Differences in health status between long-term and short-term benzodiazepine users

Department of Psychiatry, Leiden University Medical Centre, Leyden, South Holland, Netherlands
British Journal of General Practice (Impact Factor: 2.29). 11/2002; 52(483):805-8.
Source: PubMed


Despite generally accepted advice to keep treatment short, benzodiazepines are often prescibed for more than six months. Prevention of long-term benzodiazepine use could be facilitated by the utilisation of risk indicators for long-term use. However, the characteristics of long-term benzodiazepine users described in the literature are based on studies in which long-term users were compared with non-users. Thus these characteristics may be imprecise.
To study the characteristics of long-term benzodiazepine users by comparing their demographic data and health status (mental and physical) with those of short-term users.
Cross-sectional comparison of short-term and long-term benzodiazepine users.
Patients from 32 GP practices of the Nijmegen Health Area, The Netherlands.
The characteristics of 164 short-term and 158 long-term benzodiazepine users in general practice were compared, using interview data and morbidity referral and prescription data from GP records.
Long-term benzodiazepine users were (a) older, (b) had a more severe history of mental health problems for which they had received more serious treatment, (c) used more psychotropic drugs, (d) had a higher hospital specialist consultation frequency, (e) had more diagnoses of the following: diabetes, asthma, chronic obstructive pulmonary disease, hypertension a serious skin disorder, and (f) reported a lower perceived general health status. There were no sex differences.
Specific risk characteristics of long-term benzodiazepine users can be used to develop a risk profile for the management of benzodiazepines in general practice. We believe that (somatic) secondary care also contributes to benzodiazepine use. It may be worthwhile to coordinate care for benzodiazepine users between GPs and hospital specialists.

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Available from: Saskia M Zandstra
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    • "However, there is little information with regard to the prevalence and risk factors associated with long-term BZD use in patients with MDD in Asian countries. Long-term BZD use is associated with old age (Cunningham et al., 2010; Dag, 1997; Manthey et al., 2011; Veronese et al., 2007; Zandstra et al., 2002), female sex (Fortin et al., 2007; Jorm, Grayson, Creasey, Waite, & Broe, 2000), being divorced (Jorm et al., 2000) and in the lowest income quintile (Cunningham et al., 2010), history of BZD use (Dag, 1997; Manthey et al., 2011; Neutel, 2005), severe depressive (Cheng, Huang, Lin, & Shih, 2008; Luijendijk, Tiemeier, Hofman, Heeringa, & Stricker, 2008) and anxiety symptoms (Cheng et al., 2008; Manthey et al., 2011), length of illness (Veronese et al., 2007), psychiatric history (Zandstra et al., 2002), poor self-perceived life satisfaction (Fourrier, Letenneur, Dartigues, Moore, & Begaud, 2001; Zandstra et al., 2002), poor physical health (Cheng et al., 2008; Cunningham et al., 2010; Luijendijk et al., 2008; Zandstra et al., 2002), and frequent contact with medical services (Jorm et al., 2000). Our data suggest that long-term BZD use among patients with MDD is increased with age and is more frequent in patients who reported impairment in occupational functions. "
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    ABSTRACT: There have been no data about long-term benzodiazepine (BZD) use and its correlates in patients with major depressive disorder (MDD) in China. This study aimed to examine the prevalence of long-term BZD use (more than three months) and its demographic and clinical correlates in Chinese patients with MDD. A total of 1,192 patients with MDD were examined in 10 mental health centers in China. Patients' socio-demographic and clinical characteristics and prescriptions for psychotropic drugs were recorded using a standardized form. A large portion of patients (36.2%) received long-term BZD treatment. Univariate analyses revealed that long-term BZD users were older, poorer, and had more impaired occupational functioning than patients not taking BZDs. Long-term BZD users had fewer psychotic symptoms and took less antipsychotic drugs. In multivariate analyses, long-term BZD use was independently associated with older age and more severe impaired occupational functioning; long-term BZD users were less likely to receive antipsychotic medications and traditional antidepressants (tricyclic antidepressants, tetracyclic antidepressant, and monoamine oxidase inhibitors). Long-term BZD use was common in patients with MDD in China. A host of demographic and clinical factors were independently associated with long-term BZD use.
    Full-text · Article · Aug 2013 · Perspectives In Psychiatric Care
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    • "In agreement with the present case, evidence now suggests that (i) both short-and long-term BZD use is associated with old age, female sex, psychological stress and physical disease [10], (ii) long-term BZD use in old age is typically associated with mood disorders, alcohol abuse and female sex [11] and (iii) depression in old age is associated with the use of alcohol and prescription drugs, with female sex and with medical conditions such as heart disease and Alzheimer's disease [12]. "
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    ABSTRACT: Introduced in the early 1960s, diazepam remains among the most frequently prescribed benzodiazepine-type sedatives and hypnotics. Patients with chronic use of short-acting benzodiazepines are frequently switched to diazepam because the accumulating, long-acting metabolite, N-desmethyl-diazepam, prevents benzodiazepine-associated withdrawal symptoms, which can occur during trough plasma levels of short-acting benzodiazepines. Although mild to moderate withdrawal symptoms are frequently observed during benzodiazepine switching to diazepam, severe medical complications associated with this treatment approach have thus far not been reported. A 64-year-old female Caucasian with major depression, alcohol dependence and benzodiazepine dependence was successfully treated for depression and, after lorazepam-assisted alcohol detoxification, was switched from lorazepam to diazepam to facilitate benzodiazepine discontinuation. Subsequent to the benzodiazepine switch, our patient unexpectedly developed an acute delirious state, which quickly remitted after re-administration of lorazepam. A newly diagnosed early form of mixed dementia, combining both vascular and Alzheimer-type lesions, was found as a likely contributing factor for the observed vulnerability to benzodiazepine-induced withdrawal symptoms. Chronic use of benzodiazepines is common in the elderly and a switch to diazepam often precedes benzodiazepine discontinuation trials. However, contrary to common clinical practice, benzodiazepine switching to diazepam may require cross-titration with slow tapering of the first benzodiazepine to allow for the build-up of N-desmethyl-diazepam, in order to safely prevent severe withdrawal symptoms. Alternatively, long-term treatment with low doses of benzodiazepines may be considered, especially in elderly patients with chronic use of benzodiazepines and proven vulnerability to benzodiazepine-associated withdrawal symptoms.
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    • "Extensive research has attempted to characterize individual characteristics associated with the occurrence of BZD LTU, with a main focus on sociodemographic factors. For instance, age, one of the most commonly documented predictors, appears to have strong relationship with the occurrence of long-term BZD use (Bartlett et al., 2004; Fortin et al., 2007; Jorm et al., 2000; Neutel, 2005; Nomura et al., 2007; van Hulten et al., 2003; Zandstra et al., 2002, 2004); individuals in certain age subgroups, especially the elderly, were oftentimes regarded as a high-risk subgroup for BZDs-associated adverse health events. As to male–female differences, prior research generally indicated that only slight female-associated excess or no gender differences exist in the risk of long-term BZD use (Fortin et al., 2007; Isacson, 1997; Jorm et al., 2000; Neutel, 2005). "
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    ABSTRACT: Long-term use of benzodiazepines (BZDs) has been linked with an array of negative health consequences and increased medical costs and social burden. In this study, we sought to investigate the factors accounting for differential risks in the process from incident BZD use to long-term use and discontinuation in the general population. On the basis of a random sample of 187,413 people enrolled in Taiwan's National Health Insurance program on January 1, 2000, data of 2000-2002 healthcare and pharmacological services utilization were retrieved. Long-term use (LTU) was defined by having received BZD prescriptions for 180 or more days within any given calendar year. Multivariate logistic regression analyses were carried out to assess the strength of associations while adjusting for the effects of individual sociodemographics, service providers, and pharmacological agents simultaneously. Results indicated that males, elderly, and those with physical or mental disorders were more likely to become long-term users of BZDs. Having received BZD prescriptions in multiple pharmacological agents, short-acting or mixed-type agents, and hypnotic indication were associated with a roughly 2- to 5-fold increased risk of BZD LTU soon after prescription initiation. With respect to discontinuation, the effects of pharmacological characteristics seem more salient as compared to those of individual and service-provider factors. Future strategies targeting individual factors and modifying service-provider prescription behaviors may be considered to reduce possible negative consequences of BZD LTU.
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