T A T Kurko1, L K Saastamoinen2, S Tähkäpää3, A Tuulio-Henriksson2, T Taiminen4, J Tiihonen5, M S Airaksinen3, J Hietala4. 1. Department of Psychiatry, University of Turku, Turku University Central Hospital and Turku Psychiatry, Kiinamyllynkatu 4-8 (Building 11B), 20521 Turku, Finland; Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5, 00014 Helsinki, Finland. Electronic address: terhi.a.kurko@helsinki.fi. 2. Research Department, Social Insurance Institution, Nordenskiöldinkatu 12, Helsinki, Finland. 3. Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5, 00014 Helsinki, Finland. 4. Department of Psychiatry, University of Turku, Turku University Central Hospital and Turku Psychiatry, Kiinamyllynkatu 4-8 (Building 11B), 20521 Turku, Finland. 5. Department of Clinical Neuroscience, Karolinska Institutet, Karolinska Universitetssjukhuset Solna, 17176 Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland.
Abstract
BACKGROUND: Numerous treatment guidelines recommend that long-term use of benzodiazepines (BZD) should be avoided primarily due to development of tolerance and a risk for BZD dependence. Despite this, long-term BZD use remains a controversial subject in clinical patient care with "for and against" debates. However, there is no explicit understanding of what is meant by long-term BZD use in real world. The aim of this study was to assess different definitions, usage patterns, prevalence and other characteristics of long-term BZD use based on published register-based studies. Synthesis of these characteristics is essential to derive a meaningful definition of long-term BZD. METHODS: Systematic review of register-based studies on long-term BZD use published in 1994-2014. RESULTS: Fourty-one studies met our predetermined inclusion criteria. The length of BZD use defined as "long-term" varied in these studies ranging from one month to several years. The most common definition was six months or longer during a year. The prevalence of long-term BZD use in the general population was estimated to be about 3%. The relative proportion of long-term BZD users (all definitions) in adult BZD users ranged from 6% to 76% (mean 24%; 95% CL 13-36%). The estimates were higher in studies only on the elderly (47%; 95% CL 31-64%). Long-term use involved typically steady treatment with low BZD doses. However, in elderly patients long-term BZD use and exceeding recommended doses was relatively common. Several characteristics associated with long-term use were found. CONCLUSIONS: Long-term BZD use is common and a clinical reality. Uniform definitions for "long-term", which is in line with population-based evidence, is needed to have more comparable results between studies. Our systematic review suggests that duration of BZD treatment over six months, the most common definition for long-term BZD use in the included studies. As also recommended previously, it is a useful starting point for further analyses on disadvantages but also potential advantages associated with long-term BZD use.
BACKGROUND: Numerous treatment guidelines recommend that long-term use of benzodiazepines (BZD) should be avoided primarily due to development of tolerance and a risk for BZD dependence. Despite this, long-term BZD use remains a controversial subject in clinical patient care with "for and against" debates. However, there is no explicit understanding of what is meant by long-term BZD use in real world. The aim of this study was to assess different definitions, usage patterns, prevalence and other characteristics of long-term BZD use based on published register-based studies. Synthesis of these characteristics is essential to derive a meaningful definition of long-term BZD. METHODS: Systematic review of register-based studies on long-term BZD use published in 1994-2014. RESULTS: Fourty-one studies met our predetermined inclusion criteria. The length of BZD use defined as "long-term" varied in these studies ranging from one month to several years. The most common definition was six months or longer during a year. The prevalence of long-term BZD use in the general population was estimated to be about 3%. The relative proportion of long-term BZD users (all definitions) in adult BZD users ranged from 6% to 76% (mean 24%; 95% CL 13-36%). The estimates were higher in studies only on the elderly (47%; 95% CL 31-64%). Long-term use involved typically steady treatment with low BZD doses. However, in elderly patients long-term BZD use and exceeding recommended doses was relatively common. Several characteristics associated with long-term use were found. CONCLUSIONS: Long-term BZD use is common and a clinical reality. Uniform definitions for "long-term", which is in line with population-based evidence, is needed to have more comparable results between studies. Our systematic review suggests that duration of BZD treatment over six months, the most common definition for long-term BZD use in the included studies. As also recommended previously, it is a useful starting point for further analyses on disadvantages but also potential advantages associated with long-term BZD use.
Authors: Lauren B Gerlach; Donovan T Maust; Shirley H Leong; Shahrzad Mavandadi; David W Oslin Journal: JAMA Intern Med Date: 2018-11-01 Impact factor: 21.873
Authors: Greta A Bushnell; Til Stürmer; Bradley N Gaynes; Virginia Pate; Matthew Miller Journal: JAMA Psychiatry Date: 2017-07-01 Impact factor: 21.596