Exploring characteristics associated with first benzodiazepine prescription in patients with affective disorders and related diagnoses

Abstract

Objective: In patients with affective disorders, benzodiazepines (BZDs) are frequently administered at the onset, sometimes inappropriately. We sought to identify clinical variables associated with first BZD prescription in a large sample of patients with affective disorders.Methods: Four hundred sixty patients with mood or anxiety disorders attending different psychiatric services were assessed comparing those who received BZD as first treatment (BZD w/) and those who did not (BZD w/o).Results: More than one third (35.7%) of the total sample had received BZDs as first prescription. In relation to mood disorders, BZD w/ subjects more frequently (a) had not a psychiatrist as first therapist, (b) had anxious symptoms at onset, (c) had adjustment disorder as first diagnosis, (d) were treated as outpatients. In relation to specific diagnoses, (a) personal decision of treatment for major depressive disorder, (b) outpatient status for bipolar disorder and (c) longer duration of untreated illness for adjustment disorder were more frequently associated with first BZD prescription. For anxiety disorders, the presence of stressful life events and the diagnoses of panic disorder or specific phobias were more frequently observed in BZD w/ patients. Conclusion:Patients with affective disorders frequently received BZDs as first prescription with significant differences between and within mood and anxiety disorders.

Use of Benzodiazepines in Patients With Bipolar Disorder

“…In relation to the aim of this study, we found that 34.9% of bipolar patients were under BZD treatment 6 months after the appearance of the disease. This incidence found in our study is similar to the one described in a recent article (Carlo et al, 2019) in which, 35% of patients with affective disorders receive BZD, and which is related with the fact of being treated at the beginning of the disease by non-psychiatric doctors and with a longer duration of untreated disease period. Also, in a study performed in hospitalized patients, 36% released patients had BZD prescribed in their treatment, which is a risk factor for bipolar disorder (Peters el at., 2015).…”

Latency to selective serotonin reuptake inhibitor vs benzodiazepine treatment in patients with panic disorder: a naturalistic study

“…This finding indicates that, despite the guideline recommendations, BDZs continue to be widely prescribed as first treatment in PD, 29 even though existing evidence suggests that long-term BDZ prescription might delay proper treatment in patients with mood and anxiety disorders, including PD. 56,57 Finally, we compared latency to SSRI treatment with findings from previous studies and observed some significant differences. The longer DUI in the present study could reflect a longer latency to treatment in patients with PD, but may be influenced by the setting of our study: all participants were undergoing CBT treatment, and may have been more inclined to access a nonpharmacological intervention.…”

“…In addition, when we compared DUI-SSRI vs DUI-BDZ, we observed a statistically significant difference (of approximately 2.5 years) between these two measurements. This finding indicates that, despite the guideline recommendations, BDZs continue to be widely prescribed as first treatment in PD, 29 even though existing evidence suggests that long-term BDZ prescription might delay proper treatment in patients with mood and anxiety disorders, including PD 56 57 …”

The Management of Prodromal Symptoms of Bipolar Disorder: Available Options and Future Perspectives

“…Benzodiazepines (BZDs) provide fast relief in the reduction of comorbid anxiety and are approved by Canadian Network for Mood and Anxiety Treatments as symptomatic drugs in the short-term treatment in BD; however, the appropriateness of their use in at-risk patients for BD is debated. Two recent works [79,90] asserted that prolonged use of BZDs in at-risk populations may extend the duration of untreated illness up to four years, delaying the administration of an adequate psychopharmacological treatment and an appropriate medical follow-up. The risk of drug misuse and dependence in BD patients appears higher than in other patients.…”