Autores UNAM:
REBECA ROBLES GARCIA; JOSE NICOLAS IVAN MARTINEZ LOPEZ; ANA FRESAN ORELLANA;

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Autores externos:

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Idioma:

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Año de publicación:
2020

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Palabras clave:

Anxiety; Benzodiazepine use; Dependence; Depression

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Resumen:

Introduction. Benzodiazepines (BZDs) are some of the most frequently prescribed psychotropic medications in the world. Under proper prescription, BZDs have sedative and antianxiety properties useful for specific purposes in the treatment of several mental conditions, such as anxiety disorders and depression. For depression, BZDs are not routinely indicated due to their lack of antidepressant effect, but their short-term use may be helpful when depression displays severe anxiety symptoms. In general, as stated in several clinical guidelines and expert consensus, it is recommended the short-term use of BZDs and a continuous clinical monitoring of their use, as the long-term use may be associated to several complications, including dependence and worsening of the underlying condition. The present study aims to contribute to the body of knowledge about BZDs use in middle-income countries, such as Mexico, where an important number of patients with anxiety disorders and depression are treated for prolonged periods with BZDs. Therefore, the objective was to compare BZD use between patients with major depression and anxiety disorders (generalized anxiety disorder and panic disorder) to determine which demographic features are related to BZD use and constitute risk factors for BZD dependence. We hypothesize that both groups will report a prolonged time of BZDs use, and more patients with anxiety disorders will exhibit BZD dependence; while being a woman, having an older age, being single, with a more prolonged use of BZDs and having an anxiety disorder will be risk factors for BZD dependence. Method. A total of 158 patients were recruited from the outpatient service at a highly specialized psychiatric facility in Mexico City. Patients were included if they were over 18 years of age and met DSMIV criteria for major depression, generalized anxiety disorder or panic disorder without any other significant comorbidity and were current BZDs users. Diagnosis of major depression and anxiety disorders (generalized anxiety disorder and panic disorder) were determined with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Also, to determine BZD dependence, an adapted version of the substance dependence section of the SCID-I designed to assess BZD use exclusively was used. Demographic features and characteristics of BZD use of each patients were obtained by a face-to-face interview with the patient. To assess the subjective experience with BZDs in the last month, the Benzodiazepine Dependence Questionnaire in its Mexican version (BDEPQ-MX) was used. For the comparison between groups chi square tests and independent samples t Tests were used while two multivariate logistic regression models with the backward conditional method were used to determine risk factors associated to BZD dependence in patients with depression and anxiety disorders. Results. From the patients included, 55.7% (n = 88) had an anxiety disorder and the remaining 44.3% (n = 70) were diagnosed with major depression. Women accounted for most patients with depression (82.9% vs. 69.3%) while patients with anxiety disorders were younger (50.4 vs. 56.1 years). Patients with anxiety disorders had an earlier onset of BZD use (39.7 vs. 46.6 years). Insomnia, as the main reason for BZD use was reported in 47.1% (n = 33) of patients with depression and only in 20.5% (n = 18) of patients with anxiety disorders. BZD dependence was more frequently observed in patients with anxiety disorders (58.0% vs. 41.4%). No differences between groups were observed in terms of the subjective experience with BZD assessed with the BDEPQ-MX. Time of consumption was over 7 years for both groups. The results of the logistic regression models showed that time of consumption was a risk factor for BZD dependence in both groups, while protective factors for BZD dependence included being a male in patients with anxiety disorders, and being younger for patients with depression Discussion. In present study, several differences between patients with major depression and anxiety disorders related to BZD use were found. Long-term use of BZDs was observed in both groups and was the main predictor for BZD dependence. Although the presence of anxious symptoms was the most frequent reason for BZD prescription, an important percentage of patients with depression use these medications for insomnia, which may expose the patients to several risks associated to BZD use. Safety and efficacy of the long-term use of BZD has been subject of controversy. Restriction in prescription may also be ineffective as BZDs may be prescribed repeatedly, resulting in long-term use. Further studies assessing safety and effectiveness, as well as efforts to encourage and train clinicians and patients to use other alternative medications and non-pharmacological interventions for symptoms where BZDs are prescribed, such as anxiety and insomnia, are necessary to develop complementary treatments without the clinical risks associated to BZDs use. Although the effectivity of BZDs has been proved, clinicians and patients should establish clear and specific goals for their use since the initial treatment plan for depression and anxiety disorders. © 2020 Nova Science Publishers, Inc. All rights reserved.

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