidelines for ATC classification and DDD assignment. WHO, Oslo

    Google Scholar 

  16. Jones G (2003) Prescribing and taking medicines. BMJ 327:819

    Article  PubMed  Google Scholar 

  17. Committee on the Review of Medicines (1980) Systematic review of the benzodiazepines. Guidelines for data sheets on diazepam, chlordiazepoxide, medazepam, clorazepate, lorazepam, oxazepam, temazepam, triazolam, nitrazepam, and flurazepam. Br Med J 280:910–912

    Article  Google Scholar 

  18. American Psychiatric Association Task Force on Benzodiazepine Dependency (1990) Benzodiazepine dependence. Toxicity and abuse. American Psychiatric Association, Washington DC

    Google Scholar 

  19. Pollack MH, Otto MW, Tesar GE, Cohen LS, Meltzer-Brody S, Rosenbaum JF (1993) Long-term outcome after acute treatment with alprazolam or clonazepam for panic disorder. J Clin Psychopharmacol 13:257–263

    Article  PubMed  CAS  Google Scholar 

  20. Worthington JJ, III, Pollack MH, Otto MW, McLean RY, Moroz G, Rosenbaum JF (1998) Long-term experience with clonazepam in patients with a primary diagnosis of panic disorder. Psychopharmacol Bull 34:199–205

    PubMed  CAS  Google Scholar 

  21. O’Brien CP (2005) Benzodiazepine use, abuse, and dependence. J Clin Psychiatry 66(Suppl 2):28–33

    PubMed  CAS  Google Scholar 

  22. Furukawa TA, Streiner DL, Young LT (2001) Antidepressant plus benzodiazepine for major depression. Cochrane Database Syst Rev 2:CD001026

    Google Scholar 

  23. Pollack MH (1993) Innovative uses of benzodiazepines in psychiatry. Can J Psychiatry 38(Suppl 4):S122–S126

    PubMed  Google Scholar 

  24. Stevens JC, Pollack MH (2005) Benzodiazepines in clinical practice: consideration of their long-term use and alternative agents. J Clin Psychiatry 66(Suppl 2):21–27

    PubMed  CAS  Google Scholar 

  25. Rosenbaum JF (2005) Attitudes toward benzodiazepines over the years. J Clin Psychiatry 66(Suppl 2):4–8

    PubMed  Google Scholar 

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Acknowledgements

This study received no funding.

Conflict of interest statement

We have no conflicts of interest.

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Authors and Affiliations

  1. Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Ospedale Policlinico, 37134, Verona, Italy

    Antonio Veronese, Massimo Garatti, Andrea Cipriani & Corrado Barbui

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  1. Antonio Veronese
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  2. Massimo Garatti
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  3. Andrea Cipriani
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  4. Corrado Barbui
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Corresponding author

Correspondence to Corrado Barbui.

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Veronese, A., Garatti, M., Cipriani, A. et al. Benzodiazepine use in the real world of psychiatric practice: low-dose, long-term drug taking and low rates of treatment discontinuation. Eur J Clin Pharmacol 63, 867–873 (2007). https://doi.org/10.1007/s00228-007-0341-1

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  • DOI: https://doi.org/10.1007/s00228-007-0341-1

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