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Weleff J, Anand A, Squeri M, Sieke R, Thompson NR, Barnett BS. An Analysis of Benzodiazepine Prescribing to Primary Care Patients in a Large Healthcare System from 2019-2020. J Psychoactive Drugs 2024; 56:245-256. [PMID: 36940298 DOI: 10.1080/02791072.2023.2191610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/04/2023] [Indexed: 03/22/2023]
Abstract
We sought to quantify benzodiazepine prescribing by primary care providers from 2019 to 2020 and identify correlates of prescribing. We hypothesized prescribing would increase post-COVID-19 lockdown. We conducted a retrospective cohort study of adult patients with primary care visits in 2019 or 2020 in a large Ohio healthcare system. Demographics, diagnosis codes, and receipt of benzodiazepine prescriptions were collected. Using multivariable logistic regression, we examined factors associated with benzodiazepine prescription receipt during the whole study period and post-lockdown. 455,537 adult patients had 1,643,473 visits. Benzodiazepines were prescribed in 3.2% (53,049/1,643,473) of visits. Effect sizes for positive associations with benzodiazepine prescription were largest for anxiety disorders. For negative associations, they were largest for Black patients and patients with cocaine use disorder. Benzodiazepine prescribing was positively associated with multiple groups having contraindications, though effect sizes were small. Contrary to our hypothesis, odds of receiving a prescription were 8.8% lower post-lockdown. Benzodiazepine prescribing rates in our system compared favorably to national rates. Year over year odds of receiving a prescription were slightly lower post-lockdown. Racial disparities were present and deserve further study. Strategies to reduce benzodiazepine prescribing to patients with anxiety may yield the largest reductions for benzodiazepine prescribing in primary care settings.
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Affiliation(s)
- Jeremy Weleff
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Akhil Anand
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- EC-10 Cleveland Clinic, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
| | - Michael Squeri
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rachel Sieke
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nicolas R Thompson
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
- Neurological Institute, Center for Outcomes Research & Evaluation, Cleveland Clinic, Cleveland, OH, USA
| | - Brian S Barnett
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- EC-10 Cleveland Clinic, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
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Latency to selective serotonin reuptake inhibitor vs benzodiazepine treatment in patients with panic disorder: a naturalistic study. CNS Spectr 2023; 28:46-52. [PMID: 34736545 DOI: 10.1017/s1092852921000869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Panic disorder (PD) is a prevalent and impairing anxiety disorder with previous reports suggesting that the longer the condition remains untreated, the greater the likelihood of nonresponse. However, patients with PD may wait for years before receiving a guideline-recommended pharmacological treatment. The widespread prescription of benzodiazepines (BDZ) for managing anxiety symptoms and disorders might delay the administration of pharmacotherapy according to guidelines (eg, selective serotonin reuptake inhibitors, SSRIs). The present study aimed to determine the mean duration of untreated illness (DUI) in a sample of PD patients, to quantify and compare DUI-SSRI to DUI-BDZ, and to compare findings with those from previous investigations. METHODS Three hundred and fourteen patients with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition diagnosis of PD were recruited from an Italian outpatient psychotherapy unit, and epidemiological and clinical variables were retrieved from medical records. Descriptive statistical analyses were undertaken for sociodemographic and clinical variables, Wilcoxon matched-pair signed rank test was applied to compare the distribution of DUI-SSRI vs DUI-BDZ, and Welch's t test was performed to compare findings with those from previous studies. RESULTS The mean DUI-SSRI of the total sample was 64.25 ± 112.74 months, while the mean DUI-BDZ was significantly shorter (35.09 ± 78.62 months; P < 0.0001). A significantly longer DUI-SSRI, compared to findings from previous studies, was also observed. CONCLUSIONS The present results confirm a substantial delay in implementing adequate pharmacological treatments in patients with PD, and highlight the discrepancy between recommendations from international treatment guidelines and common clinical practice in relation to BDZ prescription.
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Del Favero E, Montemagni C, Bozzatello P, Brasso C, Riccardi C, Rocca P. The Management of Prodromal Symptoms of Bipolar Disorder: Available Options and Future Perspectives. ACTA ACUST UNITED AC 2021; 57:medicina57060545. [PMID: 34071356 PMCID: PMC8229021 DOI: 10.3390/medicina57060545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022]
Abstract
The onset of prodromal symptoms in subjects who are at familial or clinical risk for bipolar disorder could be considered as an important alarm bell for the development of the disease and should be carefully detected. The management of prodromes in bipolar high-risk patients appears to be an important means of prevention; nevertheless, at the moment, there aren’t clear and widely shared treatment indications. The aim of this review is to summarize the available treatment options (pharmacological, psychosocial and nutraceutical) for the management of prodromal symptoms in subjects who are at familial or clinical risk for bipolar disorder.
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Affiliation(s)
- Elisa Del Favero
- Dipartimento di Neuroscienze “Rita Levi Montalcini”, Università degli Studi di Torino, Via Cherasco 11, 10126 Turin, Italy; (E.D.F.); (P.B.); (C.B.); (C.R.)
| | - Cristiana Montemagni
- Dipartimento di Neuroscienze e Salute Mentale, A.O.U. Città Della Salute e Della Scienza, via Cherasco 11, 10126 Turin, Italy;
| | - Paola Bozzatello
- Dipartimento di Neuroscienze “Rita Levi Montalcini”, Università degli Studi di Torino, Via Cherasco 11, 10126 Turin, Italy; (E.D.F.); (P.B.); (C.B.); (C.R.)
| | - Claudio Brasso
- Dipartimento di Neuroscienze “Rita Levi Montalcini”, Università degli Studi di Torino, Via Cherasco 11, 10126 Turin, Italy; (E.D.F.); (P.B.); (C.B.); (C.R.)
| | - Cecilia Riccardi
- Dipartimento di Neuroscienze “Rita Levi Montalcini”, Università degli Studi di Torino, Via Cherasco 11, 10126 Turin, Italy; (E.D.F.); (P.B.); (C.B.); (C.R.)
| | - Paola Rocca
- Dipartimento di Neuroscienze “Rita Levi Montalcini”, Università degli Studi di Torino, Via Cherasco 11, 10126 Turin, Italy; (E.D.F.); (P.B.); (C.B.); (C.R.)
- Dipartimento di Neuroscienze e Salute Mentale, A.O.U. Città Della Salute e Della Scienza, via Cherasco 11, 10126 Turin, Italy;
- Correspondence:
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Maltsev DV, Spasov AA, Yakovlev DS, Vassiliev PM, Skripka MO, Miroshnikov MV, Sultanova KT, Kochetkov AN, Divaeva LN, Kuzmenko TA, Morkovnik AS. Searching for new anxiolytic agents among derivatives of 11-dialkylaminoethyl-2,3,4,5-tetrahydrodiazepino[1,2-a]benzimidazole. Eur J Pharm Sci 2021; 161:105792. [PMID: 33705965 DOI: 10.1016/j.ejps.2021.105792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/27/2021] [Accepted: 03/03/2021] [Indexed: 12/14/2022]
Abstract
A study on the anxiolytic activity of the new derivatives of 11-dialkylaminoethyl-2,3,4,5-tetrahydrodiazepino[1,2-a]benzimidazole, containing privileged scaffolds of benzodiazepine and benzimidazole in their structure, was conducted. The cytotoxic properties of low levels of six compounds were preliminary determined in vitro using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide test. The screening of these substances for anxiolytic activity was conducted using elevated plus maze (EPM) test in vivo, and DAB-21 was found to be the most active compound. The acute toxicity of DAB-21 was determined as less toxic than that of diazepam. The dose-dependent effect of the most active compound revealed a minimum dose of 1.26 mg/kg, which resulted in the maximum counterphobic effect. The effect of DAB-21 was superior in a number of tests compared with that of diazepam, which indicated a high level of tranquilizing activity for DAB-21. The results of in silico docking analysis suggest that DAB-21 should have a slightly lower anxiolytic activity than diazepam, but should exhibit greater specific affinity for the benzodiazepine site of the GABAA receptor, in comparison with its GABA-binding site. The interaction between DAB-21 and flumazenil in terms of EPM verifies the GABAergic mechanism of action of DAB-21. Our results highlight the potential of 11-dialkylaminomethyl-2,3,4,5-tetrahydrodiazepino[1,2-a]benzimidazoles as promising compounds in the search for new highly effective anxiolytics.
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Affiliation(s)
- Dmitriy V Maltsev
- Volgograd State Medical University, Department of Pharmacology and Bioinformatics; 1 Pavshikh Bortsov sq., Volgograd, Russia; Volgograd Medical Research Center; 1 Pavshikh Bortsov sq., Volgograd, Russia.
| | - Alexander A Spasov
- Volgograd State Medical University, Department of Pharmacology and Bioinformatics; 1 Pavshikh Bortsov sq., Volgograd, Russia; Volgograd Medical Research Center; 1 Pavshikh Bortsov sq., Volgograd, Russia
| | - Dmitriy S Yakovlev
- Volgograd State Medical University, Department of Pharmacology and Bioinformatics; 1 Pavshikh Bortsov sq., Volgograd, Russia; Volgograd Medical Research Center; 1 Pavshikh Bortsov sq., Volgograd, Russia
| | - Pavel M Vassiliev
- Volgograd State Medical University, Department of Pharmacology and Bioinformatics; 1 Pavshikh Bortsov sq., Volgograd, Russia
| | - Maria O Skripka
- Volgograd State Medical University, Department of Pharmacology and Bioinformatics; 1 Pavshikh Bortsov sq., Volgograd, Russia
| | - Mikhail V Miroshnikov
- Volgograd State Medical University, Department of Pharmacology and Bioinformatics; 1 Pavshikh Bortsov sq., Volgograd, Russia
| | - Kira T Sultanova
- Volgograd State Medical University, Department of Pharmacology and Bioinformatics; 1 Pavshikh Bortsov sq., Volgograd, Russia; Volgograd Medical Research Center; 1 Pavshikh Bortsov sq., Volgograd, Russia
| | - Andrey N Kochetkov
- Volgograd State Medical University, Department of Pharmacology and Bioinformatics; 1 Pavshikh Bortsov sq., Volgograd, Russia
| | - Lyudmila N Divaeva
- Southern Federal University, Research Institute of Physical and Organic Chemistry; 105/42 Bolshaya Sadovaya str., Rostov-on-Don, Russia
| | - Tatyana A Kuzmenko
- Southern Federal University, Research Institute of Physical and Organic Chemistry; 105/42 Bolshaya Sadovaya str., Rostov-on-Don, Russia
| | - Anatolii S Morkovnik
- Southern Federal University, Research Institute of Physical and Organic Chemistry; 105/42 Bolshaya Sadovaya str., Rostov-on-Don, Russia
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