Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
Simultaneous Antidepressant & Benzodiazepine Use
JAMA Psychiatry; ePub 2017 Jun 30; Bushnell, et al
10% of patients who were started on antidepressants were simultaneously started on benzodiazepine therapy, a recent study found. The cohort study included 765,130 adults aged 18 to 64 years from January 1, 2001, through December 31, 2014, with a recent depression diagnosis who began antidepressant therapy but had not used antidepressants or benzodiazepines in the prior year. Researchers found:
- 81,020 (10.6%) antidepressant adults with depression simultaneously initiated benzodiazepine therapy.
- The proportion of patients with simultaneous new antidepressant and benzodiazepine use increased from 6.1% in 2001 to 12.5% in 2012 before stabilizing through 2014.
- Antidepressant treatment length was similar in simultaneous new users and non-simultaneous new users.
- Among simultaneous new users, 12.3% exhibited long-term benzodiazepine use.
Bushnell GA, Stürmer T, Gaynes BN, Pate V, Miller M. Simultaneous antidepressant and benzodiazepine new use and subsequent long-term benzodiazepine use in adults with depression, United States, 2001-2014. [Published online ahead of print June 07, 2017]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.1273.
In patients with co-existing depression and anxiety, a benzodiazepine medication is often added for 2 to 6 weeks to decrease symptoms of anxiety during the time period before the antidepressant kicks in, which can take 4 to 6 weeks. Because of the concern about addiction, as well as potential long-term side effects, it is important to clarify with patients up front that the benzodiazepine prescription is only intended for short-term use. The numbers in this study, showing that 12% of new antidepressant users also received a benzodiazepine, and approximately 12% of those continued to long-term use, suggests that there is appropriate, responsible use of benzodiazepines and that the medication is likely prescribed to those individuals who are suffering with excessive anxiety, with only a small proportion of those individuals going on to long-term use. —Neil Skolnik, MD