The long-term outcome of a benzodiazepine discontinuation programme in depressed outpatients

Abstract 

Objective: To assess longitudinally the prescription of psychotropic drugs in depressed patients after they participated in a benzodiazepine discontinuation programme. Methods: Two hundred and thirty depressed patients on chronic benzodiazepine therapy took part in a discontinuation programme conducted in 36 general practices. After 2.3 years (S.D.=0.65, range 0.1–3.6) medical records were reviewed. Results: Follow-up was achieved for 207 (90%) patients. Twenty-five (12%) patients remained benzodiazepine free during the full follow-up period. The majority (n=181, 87%) was prescribed benzodiazepines at an average of 13 (±14) mg of diazepam equivalents for 537 (±375) days. Fifty-five (74% of 74) of the successfully discontinued patients restarted benzodiazepine therapy. Sixty-eight (33%) patients were prescribed benzodiazepines during the whole follow-up period. Successful taper predicted no or lower subsequent benzodiazepine prescription rates (OR=7.3; 95% CI: 2–16). No influence of GP policy towards benzodiazepine prescription could be detected (P=0.275). Antidepressants were prescribed in 115 (55%) patients for an average duration of 476 (±360) days. There was no difference in benzodiazepine prescription (dosage, duration) between patients who had or had not been prescribed an antidepressant. Limitations: Patients were not been diagnosed systematically during the follow-up period. Conclusions: If measured longitudinally, the rate of benzodiazepine prescription after discontinuation is much higher than reported in previous studies that have measured this cross-sectionally. Successful discontinuation is a strong predictor of modest or no future benzodiazepine prescription. Two-thirds of patients altered their benzodiazepine usage after taking part in a discontinuation programme. Treatment with antidepressants does not seem to influence benzodiazepine prescription. Patients’ request (not GPs’policy) seems to be an important factor in continuing or resuming benzodiazepine prescription.

Keywords:  Benzodiazepine prescription, Chronic use, Depression