Does cognitive behavioral therapy for anxiety disorders assist the discontinuation of benzodiazepines among patients with anxiety disorders? A systematic review and meta‐analysis

Abstract

Long-term use of benzodiazepines (BZD) is not recommended for the treatment of anxiety disorders. Cognitive behavioral therapy (CBT) is an effective treatment option for discontinuation of BZD in patients with anxiety disorders. This systematic review and meta-analysis sought to clarify whether CBT is effective for discontinuing BZD anxiolytics in patients with anxiety disorders. This study was preregistered with PROSPERO (registration number: CRD42019125263). A literature search of major electronic databases was conducted in December 2018. Three randomized controlled trials were included in this review, and meta-analyses were performed. The proportion of discontinuing BZD anxiolytics was significantly higher in the CBT plus gradual tapering group than in the gradual tapering alone group, both in the short term (3 months after allocation; number needed to treat: 3.2, 95% confidence interval [CI]: 2.1 to 7.1; risk ratio: 1.96, 95%CI: 1.29 to 2.98, P = 0.002, three studies) and long term (6 to 12 months after allocation; number needed to treat: 2.8, 95%CI: 1.9 to 5.3; risk ratio: 2.16, 95%CI: 1.41 to 3.32, P = 0.0004, three studies). CBT may be effective for discontinuing BZD anxiolytics, both in the short term and in the long term after the allocation. Further studies with larger sample sizes are necessary to draw definitive conclusions regarding the efficacy and safety of CBT for discontinuing BZD anxiolytics in patients with anxiety disorders.

Long-term Psychoactive Medications, Polypharmacy, and Risk of Suicide and Unintended Overdose Death Among Midlife and Older Women Veterans

“…These findings also highlight the importance of the availability of safe and effective evidence-based psychotherapies for psychiatric and related conditions, which may reduce reliance on long-term psychoactive medications while potentially alleviating multiple comorbidities. [45][46][47] This is particularly relevant for examined medications with known risks and limited benefits related to long-term use, such as benzodiazepines 42 and sedative-hypnotics. 16 Overall, long-term and coprescribed psychoactive medications may represent an important indicator of suicide and overdose risk during this vulnerable period.…”

Changes in psychotropic polypharmacy and high‐potency prescription following policy change: Findings from a large scale Japanese claims database

“…The high inflammatory response at t = 0 could be associated with the initial cognitive impairment, as suggested in other studies. 4,5 However, the persistence of cognitive impairment at t = 1 did not match with the recovery in the inflammatory status of the patient. Indeed, after 6 months of acute WE symptoms, and under thiamine treatment, the general inflammatory condition improved, whereas the cognitive impairment persisted, with no evolution to Korsakoff syndrome, pointing out the great difficulty of cognitive processes to return to normal once impairment has occurred.…”

“…Cognitive-behavioral therapy (CBT) may be considered in patients with anxiety disorders who cannot reduce or discontinue anxiolytic use; CBT promotes the discontinuation of both short and long-term anxiolytic use. 4 In contrast, CBT for insomnia facilitates the short-term discontinuation of benzodiazepines; however, the effects may not last long. 5 Therefore, new long-term effective treatments for discontinuing hypnotics in patients with insomnia are required.…”

Cognitive Behavioral Therapy and Acceptance and Commitment Therapy for the Discontinuation of Long-Term Benzodiazepine Use in Insomnia and Anxiety Disorders

“…The number of studies is too small to firmly conclude that CBT is more effective than withdrawal programs alone [ 126 ]. However, some meta-analyses show that CBT at least doubles the abstinence rate compared to a simple withdrawal program [ 82 , 127 , 128 ]. As this control condition is itself more effective than WL or TAU, which have a success rate of only 5%, we can suppose that the effectiveness of CBT compared to brief interventions (which include WL or TAU as a control condition) is clearly underestimated in the meta-analyses on the treatment of BZD use disorder.…”