High dose benzodiazepines prolong reaction times in chronic users who have major depressive and/or anxiety disorders

Abstract

AIMShort term administration of benzodiazepines (BZD) was found to prolong reaction time (RT) in experimental studies. However, studies on long term BZD use did not always adjust for important confounders and showed inconsistent results. We aimed to identify a possible relationship between long term BZD use and RT in BZD users in this large cross-sectional, observational study. METHODSThe RTs of non-users (n = 2404) were compared with low (n = 288), intermediate (n = 74), and high dose BZD users (n = 57) in the Netherlands Study of Depression and Anxiety (NESDA). RTs were obtained from the Implicit Association Test. Analyses were adjusted for sociodemographic characteristics, health indicators, severity of psychopathology and antidepressant use. RESULTSOf the NESDA participants, 419 subjects (14.8%) used BZDs. A higher dose of BZDs was associated with prolonged RTs (P = 0.01). When comparing the different dose groups, the high dose group, but not the low and medium dose groups, had significantly longer RTs than the non-users. CONCLUSIONSTolerance for the RT prolonging effect of relatively high doses of BZDs does not seem to develop. As prolonged RTs can have adverse consequences in daily life, BZDs should be prescribed conservatively at the lowest possible dose. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Short term benzodiazepine (BZD) use prolongs reaction time (RT).• Although the prevalence of long term BZD use is high, it in unclear whether RT is still affected in chronic use. WHAT THIS STUDY ADDS• High dose BZD use is associated with prolonged RTs in chronic users (independent of psychopathology).• Tolerance for the RT prolonging effect of BZDs does not seem to develop at high doses in chronic users.

Influence of Long-Term Benzodiazepine use on Neurocognitive Skills Related to Driving Performance in Patient Populations: A Review

“…Thirteen studies were included in this review. Ten studies compared neurocognitive and/or driving performance of long-term users to other patient groups [22][23][24], to healthy controls [25][26][27], or to both [28][29][30][31]. Three studies assessed the influence of acute benzodiazepine administration on neurocognitive and/or driving performance of long-term users in comparison to the acute effects of a benzodiazepine in treatment naïve controls [32], placebo [33], or both [34].…”

“…Several studies suggested that psychomotor function of long-term benzodiazepine users was comparable to that of drug-free patients [22] or healthy controls [30,31]. In contrast, other studies reported the presence of psychomotor impairment [25,27,29], particularly at higher benzodiazepine dosages [23]. Overall, comparative studies indicate the presence of neurocognitive impairments in patients who, on, average, had been using benzodiazepines for 5-15 years.…”

“…Manthey et al [23] compared the psychomotor performance of chronic benzodiazepine users in a large psychiatric population with either major depressive or anxiety disorders. Four subgroups were identified: non-users (n = 2 404), benzodiazepine low dose (n = 288), intermediate dose (n = 74), and high dose (n = 57).…”

Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice

“…However, cognitive effects, such as prolonged reaction time, seem to be associated only with high BDZ doses (>10 mg of diazepam equivalents/day). 232 As prolonged reaction times can have adverse consequences in daily life, BDZs should be prescribed conservatively at the lowest possible dose.…”

Beyond Prescriptions Monitoring Programs: The Importance of Having the Conversation about Benzodiazepine Use

“…Since that time evidence of broad-ranging harms resulting from long-term BDZ use has continued to grow, including cognitive deficits [8][9][10], reductions in quality of life [11][12][13], depression [14][15][16], risk of suicide [17], risk for road accidents [18,19], and specific to older adults-the risk of falls [20][21][22], developing dementia [23][24][25], and of mortality [26][27][28]. Short-term, paradoxical effects such as increased anxiety, agitation, disinhibition, and aggression have also been observed [29,30].…”