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The most severely depressed people and TCA users more often have the MetSyn, which is driven by abdominal adiposity and dyslipidemia.

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Benzodiazepines (BZDs) are not only used as a treatment for anxiety and depression (besides epilepsy), but also inappropriately for chronic insomnia, pain, somatic illnesses [1] and uncontrollable stress.• In spite of lack of effectiveness and adverse health consequences in chronic BZD use, over 50% are long-term users.• The relative importance of sociodemographic, psychological and physical determinants of BZD use in general and inappropriate use has never been investigated in a comprehensive, multivariable model. WHAT THIS STUDY ADDS• BZDs were used by a considerable proportion of the NESDA participants and BZD use was rarely in accordance with all guidelines, mainly because of an extended duration of use.• Mentally or physically vulnerable subjects were most likely to use BZDs as well as to use it inappropriately.• Clinicians should be vigilant when initiating BZD prescriptions for vulnerable subjects, particularly when patients are chronically ill and old, as those subjects are at high risk of inappropriate use. AIMResults on determinants of benzodiazepine (BZD) use in general and inappropriate use were inconsistent and mostly univariate. The relative importance of sociodemographic, psychological and physical determinants has never been investigated in a comprehensive, multivariate model. METHODSWe included 429 BZD users and 2423 non-users from the Netherlands Study of Depression and Anxiety (NESDA) in order to investigate sociodemographic, psychological and physical determinants of BZD use and inappropriate use by logistic and linear regression analyses. RESULTSBZDs were used by a considerable proportion of the 2852 NESDA participants (15.0%

People with initially severe symptoms of depression or anxiety showed a subsequent decrease in HDL cholesterol levels and an increase in abdominal obesity over time, independent of a potential reduction in symptom severity in this period. Therefore, such people are at elongated and increasing risk for dyslipidemia and obesity, predisposing them to cardiovascular disease.

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