Should Benzodiazepines Be Replaced by Antidepressants in the Treatment of Anxiety Disorders? Fact or Fiction?

Rickels, Karl

doi:10.1159/000353502

Cited by 22 publications

(10 citation statements)

References 12 publications

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“…Defining ‘withdrawal syndromes' as those pertaining to benzodiazepines [27], antipsychotic drugs [93], and tricyclic antidepressants [80] and ‘discontinuation syndromes' as those of SSRI does not appear to reflect the evidence in the literature. Indeed, the use of this latter term has minimized the potential vulnerabilities induced by SSRI and has provided the ground for misleading indications (e.g., AD are to be preferred to benzodiazepines in anxiety disorders due to a lack of dependence) [94,95]. …”

Section: Discussionmentioning

confidence: 99%

Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review

Fava

Gatti

Belaise

et al. 2015

Psychother Psychosom

343

383

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Background: Selective serotonin reuptake inhibitors (SSRI) are widely used in medical practice. They have been associated with a broad range of symptoms, whose clinical meaning has not been fully appreciated. Methods: The PRISMA guidelines were followed to conduct a systematic review of the literature. Titles, abstracts, and topics were searched using the following terms: ‘withdrawal symptoms' OR ‘withdrawal syndrome' OR ‘discontinuation syndrome' OR ‘discontinuation symptoms', AND ‘SSRI' OR ‘serotonin' OR ‘antidepressant' OR ‘paroxetine' OR ‘fluoxetine' OR ‘sertraline' OR ‘fluvoxamine' OR ‘citalopram' OR ‘escitalopram'. The electronic research literature databases included CINAHL, the Cochrane Library, PubMed and Web-of-Science from inception of each database to July 2014. Results: There were 15 randomized controlled studies, 4 open trials, 4 retrospective investigations, and 38 case reports. The prevalence of the syndrome was variable, and its estimation was hindered by a lack of case identification in many studies. Symptoms typically occur within a few days from drug discontinuation and last a few weeks, also with gradual tapering. However, many variations are possible, including late onset and/or longer persistence of disturbances. Symptoms may be easily misidentified as signs of impending relapse. Conclusions: Clinicians need to add SSRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with benzodiazepines, barbiturates, and other psychotropic drugs. The term ‘discontinuation syndrome' that is currently used minimizes the potential vulnerabilities induced by SSRI and should be replaced by ‘withdrawal syndrome'.

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Section: Discussionmentioning

confidence: 99%

Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review

Fava

Gatti

Belaise

et al. 2015

Psychother Psychosom

343

383

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“…These findings suggest that FCOI may function subtly, but powerfully, to shift the direction of the research, focusing on interventions that are the most commercially attractive but that do not necessarily represent the best science. Indeed, as was recently noted, when NIH decreased funding of clinical trials for new drugs, ‘turning new drug development over to industry, many clinically important clinical trials… were simply not done' [[25]; see also [26]]. Hence, there must be systemic valuing and support of disinterested experts and their scientific contributions [27], and there is a clear need for drug trials that are not sponsored by and managed by industry.…”

Section: Discussionmentioning

confidence: 99%

Tripartite Conflicts of Interest and High Stakes Patent Extensions in the DSM-5

Cosgrove

Krimsky

Wheeler

et al. 2014

Psychother Psychosom

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Background: The revision process for and recent publication of the DSM-5 initiated debates about the widening of diagnostic boundaries. The pharmaceutical industry had a major financial stake in the outcome of these debates. This study examines the three-part relationship among DSM panel members, principal investigators (PIs) of clinical trials for new DSM-5 diagnoses, and drug companies. Methods: Financial conflicts of interest (FCOI) of DSM panel members responsible for some new diagnoses in the DSM-5 and PIs of clinical trials for related drug treatments were identified. Trials were found by searching ClinicalTrials.gov. Patent and revenue information about these drugs was found using the US Food and Drug Administration's Orange Book and manufacturer Annual Reports. Results: Thirteen trials met inclusion criteria (testing drugs for some new DSM disorders). Sixty-one percent of the DSM Task Force members and 27% of Work Group members reported FCOI to the trial drug manufacturers. In 5 of the 13 trials (38%), PIs reported ties other than research funding to the drug manufacturer. In 3 of the trials (23%), a PI had financial ties to the drug manufacturer and was also a DSM panel member who had decision-making authority over the revision process. Conclusions: These findings suggest that increased transparency (e.g., registration on ClinicalTrials.gov) and mandatory disclosure policies (e.g., the American Psychiatric Association's disclosure policy for DSM-5 panel members) alone may not be robust enough strategies to prevent the appearance of bias in both the DSM revision process as well as clinical decisions about appropriate interventions for DSM disorders.

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“…Indeed, benzodiazepines showed fewer treatment drop-outs and adverse events than antidepressant drugs in panic disorder with and without agoraphobia [26]. A major drive over time in the shift from benzodiazepines to antidepressants in anxiety disorders was the well-known risk of dependence with benzodiazepines [26,27]. However, in due course after their introduction, similar, if not more pronounced, problems occurred with most of the newer antidepressants [14].…”

Section: Risk Responsiveness and Vulnerabilitymentioning

confidence: 99%

Iatrogenic Comorbidity in Childhood and Adolescence: New Insights from the Use of Antidepressant Drugs

2014

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Should Benzodiazepines Be Replaced by Antidepressants in the Treatment of Anxiety Disorders? Fact or Fiction?

Cited by 22 publications

References 12 publications

Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review

Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review

Tripartite Conflicts of Interest and High Stakes Patent Extensions in the DSM-5

Iatrogenic Comorbidity in Childhood and Adolescence: New Insights from the Use of Antidepressant Drugs

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