Chronic benzodiazepine use in general practice patients with depression: an evaluation of controlled treatment and taper-off: report on behalf of the Dutch Chronic Benzodiazepine Working Group.
BACKGROUND
Many patients with depression take benzodiazepine drugs long term despite the absence of continuing therapeutic value.


OBJECTIVE
To evaluate a treatment programme involving gradual discontinuation with or without simultaneous selective serotonin reuptake inhibitor (SSRI) prescribing and to determine the long-term outcome after benzodiazepine withdrawal.


METHODS
Patients went through three phases - change to an equivalent dose of diazepam; subsequent randomisation to either 20 mg of paroxetine or placebo; and gradual reduction of diazepam in depression-free patients - with a follow-up after 2 or 3 years.


RESULTS
A total of 230 patients were recruited and 75% in the paroxetine group and 61% in the placebo group were successfully treated after 6 weeks (P:=0.067). After 2 or 3 years 13% of patients were still benzodiazepine free: 26% of those who had successfully tapered off benzodiazepine and 6% of the total group.


CONCLUSIONS
Transfer to diazepam followed by gradual withdrawal is an effective way of discontinuing chronic benzodiazepine use. The addition of SSRI treatment is of limited value.
Department of Psychiatry, BIP, PO Box 9600, 2300 RC Leiden, The Netherlands. f.g.zitman@lumc.nl
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Couvée
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy*; D003975:Diazepam / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017374:Paroxetine / Q000627:therapeutic use*; D018401:Sample Size; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control
D014151:Anti-Anxiety Agents; D018687:Antidepressive Agents, Second-Generation; D003975:Diazepam; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors