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.
Zitman
F G
FG
Department of Psychiatry, BIP, PO Box 9600, 2300 RC Leiden, The Netherlands. f.g.zitman@lumc.nl
Couvée
J E
JE
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