Older adults and withdrawal from benzodiazepine hypnotics in general practice: effects on cognitive function, sleep, mood and quality of life

Curran, H. Valerie; Collins, Ron; Fletcher, Sally; Kee, S. C. Y.; Woods, Bob; Iliffe, Steve

doi:10.1017/s0033291703008213

Cited by 164 publications

(112 citation statements)

References 38 publications

(42 reference statements)

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“…These range from 25% at 12 months for those with complicated dependence 15 to 80% for older adults in general practice. 16 Abrupt cessation of benzodiazepines after a period of 1-6 months of use can cause life-threatening seizures so the dose should be gradually reduced.…”

Section: Discontinuation With the Aim Of Abstinencementioning

confidence: 99%

Management of benzodiazepine misuse and dependence

Brett¹,

Murnion²

2015

Aust Prescr

179

121

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Section: Discontinuation With the Aim Of Abstinencementioning

confidence: 99%

Management of benzodiazepine misuse and dependence

Brett¹,

Murnion²

2015

Aust Prescr

179

121

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“…Interestingly, randomised controlled trials have shown that withdrawal from benzodiazepines give significant better psychomotoric function compared to the control group remaining on benzodiazepines [10,11].…”

Section: Introductionmentioning

confidence: 99%

Disability pension is associated with the use of benzodiazepines 20 years later: A prospective study

Hartz

Lundesgaard

Tverdal

2009

Scand J Public Health

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ObjectivesThe Norwegian Government urges that actions are needed to stimulate the working capacity in disability pension (DP) recipients with such a potential. Identification of factors that may impair rehabilitation efforts, such as information on the start of benzodiazepines in DP recipients, may be useful information in this context. Thus, the aim of the study was to describe the association between receipt of disability pension and later prescriptions of benzodiazepines among non-users at baseline. MethodsWe followed a cohort reporting non-use of benzodiazepines, 6645 men and 6455 ResultsIn both gender, the proportion started on at least one prescription of a benzodiazepine was about doubled among those reporting to be on a DP 20 years in the past, 21 % of all men and 29 % of all women, respectively.Univariate odds ratio for a benzodiazepine prescription for men and women on a DP were 2.6 (95% CI 1.5-4.4) and 2.1 (1.5-2.9), respectively, as compared with those not receiving a DP. After adjustment for alcohol, smoking habits, physical activity, socioeconomic and health variables, the odds ratios was lowered for both sexes, being 2.1 (1.2-3.7) (men) and 1.6 (1.1-2.3) (women). Conclusions 4For both men and women the chance of being prescribed benzodiazepines was higher among those reporting to DP recipients 20 years in the past.

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“…Only 1 RCT made wanting to discontinue a specific participant inclusion criterion [20], but 8 more commented on the issue (e.g., it is “difficult” to recruit treatment-responding participants “who are willing to be potentially randomly assigned to placebo” [21]; “participants were motivated ... and willing to discontinue their hypnotic medication” [22]). Similarly, 12 of 80 trials commented on environmental influences on discontinuation such as “caregiver distress and shortness of available staff time” [23]), but only 2 (discontinuing APs from residents with intellectual disability) assessed such variables, reaching opposite conclusions: “[C]hanges in environmental circumstances were of no influence on completion or non-completion of ... discontinuation” [24] and “[D]ifferences [between successfully or unsuccessfully drug-reduced participants] were apparent ... mainly in staff and environmental characteristics” [25].…”

Section: Resultsmentioning

confidence: 99%

Discontinuing Psychotropic Drugs from Participants in Randomized Controlled Trials: A Systematic Review

Cohen

Recalt

2019

Psychother Psychosom

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Background and Objective: Methods and justifications for discontinuing psychotropic drugs in randomized controlled trials (RCTs), and RCTs’ acknowledgement of possible withdrawal symptoms following discontinuation, have not been examined systematically, which this review aims to do. Study Eligibility, Data Extraction, and Synthesis: Publications in MEDLINE, EMBASE, and PsycINFO (2000–2017) randomly assigning participants diagnosed with mental disorders to discontinue antipsychotic, antidepressant, anticonvulsant, antimanic, mood-stabilizing, benzodiazepine, or stimulant drugs. Authors independently extracted data, devised a typology of trials, and assessed trials’ recognition of withdrawal symptoms. Results: Eighty RCTs (70% with industry participation) discontinued drugs from 5,757 participants to investigate relapse prevention (44%), successful discontinuation (26%), architecture of withdrawal (14%), and practicality of discontinuation (10%). RCTs of stimulants, antidepressants, and antipsychotics mostly aimed to reach conclusions about relapse prevention by testing abrupt or rapid discontinuations; RCTs of benzodiazepines mostly aimed to reduce drug use by testing longer-lasting, supportive discontinuations. In 67% of RCTs, no justification was given for the specific discontinuation strategy, which lasted under 2 weeks in 60% of RCTs. Possible withdrawal confounding of trial outcomes was addressed in 14% of eligible RCTs. Limitations: Only the published literature was searched. Conclusions and Implications: RCTs use drug discontinuation to study several key issues in psychopharmacology but infrequently justify how they implement it or acknowledge that possible withdrawal symptoms may threaten internal validity. Reappraising the use of drug discontinuation and the recognition of withdrawal symptoms in RCTs is required.

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Older adults and withdrawal from benzodiazepine hypnotics in general practice: effects on cognitive function, sleep, mood and quality of life

Cited by 164 publications

References 38 publications

Management of benzodiazepine misuse and dependence

Management of benzodiazepine misuse and dependence

Disability pension is associated with the use of benzodiazepines 20 years later: A prospective study

Discontinuing Psychotropic Drugs from Participants in Randomized Controlled Trials: A Systematic Review

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