Clinical management of withdrawal from benzodiazepine anxiolytic and hypnotic medications

Baldwin, David S.

doi:10.1111/add.15695

Cited by 11 publications

(2 citation statements)

References 127 publications

(168 reference statements)

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“…At the same time, high exposure to benzodiazepines was more often involved in hospitalizations during the two lockdowns in young adults than in the older group. Reasons for this benzodiazepine use over the pandemic period may be the following: i) they are often involved in intentional drug overdose, alone or in association with alcohol and other drugs; ii) the psychiatric vulnerability of young adults during the lockdowns may have led to the broad prescription of benzodiazepines in this population, making them more available and facilitating their misuse ( Baldwin, 2022 ). This increase in prescription might have particularly concerned patients with psychiatric disorders or substance use disorders.…”

Section: Discussionmentioning

confidence: 99%

General hospital admissions in young and middle-aged people who use psychoactive substances: Impact of Covid-19 lockdowns

Perino

Ramaroson

Ong

et al. 2023

International Journal of Drug Policy

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Section: Discussionmentioning

confidence: 99%

General hospital admissions in young and middle-aged people who use psychoactive substances: Impact of Covid-19 lockdowns

Perino

Ramaroson

Ong

et al. 2023

International Journal of Drug Policy

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“…Current recommended length of treatment with BDZs is 2–4 weeks, with no BDZ approved for use for more than 4 months. Yet, many patients are prescribed BDZs for months, years, decades, sometimes indefinitely ( 47 – 53 ). More alarmingly, while the number of new BDZ prescriptions remained stable between 2005 and 2015, there was a 50% increase in renewed prescriptions during the same period, suggesting a specific increase in this problematic, longer-term use ( 54 ).…”

Section: Benzodiazepine Abuse and Misusementioning

confidence: 99%

GABAA receptor subtypes and benzodiazepine use, misuse, and abuse

Engin

2023

Front. Psychiatry

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Benzodiazepines have been in use for over half a century. While they remain highly prescribed, their unfavorable side-effect profile and abuse liability motivated a search for alternatives. Most of these efforts focused on the development of benzodiazepine-like drugs that are selective for specific GABAA receptor subtypes. While there is ample evidence that subtype-selective GABAA receptor ligands have great potential for providing symptom relief without typical benzodiazepine side-effects, it is less clear whether subtype-selective targeting strategies can also reduce misuse and abuse potential. This review focuses on the three benzodiazepine properties that are relevant to the DSM-5-TR criteria for Sedative, Hypnotic, or Anxiolytic Use Disorder, namely, reinforcing properties of benzodiazepines, maladaptive behaviors related to benzodiazepine use, and benzodiazepine tolerance and dependence. We review existing evidence regarding the involvement of different GABAA receptor subtypes in each of these areas. The reviewed studies suggest that α1-containing GABAA receptors play an integral role in benzodiazepine-induced plasticity in reward-related brain areas and might be involved in the development of tolerance and dependence to benzodiazepines. However, a systematic comparison of the contributions of all benzodiazepine-sensitive GABAA receptors to these processes, a mechanistic understanding of how the positive modulation of each receptor subtype might contribute to the brain mechanisms underlying each of these processes, and a definitive answer to the question of whether specific chronic modulation of any given subtype would result in some or all of the benzodiazepine effects are currently lacking from the literature. Moreover, how non-selective benzodiazepines might lead to the maladaptive behaviors listed in DSM and how different GABAA receptor subtypes might be involved in the development of these behaviors remains unexplored. Considering the increasing burden of benzodiazepine abuse, the common practice of benzodiazepine misuse that leads to severe dependence, and the current efforts to generate side-effect free benzodiazepine alternatives, there is an urgent need for systematic, mechanistic research that provides a better understanding of the brain mechanisms of benzodiazepine misuse and abuse, including the involvement of specific GABAA receptor subtypes in these processes, to establish an informed foundation for preclinical and clinical efforts.

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Motor behavior induced by bergamot essential oil in experimental tasks is differentially modulated by pretreatment with metabotropic glutamate receptor 2/3 or 5 antagonists

Rombolà,

De Rasis,

Sakurada

et al. 2024

Phytotherapy Research

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Bergamot essential oil shows anxiolytic‐relaxant effects devoid of sedative action and motor impairment typical of benzodiazepines. Considering the potential for clinical of these effects, it is important to understand the underlying mechanisms of the phytocomplex. Modulation of glutamate group I and II metabotropic receptors is involved in stress and anxiety disorders, in cognition and emotions and increases locomotor activity and wakefulness. Interestingly, early data indicate that bergamot essential oil modulates glutamatergic transmission in specific manifestations of the central nervous system. The aim of this work is to investigate if selective antagonists of metabotropic glutamate 2/3 and 5 receptors affect behavioral parameters modulated by the phytocomplex. Male Wistar rats were used to measure behavioral parameters to correlate anxiety and motor activity using elevated plus maze (EPM), open field (OF), and rotarod tasks. Bergamot essential oil increases in EPM the time spent in open/closed arms and reduces total number of entries. The essential oil also increases immobility in EPM and OF and not affect motor coordination in rotarod. Pretreatment with the metabotropic glutamate antagonists does not affect the time spent in open/close arms, however, differently affects motor behavior measured after administration of phytocomplex. Particularly, glutamate 2/3 antagonist reverts immobility and glutamate 5 antagonist potentiates this parameter induced by the phytocomplex. Our data show that modulation of both metabotropic glutamate receptors is likely involved in some of behavioral effects of bergamot essential oil.

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Clinical management of withdrawal from benzodiazepine anxiolytic and hypnotic medications

Cited by 11 publications

References 127 publications

General hospital admissions in young and middle-aged people who use psychoactive substances: Impact of Covid-19 lockdowns

General hospital admissions in young and middle-aged people who use psychoactive substances: Impact of Covid-19 lockdowns

GABAA receptor subtypes and benzodiazepine use, misuse, and abuse

Motor behavior induced by bergamot essential oil in experimental tasks is differentially modulated by pretreatment with metabotropic glutamate receptor 2/3 or 5 antagonists

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