Gradual withdrawal from benzodiazepines in residents of homes for the elderly: experience and suggestions for future research

Habraken, Hilde; Soenen, K.; Blondeel, Luc; Elsen, J. Van; Bourda, J.; Coppens, Evelien; Willeput, M.

doi:10.1007/s002280050213

Cited by 27 publications

(31 citation statements)

References 12 publications

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“…Cocaine users usually experience dramatic withdrawal symptoms ("crash") within 30 minutes after a single ingestion, given cocaine's rapid clearance from the brain (Volkow et al, 1995). In contrast, regular BZD users who ingest a single dose per day might never experience typical BZD withdrawal symptoms such as increased anxiety, insomnia, and autonomic instability (Graves et al, 1997;Habraken et al, 1997;Murphy & Tyrer, 1991). Moreover, many BZD users who withdraw experience only mild or no transient symptoms (Voyer, Richard, & Dupont, 2001).…”

Section: Criterion 5: Time Expended Due To Drug Usementioning

confidence: 87%

Unconventional Indicators of Drug Dependence Among Elderly Long-Term Users of Benzodiazepines

Voyer

McCubbin

Cohen

et al. 2004

Issues in Mental Health Nursing

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A quarter of the elderly population is prescribed benzodiazepines (BZD). This has led to growing concerns about drug dependence and the validity of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for dependence to a substance. This study aimed to understand how dependence was experienced by long-term BZD users. Interviews were conducted with 45 elderly persons who had been using BZDs for an average of nine years. These users' comments suggest six indicators of dependence: self-identifying as a dependent user, invoking multiple stressors to justify BZD use, using BZD to cope with anticipated stressors, trivializing the dangers of BZDs, keeping a supply in reserve, having previously tried and failed to stop, and reducing the dosage. Our results stress the need to take a more elaborate, person-centered view of dependence.

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Section: Criterion 5: Time Expended Due To Drug Usementioning

confidence: 87%

Unconventional Indicators of Drug Dependence Among Elderly Long-Term Users of Benzodiazepines

Voyer

McCubbin

Cohen

et al. 2004

Issues in Mental Health Nursing

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“…These drugs are, besides antihypertensive and anticholinergic agents, frequently cited as a cause of a dementia-like state (46). A moderate recovery of some cognitive deficits in long-term users, six months after withdrawal from BZDs, has been reported (47).…”

Section: Susceptibility Of the Elderly To Benzodiazepinesmentioning

confidence: 99%

Is There a Rationale for Prescription of Benzodiazepines in the Elderly? Review of the Literature

Petrovic

Mariman

Warie

et al. 2003

Acta Clinica Belgica

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Benzodiazepines (BZDs) constitute the most widely used symptomatic treatment of insomnia and anxiety. Many of these drugs are associated with adverse effects, such as daytime sedation and dependence with continued use. There is a concern about the rationale for and extent of benzodiazepine (BZD) use in the elderly. The sedation due to BZD use is a main risk factor for falls and other accidents. Impaired cognitive function with continuous use appears to be a major side effect. There is a general awareness that BZD use is inappropriate in many patients, and therefore discontinuation should be recommended whenever possible. Moreover, long-term use of these drugs should be actively discouraged. Although no unanimous recommendations concerning the optimal duration of the withdrawal process exist, BZDs may easily be withdrawn during a short period in most patients who are habituated to a low dose, if an initial phase with dose reduction and psychological support are provided. Alternative approaches involve sleep hygiene guidelines, behavioural treatment and psychotherapy tailored to the needs of the individual patient.

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“…We therefore cannot predict the durability of the withdrawal course in the long term. Other studies report that abstinence may be maintained during 1 year after discontinuance of BZD treatment (Salzman et al, 1992;Habraken et al, 1997). We anticipated that most of our patients would not resume the use of BZD after discharge from the hospital, as they would receive continuing support from their family members and general practitioners, who were asked not to provide BZD unless strict medical indications were present.…”

Section: Discussionmentioning

confidence: 89%

“…Despite the frequent use of BZD in the older age group, withdrawal in the elderly has not been the subject of extensive investigation. To the best of our knowledge, only three controlled trials have dealt with outcome and severity of withdrawal symptoms in elderly patients (Schweizer et al, 1989;Salzman et al, 1992;Habraken et al, 1997). In the study by Schweizer et al, a gradual taper of BZD doses was applied in elderly and compared to younger subjects in an outpatient setting.…”

Section: Discussionmentioning

confidence: 96%

A programme for short-term withdrawal from benzodiazepines in geriatric hospital inpatients: success rate and effect on subjective sleep quality

Petrovic

Pevernagie

Noortgate

et al. 1999

Int. J. Geriat. Psychiatry

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Objective We tested the hypothesis that a short‐term programme for withdrawal of benzodiazepines (BZD) is feasible in hospitalized geriatric patients. Methods Fifty‐six geriatric subjects who had been taking BZD for at least 3 months were asked to discontinue these drugs upon admission to the inpatient ward. A withdrawal programme including initial substitution therapy combined with psychological consulting was offered. The usual BZD medication was replaced by either lormetazepam 1 mg or trazodone 50 mg, administered at bedtime. After 1 week of replacement therapy all sedative medication was stopped. The subjective estimations of sleep quality were evaluated four times during a period of 6 weeks. Results Forty‐nine patients agreed to participate. In this group four subjects (8.2%) resumed BZD use while in the hospital and another seven subjects (14.3%) relapsed after discharge. Therefore, the overall success rate was 77.6% in the group of volunteers and 67.9% in the total group of eligible patients. The data of the present study further demonstrate that no major withdrawal symptoms occurred and that the subjective quality of sleep remained virtually unchanged in the course of the programme. The sleep quality was not significantly different in patients on trazodone versus patients on lormetazepam. The success rate was similar in both drug substitution groups. Conclusions Short‐term withdrawal of BZD may be achieved in two‐thirds of elderly hospital inpatients without deterioration of sleep quality or other deleterious side‐effects. Copyright © 1999 John Wiley & Sons, Ltd.

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Gradual withdrawal from benzodiazepines in residents of homes for the elderly: experience and suggestions for future research

Abstract: The findings are promising for further research, but researchers should anticipate the problems inherent in executing a trial with institutionalised elderly subjects.

Cited by 27 publications

References 12 publications

Unconventional Indicators of Drug Dependence Among Elderly Long-Term Users of Benzodiazepines

Unconventional Indicators of Drug Dependence Among Elderly Long-Term Users of Benzodiazepines

Is There a Rationale for Prescription of Benzodiazepines in the Elderly? Review of the Literature

A programme for short-term withdrawal from benzodiazepines in geriatric hospital inpatients: success rate and effect on subjective sleep quality

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