Strategies for Treating Benzodiazepine Dependence

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The indication for a benzodiazepine prescription should be evaluated and reevaluated.
The indication for a benzodiazepine prescription should be evaluated and reevaluated.

HealthDay News -- Effective treatment of benzodiazepine dependence includes cognitive behavioral therapy and motivational approaches, according to a study published in The New England Journal of Medicine.

Noting that benzodiazepines are relatively safe for short-term use, but that their safety has not been established beyond that period and that dependence often develops with use for more than 1 month, Michael Soyka, MD, from Ludwig Maximilian University in Munich, Germany, addresses the issues relating to benzodiazepine dependence and subsequent treatment strategies.

Dr Soyka notes that benzodiazepine prescriptions lasting 2-3 months or more and marked dose increases should be avoided, and that intervals of treatment may be advisable for some patients, especially those with sleep disorders. The indication for a prescription should be evaluated and reevaluated, while adherence to dosing, avoidance of multiple prescriptions, and timely discontinuation are essential. Clear and evidence-based standards for medication withdrawal are available for benzodiazepine-dependent patients, with good evidence for cognitive behavioral therapy and motivational approaches, and for provision of psychoeducation. 

Benzodiazepine withdrawal does not have to be attempted in every case; stabilization may be warranted before withdrawal treatment for patients without any motivation for withdrawal or with a severe depressive episode or other major mental disorder. If complete discontinuation of benzodiazepines is unlikely, reducing the dose can be a harm-reduction strategy.

"Additional studies on adequate pharmacotherapy during and after benzodiazepine withdrawal and more evidence-based strategies clearly are required," Dr Soyka wrote.

The author disclosed financial ties to the pharmaceutical industry.

Reference

Soyka M. Treatment of benzodiazepine dependence. N Engl J Med. 2017;376(12):1147-1157. doi:10.1056/NEJMra1611832

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