Factors Associated with the Combined Use of Antidepressants and Benzodiazepines in Major Depression: A Case–Control Study

Abstract

The aim of this study was to identify the factors associated with the combined use of antidepressants and benzodiazepines (BDZs) in patients with major depression. We conducted a case-control study in the public health service of the city of São Paulo, Brazil. The participants were all patients being treated with antidepressants, who were diagnosed with major depression. Patients who received a combination of antidepressants and BDZs were classified as cases, and those who used only antidepressants, as controls. Data were obtained from a pharmacy database, medical records and interviews with the healthcare team. The association of predisposing factors for combined therapy was analysed using logistic regression analysis, and the odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Of the 1355 users of antidepressants, 265 had major depression, of whom 138 were cases and 127 were controls. The factors associated with combined use were age older than 35 years (OR 2.2, 95% CI 1.0-4.7), absence of comorbidities (OR 2.3, 95% CI 1.4-4.1) and no use of other drugs (OR 1.9, 95% CI 1.1-3.3). Patients with combined use were more likely to exhibit inadequate prescribing, including inappropriate antidepressants (OR 4.7, 95% CI 2.2-9.9), inadequate dosages (OR 3.62, 95% CI 1.4-9.6) and/or a non-recommended duration (OR 66.6, 95% CI 18.4-240.7). The factors identified showed the groups most susceptible to combined use in this population, who in turn are more likely to receive inappropriate prescriptions.

Concurrent benzodiazepine use in older adults treated with antidepressants in Asia

“…This was the first large-scale, international survey of concurrent prescription of benzodiazepines and antidepressants in older adults. The proportion of combination treatment was 44.3% in Asia, which is lower than the figure (52%) in patients with major depression (mean age: 52.1 years) in Brazil (Fulone et al, 2016), but higher than the 20.5% found in older veterans with depression (mean age: 64.9 years) in the USA (Leggett et al, 2015).…”

“…Regular cross-sectional surveys of prescription patterns are an efficient and quick method to assess the appropriateness of pharmacotherapy (Ungvari et al, 1997). Several surveys have examined the combined use of benzodiazepines and antidepressants for psychiatric disorders, with the percentage ranging from 20.5% to 57% (van Dijk et al, 2002;Leggett et al, 2015;Fulone et al, 2016;Bushnell et al, 2017). However, very little is known about the co-prescription of these two groups of medications in Asian older psychiatric patients (Xiang et al, 2014a).…”