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Kurvits K, Toompere K, Jaanson P, Uusküla A. The COVID-19 pandemic and the use of benzodiazepines and benzodiazepine-related drugs in Estonia: an interrupted time-series analysis. Child Adolesc Psychiatry Ment Health 2024; 18:66. [PMID: 38845001 PMCID: PMC11157874 DOI: 10.1186/s13034-024-00757-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 05/24/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has posed challenges that worsened people's mental health. We explored the impact of the COVID-19 pandemic on the mental well-being of the population, as indicated by the prevalence rates of benzodiazepine and benzodiazepine-related drug (BDZ) use. METHODS This population-based, time-series analysis included all prescriptions of BDZs dispensed in Estonia between 2012 and 2021. The monthly prevalence rates of BDZ use were calculated. Autoregressive integrated moving average models with pulse and slope intervention functions tested for temporary and long-term changes in monthly prevalence rates after the onset of the COVID-19 pandemic. RESULTS Throughout the 10-year study period, a total of 5,528,911 BDZ prescriptions were dispensed to 397,436 individuals. A significant temporary increase in the overall prevalence rate of BDZ use in March 2020 (2.698 users per 1000, 95% CI 1.408-3.988) was observed, but there was no statistically significant long-term change. This temporary increase affected all the examined subgroups, except for new users, individuals aged 15-29 years, and prescribing specialists other than general practitioners and psychiatrists. The long-term increase in BDZ use was confined to females aged 15-29 years (0.056 users per 1000 per month, 95% CI 0.033-0.079), while no significant change was observed among males of the same age (0.009 users per 1000 per month, 95% CI - 0.017 to 0.035). Among females aged 15-29 years, a significant long-term increase in BDZ use was observed for anxiety disorders (0.017 users per 1000 per month, 95% CI 0.010-0.023), depressive disorders (0.021 users per 1000 per month, 95% CI 0.012-0.030), and other mental and behavioral disorders (0.020 users per 1000 per month, 95% CI 0.010-0.030), but not for sleep disorders (- 0.008 users per 1000 per month, 95% CI - 0.018-0.002). CONCLUSION The COVID-19 pandemic led to a short-term increase in BDZ use immediately after the pandemic was declared. In the long term, young females experienced a sustained increase in BDZ use. The prolonged effect on girls and young women suggests their greater vulnerability. These results underscore the need to effectively address the long-term effects of the pandemic among youth.
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Affiliation(s)
- Katrin Kurvits
- Institute of Family Medicine and Public Health, University of Tartu, 19 Ravila Street, 50411, Tartu, Estonia.
- State Agency of Medicines, Tartu, Estonia.
| | - Karolin Toompere
- Institute of Family Medicine and Public Health, University of Tartu, 19 Ravila Street, 50411, Tartu, Estonia
| | | | - Anneli Uusküla
- Institute of Family Medicine and Public Health, University of Tartu, 19 Ravila Street, 50411, Tartu, Estonia
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Curry G, Cheung T, Zhang SD, Logue S, McAnena L, Price R, Sittlington JJ. Repeated electrical vestibular nerve stimulation (VeNS) reduces severity in moderate to severe insomnia; a randomized, sham-controlled trial; The Modius Sleep Study. Brain Stimul 2024:S1935-861X(24)00092-5. [PMID: 38797370 DOI: 10.1016/j.brs.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/26/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Insomnia is a prevalent health concern in the general population associated with a range of adverse health effects. New, effective, safe and low-cost treatments, suitable for long-term use, are urgently required. Previous studies have shown the potential of electrical vestibular nerve stimulation (VeNS) in improving insomnia symptoms, however only one sham-controlled trial has been conducted on people with chronic insomnia. OBJECTIVES /Hypothesis: Repeated VeNS delivered by the Modius Sleep device prior to sleep onset will show superior improvement in Insomnia Severity Index (ISI) scores over a 4-week period compared to sham stimulation. METHODS In this double-blinded, multi-site, randomised, sham-controlled study, 147 participants with moderate to severe insomnia (ISI≥15) were recruited and allocated a VeNS or a sham device (1:1 ratio) which they were asked to use at home for 30 minutes daily (minimum 5 days per week) for 4 weeks. RESULTS After 4 weeks, mean ISI score reduction was 2.26 greater in the VeNS treatment group than the sham group (p=0.002). In the per protocol analysis, the treatment group had a mean ISI score decrease of 5.8 (95% CI [-6.8, -4.81], approaching the clinically meaningful threshold of a 6-point reduction, with over half achieving a clinically significant decrease. Furthermore, the treatment group showed superior improvement to the sham group in the SF-36 (Quality of Life) energy/fatigue component (PP p=0.004, effect size 0.26; ITT p=0.006, effect size 0.22). CONCLUSIONS Modius sleep has the potential to provide a viable, non-invasive and safe clinically meaningful alternative treatment option for insomnia.
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Affiliation(s)
- Grace Curry
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
| | - Teris Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China; The Mental Health Research Centre, The Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Shu-Dong Zhang
- School of Medicine, Ulster University, Londonderry, BT48 7JL, United Kingdom.
| | - Susan Logue
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
| | - Liadhan McAnena
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
| | - Ruth Price
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
| | - Julie J Sittlington
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
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Van Ngoc P, Ceuterick M, Belche JL, Scholtes B. Professionals' treatment goals for long-term benzodiazepine and Z-drugs management: a qualitative study. BJGP Open 2024; 8:BJGPO.2023.0034. [PMID: 37726172 PMCID: PMC11169967 DOI: 10.3399/bjgpo.2023.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/12/2023] [Accepted: 08/11/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Benzodiazepines and Z-drugs (BZD/Z) are frequently prescribed for longer than recommended. Through their interactions with patients taking BZD/Z, primary care and mental health professionals play a key role in the management of this medication. AIM To explore how primary care and mental health care professionals set treatment goals with users of long-term BZD/Z. DESIGN & SETTING A qualitative study using semi-structured interviews with professionals from mental health, addiction care, and primary care practices in Belgium. METHOD Semi-structured interviews were conducted, online and in person, with 24 professionals working in mental health and primary care. Inductive thematic content analysis was performed. RESULTS Seven themes were identified from the analysis. Professionals tended not to use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) standard to diagnose a BZD/Z substance use disorder. They described criteria based on their experience. They identified diverse types of patients that influence their choice of treatment goals. Professionals appeared to position themselves according to their own treatment goals for their patients, either by promoting the goal of abstinence or harm reduction. Some of them reported feeling trapped into continuing to prescribe and considered BZD/Z withdrawal to be difficult. Some were afraid to engage in a conversation that might break the bond of trust with the patient. Few professionals mentioned patient participation in the treatment goal setting. They asked for targeted withdrawal recommendations, perceiving the current recommendations to be too broad. CONCLUSION Whether primary care or mental health care professionals are more in favour of a total abstinence or a harm reduction approach to BZD/Z, professionals should be guided towards greater patient participation in setting and evaluating goals with patients taking BZD/Z.
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Affiliation(s)
- Pauline Van Ngoc
- Research Unit of Primary Care and Health, Department of General Medicine, University of Liège, Liège, Belgium
| | | | - Jean-Luc Belche
- Research Unit of Primary Care and Health, Department of General Medicine, University of Liège, Liège, Belgium
| | - Beatrice Scholtes
- Research Unit of Primary Care and Health, Department of General Medicine, University of Liège, Liège, Belgium
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Tachibana M, Kanahara N, Oda Y, Hasegawa T, Kimura A, Iyo M. A retrospective clinical practice study comparing the usefulness of dual-orexin receptor antagonists and a melatonin receptor agonist in patients switching from long-term benzodiazepine receptor agonists. J Clin Sleep Med 2024; 20:603-613. [PMID: 38063235 PMCID: PMC10985311 DOI: 10.5664/jcsm.10946] [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: 05/31/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 04/04/2024]
Abstract
STUDY OBJECTIVES Although novel hypnotics have recently emerged, there are currently no data comparing the clinical potency of benzodiazepine receptor agonists (BZRAs) and novel hypnotics, or the effectiveness of different methods of switching between them. This study examined how novel hypnotics might help reduce BZRA use in real-world practice. METHODS 289 patients with psychiatric disorders who took BZRAs for over 1 year before switching to either of 2 dual-orexin receptor antagonists (DORAs; suvorexant [SUV] or lemborexant [LEM]) or a melatonin receptor agonist (ramelteon [RMT]) were enrolled. We collected data on BZRAs at baseline and 3 months after commencement of SUV/LEM/RMT. RESULTS Significant reductions in BZRAs were observed for all 3 agents: -4.10, -2.80, and -1.65 mg in diazepam-equivalent doses in the SUV, LEM, and RMT groups, respectively. Dose reduction was significantly greater in the DORA than the RMT group (F = 15.053, P < .001). Within the DORA group, dose reduction was significantly greater in patients taking SUV than those taking LEM (F = 4.337, P = .043). The switching success rate did not differ among the switching methods for any of the hypnotics. CONCLUSIONS The reduction rate of BZRAs achieved by the switch fell into their equivalent-potency range estimated from clinical trials. The results suggest that DORAs can replace approximately 1 tablet of a BZRA. The difference in dose reduction between DORAs and RMT reflected the greater sleeping potency of the DORAs, whereas that between SUV and LEM might have reflected patient backgrounds: patients taking LEM may have been more strongly dependent on BZRAs. CITATION Tachibana M, Kanahara N, Oda Y, Hasegawa T, Kimura A, Iyo M. A retrospective clinical practice study comparing the usefulness of dual-orexin receptor antagonists and a melatonin receptor agonist in patients switching from long-term benzodiazepine receptor agonists. J Clin Sleep Med. 2024;20(4):603-613.
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Affiliation(s)
- Masumi Tachibana
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
- Safety and Health Organization, Chiba University, Chiba, Japan
| | - Nobuhisa Kanahara
- Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Yasunori Oda
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tadashi Hasegawa
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
- Chiba University Hospital Palliative Care Center, Chiba, Japan
| | - Atsushi Kimura
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
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Griffeuille P, El Balkhi S, Dulaurent S, Saint-Marcoux F. Probe Electrospray Ionization Tandem Mass Spectrometry for the Detection and Quantification of Benzodiazepines. Ther Drug Monit 2024:00007691-990000000-00198. [PMID: 38498915 DOI: 10.1097/ftd.0000000000001189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/26/2023] [Indexed: 03/20/2024]
Abstract
BACKGROUND Legally prescribed benzodiazepines (BZDs) and designer BZDs are widely misused and must be determined in multiple contexts (eg, overdose, drug-facilitated sexual assaults, or driving under the influence of drugs). This study aimed to develop a method for measuring serum BZD levels using probe electrospray ionization (PESI) mass spectrometry and an isotope dilution approach. METHODS A tandem mass spectrometer equipped with a probe electrospray ionization source in multiple reaction monitoring mode was used. Isotope dilution was applied for quantification using a deuterated internal standard at a fixed concentration for alprazolam, bromazepam, diazepam, nordiazepam, oxazepam, temazepam, zolpidem, and zopiclone. This method included designer BZDs: clonazolam, deschloroetizolam, diclazepam, etizolam, flualprazolam, flubromazepam, flubromazolam, meclonazepam, nifoxipam, and pyrazolam. Sample preparation was done by mixing 10 µL of serum with 500 µL of an ethanol/ammonium formate 0.01 mol/L buffer. Complete validation was performed, and the method was compared with liquid chromatography coupled with mass spectrometry (LC-MS/MS) and immunoassays (IC) by analyzing 40 real samples. RESULTS The analysis time for identification and quantification of the 18 molecules was 2.5 minutes. This method was fully validated, and the limits of quantification varied from 5 to 50 mcg/L depending on the molecule. In the 40 real samples, 100% of molecules (n = 89) were detected by both LC-MS/MS and PESI-MS/MS, and regression analysis showed excellent agreement between the 2 methods (r2 = 0.98). On IC, bromazepam and zolpidem were not detected in 2 and 1 cases, respectively. CONCLUSIONS PESI-MS/MS allows serum BZD detection and measurement. Given the isotope dilution approach, a calibration curve was not required, and its performance was similar to that of LC-MS/MS, and its specificity was higher than that of IC.
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Affiliation(s)
- Pauline Griffeuille
- Department of Pharmacology and Toxicology, Limoges University Hospital, Limoges,France; and
| | - Souleiman El Balkhi
- Department of Pharmacology and Toxicology, Limoges University Hospital, Limoges,France; and
| | - Sylvain Dulaurent
- Department of Pharmacology and Toxicology, Limoges University Hospital, Limoges,France; and
| | - Franck Saint-Marcoux
- Department of Pharmacology and Toxicology, Limoges University Hospital, Limoges,France; and
- Department of Toxicology, Faculty of Pharmacy, University of Limoges, Limoges, France
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Rosenqvist TW, Wium-Andersen MK, Wium-Andersen IK, Jørgensen MB, Osler M. Long-Term Use of Benzodiazepines and Benzodiazepine-Related Drugs: A Register-Based Danish Cohort Study on Determinants and Risk of Dose Escalation. Am J Psychiatry 2024; 181:246-254. [PMID: 37727098 DOI: 10.1176/appi.ajp.20230075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
OBJECTIVE The authors investigated the frequency and determinants of long-term use and risk of dose escalation of benzodiazepines and benzodiazepine-related drugs (benzodiazepine receptor agonists, or BZRAs). METHODS All adults ages 20-80 years living in Denmark on January 1, 2000 (N=4,297,045) were followed for redeemed prescriptions of BZRAs in the Danish National Prescription Registry from January 1, 2000, to December 31, 2020. For each drug class, we calculated long-term use for more than 1 or 7 years, and dose escalation measured as increase in dose to a level above the recommended level. Associations were examined using logistic regression. RESULTS The authors identified 950,767 incident BZRA users, of whom 15% and 3% became long-term users for more than 1 or 7 years, respectively. These percentages were highest for individuals who initiated Z-drugs (17.8% and 4%). Among the 5% of BZRA users who had at least 3 years of continuous use, there was no indication of dose escalation, as the median dose remained relatively stable. However, 7% (N=3,545) of BZRA users escalated to doses above the recommended level. Psychiatric comorbidity, especially substance use disorder, was associated with higher risk of long-term use and dose escalation. CONCLUSIONS A limited portion of the population that received BZRA prescriptions were classified as continuous users, and only a small proportion of this group escalated to doses higher than those recommended in clinical guidelines. Thus, this study does not, under the current regulations, support the belief that BZRA use frequently results in long-term use or dose escalation.
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Affiliation(s)
- Thomas Wolff Rosenqvist
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark (Rosenqvist, M.K. Wium-Andersen, I.K. Wium-Andersen, Osler); Psychiatric Center Copenhagen, Dept. O, Frederiksberg Hospital, Frederiksberg, Denmark (I.K. Wium-Andersen, Jørgensen); Section of Epidemiology, Department of Public Health (Osler), and Department of Clinical Medicine (Jørgensen), University of Copenhagen, Copenhagen
| | - Marie Kim Wium-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark (Rosenqvist, M.K. Wium-Andersen, I.K. Wium-Andersen, Osler); Psychiatric Center Copenhagen, Dept. O, Frederiksberg Hospital, Frederiksberg, Denmark (I.K. Wium-Andersen, Jørgensen); Section of Epidemiology, Department of Public Health (Osler), and Department of Clinical Medicine (Jørgensen), University of Copenhagen, Copenhagen
| | - Ida Kim Wium-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark (Rosenqvist, M.K. Wium-Andersen, I.K. Wium-Andersen, Osler); Psychiatric Center Copenhagen, Dept. O, Frederiksberg Hospital, Frederiksberg, Denmark (I.K. Wium-Andersen, Jørgensen); Section of Epidemiology, Department of Public Health (Osler), and Department of Clinical Medicine (Jørgensen), University of Copenhagen, Copenhagen
| | - Martin Balslev Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark (Rosenqvist, M.K. Wium-Andersen, I.K. Wium-Andersen, Osler); Psychiatric Center Copenhagen, Dept. O, Frederiksberg Hospital, Frederiksberg, Denmark (I.K. Wium-Andersen, Jørgensen); Section of Epidemiology, Department of Public Health (Osler), and Department of Clinical Medicine (Jørgensen), University of Copenhagen, Copenhagen
| | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark (Rosenqvist, M.K. Wium-Andersen, I.K. Wium-Andersen, Osler); Psychiatric Center Copenhagen, Dept. O, Frederiksberg Hospital, Frederiksberg, Denmark (I.K. Wium-Andersen, Jørgensen); Section of Epidemiology, Department of Public Health (Osler), and Department of Clinical Medicine (Jørgensen), University of Copenhagen, Copenhagen
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Ali DN, Ali HM, Lopez MR, Kang S, Choi DS. Astrocytic GABAergic Regulation in Alcohol Use and Major Depressive Disorders. Cells 2024; 13:318. [PMID: 38391931 PMCID: PMC10887002 DOI: 10.3390/cells13040318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/26/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
Gamma-aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the central nervous system (CNS). Most GABAergic neurons synthesize GABA from glutamate and release it in the synaptic cleft in the CNS. However, astrocytes can also synthesize and release GABA, activating GABA receptors in the neighboring neurons in physiological and pathological conditions. As the primary homeostatic glial cells in the brain, astrocytes play a crucial role in regulating GABA homeostasis and synaptic neurotransmission. Accumulating evidence demonstrates that astrocytic GABA dysregulation is implicated in psychiatric disorders, including alcohol use disorder (AUD) and major depressive disorder (MDD), the most prevalent co-occurring psychiatric disorders. Several current medications and emerging pharmacological agents targeting GABA levels are in clinical trials for treating AUD and MDD. This review offers a concise summary of the role of astrocytic GABA regulation in AUD and MDD. We also provide an overview of the current understanding and areas of debate regarding the mechanisms by which astrocytes regulate GABA in the CNS and their potential significance in the molecular basis of AUD and MDD, paving the way toward future research directions and potential therapeutic target areas within this field.
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Affiliation(s)
- Dina N. Ali
- Department of Molecular Pharmacology and Experimental Therapeutics, Rochester, MN 55905, USA; (D.N.A.); (H.M.A.); (M.R.L.); (S.K.)
| | - Hossam M. Ali
- Department of Molecular Pharmacology and Experimental Therapeutics, Rochester, MN 55905, USA; (D.N.A.); (H.M.A.); (M.R.L.); (S.K.)
| | - Matthew R. Lopez
- Department of Molecular Pharmacology and Experimental Therapeutics, Rochester, MN 55905, USA; (D.N.A.); (H.M.A.); (M.R.L.); (S.K.)
| | - Shinwoo Kang
- Department of Molecular Pharmacology and Experimental Therapeutics, Rochester, MN 55905, USA; (D.N.A.); (H.M.A.); (M.R.L.); (S.K.)
| | - Doo-Sup Choi
- Department of Molecular Pharmacology and Experimental Therapeutics, Rochester, MN 55905, USA; (D.N.A.); (H.M.A.); (M.R.L.); (S.K.)
- Neuroscience Program, Rochester, MN 55905, USA
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
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Zamboni L, Portoghese I, Casari R, Fusina F, Santin L, Lecca LI, Campagnari S, Carli S, Zandonai T, Lugoboni F. High-dose benzodiazepine use and QTc interval prolongation, a latent class analysis study. Sci Rep 2024; 14:155. [PMID: 38168538 PMCID: PMC10762262 DOI: 10.1038/s41598-023-50489-3] [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: 07/13/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
Benzodiazepine (BDZ) addiction is a widespread and multifaceted phenomenon. For many patients, especially females, the concomitant use of other drugs also increases their risk of QTc prolongation, possibly leading to complications such as seizures and even sudden death. However, the relationship between BDZ use and QTc prolongation is currently unclear. The present study aims to examine patterns of polysubstance use among a sample of Italian adults with BDZ dependence in relation with their QTc prolongation risk. We used Latent Class Analysis (LCA) on data collected from 251 inpatients of the Addiction Medicine Unit in Verona to group patients into three classes according to their substance use and their QTc prolongation risk. Results showed no significant relationship between QTc prolongation and BDZ use in any of the classes considered. We conclude that BDZs, even if used long-term and at high dosages, can be considered safe in terms of cardiovascular complications for patients.
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Affiliation(s)
- Lorenzo Zamboni
- Unit of Addiction Medicine, Department of Internal Medicine, G.B. Rossi Hospital, Verona, Italy.
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy.
| | - Igor Portoghese
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi di Cagliari, Cagliari , Italy
| | - Rebecca Casari
- Unit of Addiction Medicine, Department of Internal Medicine, G.B. Rossi Hospital, Verona, Italy
| | - Francesca Fusina
- Department of General Psychology, University of Padova, Padua, Italy
| | - Laura Santin
- Unit of Addiction Medicine, Department of Internal Medicine, G.B. Rossi Hospital, Verona, Italy
| | - Luigi Isaia Lecca
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi di Cagliari, Cagliari , Italy
| | - Simone Campagnari
- Unit of Addiction Medicine, Department of Internal Medicine, G.B. Rossi Hospital, Verona, Italy
| | - Silvia Carli
- Unit of Addiction Medicine, Department of Internal Medicine, G.B. Rossi Hospital, Verona, Italy
| | - Thomas Zandonai
- Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University of Elche, Elche, Spain
- Addiction Science Lab at the Department of Psychology and Cognitive Science , University of Trento, Trento, Italy
| | - Fabio Lugoboni
- Unit of Addiction Medicine, Department of Internal Medicine, G.B. Rossi Hospital, Verona, Italy
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Rodrigues-Ribeiro L, Resende BL, Pinto Dias ML, Lopes MR, de Barros LLM, Moraes MA, Verano-Braga T, Souza BR. Neuroproteomics: Unveiling the Molecular Insights of Psychiatric Disorders with a Focus on Anxiety Disorder and Depression. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1443:103-128. [PMID: 38409418 DOI: 10.1007/978-3-031-50624-6_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Anxiety and depression are two of the most common mental disorders worldwide, with a lifetime prevalence of up to 30%. These disorders are complex and have a variety of overlapping factors, including genetic, environmental, and behavioral factors. Current pharmacological treatments for anxiety and depression are not perfect. Many patients do not respond to treatment, and those who do often experience side effects. Animal models are crucial for understanding the complex pathophysiology of both disorders. These models have been used to identify potential targets for new treatments, and they have also been used to study the effects of environmental factors on these disorders. Recent proteomic methods and technologies are providing new insights into the molecular mechanisms of anxiety disorder and depression. These methods have been used to identify proteins that are altered in these disorders, and they have also been used to study the effects of pharmacological treatments on protein expression. Together, behavioral and proteomic research will help elucidate the factors involved in anxiety disorder and depression. This knowledge will improve preventive strategies and lead to the development of novel treatments.
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Affiliation(s)
- Lucas Rodrigues-Ribeiro
- Department of Physiology and Biophysics, National Institute of Science and Technology in Nanobiopharmaceutics (INCT-Nanobiofar), Federal University of Minas Gerais, Belo Horizonte, Brazil
- Department of Physiology and Biophysics, Proteomics Group (NPF), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Bruna Lopes Resende
- Department of Physiology and Biophysics, Laboratory of Neurodevelopment and Evolution (NeuroDEv), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Maria Luiza Pinto Dias
- Department of Physiology and Biophysics, National Institute of Science and Technology in Nanobiopharmaceutics (INCT-Nanobiofar), Federal University of Minas Gerais, Belo Horizonte, Brazil
- Department of Physiology and Biophysics, Proteomics Group (NPF), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Megan Rodrigues Lopes
- Department of Physiology and Biophysics, National Institute of Science and Technology in Nanobiopharmaceutics (INCT-Nanobiofar), Federal University of Minas Gerais, Belo Horizonte, Brazil
- Department of Physiology and Biophysics, Proteomics Group (NPF), Federal University of Minas Gerais, Belo Horizonte, Brazil
- Department of Physiology and Biophysics, Laboratory of Neurodevelopment and Evolution (NeuroDEv), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Larissa Luppi Monteiro de Barros
- Department of Physiology and Biophysics, National Institute of Science and Technology in Nanobiopharmaceutics (INCT-Nanobiofar), Federal University of Minas Gerais, Belo Horizonte, Brazil
- Department of Physiology and Biophysics, Proteomics Group (NPF), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Muiara Aparecida Moraes
- Department of Physiology and Biophysics, Laboratory of Neurodevelopment and Evolution (NeuroDEv), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Thiago Verano-Braga
- Department of Physiology and Biophysics, National Institute of Science and Technology in Nanobiopharmaceutics (INCT-Nanobiofar), Federal University of Minas Gerais, Belo Horizonte, Brazil.
- Department of Physiology and Biophysics, Proteomics Group (NPF), Federal University of Minas Gerais, Belo Horizonte, Brazil.
| | - Bruno Rezende Souza
- Department of Physiology and Biophysics, Laboratory of Neurodevelopment and Evolution (NeuroDEv), Federal University of Minas Gerais, Belo Horizonte, Brazil.
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Grimmsmann T, Himmel W. [Private Prescriptions In East And West Germany - A Secondary Data Analysis]. DAS GESUNDHEITSWESEN 2023; 85:1213-1219. [PMID: 38081175 PMCID: PMC10713339 DOI: 10.1055/a-2160-2679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Benzodiazepines and Z-drugs are prescribed to a considerable extent as private prescription also for persons insured by a statutory health insurance (SHI), with formerly large differences between East and West Germany. The aim of the present study was to investigate whether these differences still exist today. METHOD This secondary data analysis used anonymized prescription data from general practitioners (GPs), community neurologists, and psychiatrists. SHI-insured patients with at least one prescription for a benzodiazepine or Z-substance between 2014 and 2020 were included. Differences between East and West Germany in the proportion of private prescriptions were the central outcome. Multiple regression analyses were performed to test whether the factors region (eastern vs. western Germany) and specialist group (GPs vs. neurologists/psychiatrists) were statistically significant predictors of the proportion of private prescriptions - taking into account the age and gender composition of patients in a practice. RESULTS From 867 practices, 2,200,446 prescriptions for Z-substances, benzodiazepine anxiolytics, and benzodiazepine hypnotics/sedatives were evaluated. More than 38% of these prescriptions were issued as private prescriptions: 53.6% in eastern Germany and 34.8% in western Germany. For Z-substances, the proportion of private prescriptions was particularly high (70.7% in eastern and 43.0% in western Germany). GPs issued private prescriptions far more frequently than neurologists and psychiatrists. The proportion of private prescriptions increased during the study period, comparatively strongly in the western states (from 33% to 39%) and slightly in the eastern states (from 53% to 54%). In the multivariate model, practice area (east/west) and specialist group were similarly strong predictors of the extent of private prescriptions, especially for Z-substances. CONCLUSION Contrary to a general alignment in life expectancy, morbidity risks, and health behaviour in East and West Germany, there is, despite convergence, still a significant difference in the proportion of private prescriptions for benzodiazepines and especially for Z-substances between the two regions. The groups of physicians who mainly prescribe these substances, namely neurologists and psychiatrists, on the one hand, and GPs, on the other, also differ considerably in the proportion of their private prescriptions for these substances.
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Affiliation(s)
- Thomas Grimmsmann
- Referat Arzneimittel und Methoden, Medizinischer Dienst
Mecklenburg-Vorpommern, Schwerin, Deutschland
| | - Wolfgang Himmel
- Institut für Allgemeinmedizin, Universitätsmedizin
Göttingen, Gottingen, Deutschland
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11
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Berry K, Matheson C, Schofield J, Dumbrell J, Parkes T, Hill D, Kilonzo M, MacLennan G, Stewart D, Ritchie T, Turner M. Development of an intervention to manage benzodiazepine dependence and high-risk use in the context of escalating drug related deaths in Scotland: an application of the MRC framework. BMC Health Serv Res 2023; 23:1205. [PMID: 37925423 PMCID: PMC10625279 DOI: 10.1186/s12913-023-10201-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Scotland has the highest rate of drug related deaths (DRD) in Europe. These are deaths in people who use drugs such as heroin, cocaine, benzodiazepines and gabapentinoids. It is a feature of deaths in Scotland that people use combinations of drugs which increases the chance of a DRD. Many deaths involve 'street' benzodiazepines, especially a drug called etizolam. Many of the 'street' benzodiazepines are not licensed in the UK so come from illegal sources. People who use opiates can be prescribed a safer replacement medication (e.g., methadone). While guidance on management of benzodiazepines use highlights that there is little evidence to support replacement prescribing, practice and evidence are emerging. AIM To develop an intervention to address 'street' benzodiazepines use in people who also use opiates. METHODS The MRC Framework for Complex Interventions was used to inform research design. Co-production of the intervention was achieved through three online workshops with clinicians, academics working in the area of substance use, and people with lived experience (PWLE). Each workshop was followed by a PWLE group meeting. Outputs from workshops were discussed and refined by the PWLE group and then further explored at the next workshop. RESULTS After these six sessions, a finalised logic model for the intervention was successfully achieved that was acceptable to clinicians and PWLE. Key components of the intervention were: prescribing of diazepam; anxiety management, sleep, and pain; and harm reduction resources (locked box and a range of tips), personal safety conversations, as well as a virtual learning environment. CONCLUSION A co-produced intervention was developed for next stage clinical feasibility testing.
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Grants
- HIPS/20/09 Chief Scientist Office, Scottish Government Health and Social Care Directorate
- HIPS/20/09 Chief Scientist Office, Scottish Government Health and Social Care Directorate
- HIPS/20/09 Chief Scientist Office, Scottish Government Health and Social Care Directorate
- HIPS/20/09 Chief Scientist Office, Scottish Government Health and Social Care Directorate
- HIPS/20/09 Chief Scientist Office, Scottish Government Health and Social Care Directorate
- HIPS/20/09 Chief Scientist Office, Scottish Government Health and Social Care Directorate
- HIPS/20/09 Chief Scientist Office, Scottish Government Health and Social Care Directorate
- HIPS/20/09 Chief Scientist Office, Scottish Government Health and Social Care Directorate
- HIPS/20/09 Chief Scientist Office, Scottish Government Health and Social Care Directorate
- HIPS/20/09 Chief Scientist Office, Scottish Government Health and Social Care Directorate
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12
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McCabe SE, Schulenberg JE, Wilens TE, Schepis TS, McCabe VV, Veliz P. Transitions in Prescription Benzodiazepine Use and Misuse and in Substance Use Disorder Symptoms Through Age 50. Psychiatr Serv 2023; 74:1154-1162. [PMID: 37143335 PMCID: PMC10867819 DOI: 10.1176/appi.ps.20220247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Prescription benzodiazepines are among the most commonly used and misused controlled medications. The authors aimed to examine transitions from medical use of prescription benzodiazepines to prescription benzodiazepine misuse, prescription opioid misuse, and substance use disorder symptoms during adulthood. METHODS Eleven national cohorts of U.S. 12th graders (N=26,575) were followed up from ages 18 (1976-1986) to 50 (2008-2018). Prescription benzodiazepine misuse, prescription opioid misuse, and substance use disorder symptoms were examined with prevalence estimates and multivariable logistic regression. RESULTS By age 35, 70.9% of respondents had not used or misused prescription benzodiazepines, 11.3% reported medical use only, 9.8% indicated both medical use and misuse, and 14.1% reported misuse only. In analyses adjusted for demographic and other characteristics, adults reporting only medical use of prescription benzodiazepines by age 35 had higher odds of later prescription benzodiazepine misuse (adjusted OR [AOR]=2.17, 95% CI=1.72-2.75) and prescription opioid misuse (AOR=1.40, 95% CI=1.05-1.86) than respondents ages 35-50 who never used prescription benzodiazepines. More frequent medical use of prescription benzodiazepines by age 35 was associated with increased risk for substance use disorder symptoms at ages 40-50. Any history of prescription benzodiazepine misuse by age 35 was associated with higher odds of later prescription benzodiazepine misuse, prescription opioid misuse, and substance use disorder symptoms, compared with no misuse. CONCLUSIONS Prescription benzodiazepine use or misuse may signal later prescription drug misuse or substance use disorders. Medical use of prescription benzodiazepines by age 35 requires monitoring for prescription drug misuse, and any prescription benzodiazepine misuse warrants an assessment for substance use disorder.
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Affiliation(s)
- Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor (all authors); Institute for Social Research (S. E. McCabe, Schulenberg, Veliz) and Department of Psychiatry (V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - John E Schulenberg
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor (all authors); Institute for Social Research (S. E. McCabe, Schulenberg, Veliz) and Department of Psychiatry (V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Timothy E Wilens
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor (all authors); Institute for Social Research (S. E. McCabe, Schulenberg, Veliz) and Department of Psychiatry (V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Ty S Schepis
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor (all authors); Institute for Social Research (S. E. McCabe, Schulenberg, Veliz) and Department of Psychiatry (V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Vita V McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor (all authors); Institute for Social Research (S. E. McCabe, Schulenberg, Veliz) and Department of Psychiatry (V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Philip Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor (all authors); Institute for Social Research (S. E. McCabe, Schulenberg, Veliz) and Department of Psychiatry (V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
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13
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McAuley A, Palmateer N, Goldberg DJ, Shivaji T, Ritchie T, Licence K, Carter D, Hutchinson SJ. Increased risk of non-fatal overdose associated with non-prescribed benzodiazepine use in Scotland, UK. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023:104236. [PMID: 37865531 DOI: 10.1016/j.drugpo.2023.104236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/26/2023] [Accepted: 10/09/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Drug-related deaths (DRDs) in Scotland increased for seven years in a row between 2014 and 2020, consolidating Scotland's place at the top of the United Kingdom and European drug-related mortality charts. One of the defining features of this recent and rapid rise has been the role of benzodiazepines, which are now involved in the majority of all DRDs. These deaths are linked to use of non-prescribed, benzodiazepine-type novel psychoactive substances (NPS) which have been identified by the United Nations as a global threat to public health. This study aimed to estimate the prevalence and determinants of non-prescribed benzodiazepine use and its association with recent non-fatal overdose among a national sample of people who inject drugs (PWID). METHODS Data from the 2019-20 Needle Exchange Surveillance Initiative (NESI) was analysed using logistic regression. NESI is a voluntary, anonymous, biennial, cross-sectional, bio-behavioural survey of PWID attending community-based services providing injecting equipment in mainland Scotland. RESULTS Prevalence of non-prescribed benzodiazepine use in the past six months was 52% and significantly associated with age (aOR 0.97, 0.96-0.98), frequent incarceration (aOR 1.29, 1.07-1.57), recent public injecting (aOR 3.25, 2.33-4.55), a recent methadone prescription (aOR 1.87, 1.51-2.33), and a history of benzodiazepine prescription (aOR 1.92, 1.47-2.52). In addition, non-prescribed benzodiazepine use was significantly associated with non-fatal overdose in the past year among PWID (aOR 2.47, 1.90-3.21). CONCLUSION This study found a high prevalence of non-prescribed benzodiazepine use among a national sample of PWID in Scotland. Prevalence was highest among populations known to be at increased risk of drug-related death and use was strongly associated with overdose. These novel findings highlight the scale of the non-prescribed benzodiazepine issue Scotland faces, and the urgency required to expand its harm reduction infrastructure to address this unique element of its overdose crisis.
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Affiliation(s)
- A McAuley
- Public Health Scotland, Glasgow, UK; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
| | - N Palmateer
- Public Health Scotland, Glasgow, UK; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - D J Goldberg
- Public Health Scotland, Glasgow, UK; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - T Ritchie
- Glasgow Alcohol and Drug Recovery Services, Glasgow, UK
| | | | - D Carter
- Glasgow Alcohol and Drug Recovery Services, Glasgow, UK
| | - S J Hutchinson
- Public Health Scotland, Glasgow, UK; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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14
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Terman SW, Niznik JD, Growdon ME, Gerlach LB, Burke JF. Secular Trends in Central Nervous System-Active Polypharmacy Among Serial Cross-Sections of US Adults, 2009-2020. Drugs Aging 2023; 40:941-951. [PMID: 37695395 PMCID: PMC10629698 DOI: 10.1007/s40266-023-01066-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Data comprehensively examining trends in central nervous system (CNS)-active polypharmacy are limited. The objective of this cross-sectional study was to characterize the composition of and trends in CNS-active medication use in US adults. METHODS We included all participants ≥ 18 years old in the National Health and Nutrition Examination Study (NHANES), 2009-2020. The primary outcome was the percent of adults with CNS-active polypharmacy. This was defined as ≥ 3 medications among antidepressants [tricyclic, selective and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs), opioids, antiepileptics, antipsychotics, benzodiazepines, and nonbenzodiazepine receptor agonists ("Z-drugs")]. Secondary outcomes included prevalence of any CNS-active medication and specific medications and classes over time, and their indications. Percentages were weighted according to NHANES's nationally representative sampling frame. log binomial regressions evaluated the relative risk (RR) for each outcome, comparing the last (2017-2020) versus the first (2010-2011) survey cycle. RESULTS We included 34,189 adults (18.8% at least 65 years old) from five serial cross-sections (survey cycles). The prevalence of CNS-active polypharmacy was 2.1% in 2009-2010 and 2.6% in 2017-2020 [RR 1.18, 95% confidence interval (CI) 0.94-1.47]. The prevalence of CNS-active polypharmacy did not significantly change within any specific age group (e.g., age at least 65 years: RR 1.29, CI 0.74-2.24). The prevalence of any CNS-active medication was 21.0% in 2009 and 24.6% in 2017-2020 (RR] 1.12, 95% CI 1.02-1.25). A substantial increase occurred for antiepileptics (5.1-8.3%), specifically among participants aged 65 years and older (8.3-13.7%). This was largely driven by increasing gabapentin prevalence (1.4-3.6% overall; 3.3-7.9% age 65 years and older). Anticholinergic, SSRIs/SNRIs, antiepileptics, and benzodiazepines were elevated in most cycles for participants at least 65 years old compared with participants less than 65 years, and opioid use was increased in several cycles for older participants as well. Alprazolam was the most common benzodiazepine and third most common medication for anxiety/depression. Gabapentin was the most common CNS-active medication (3.6% of all participants in 2017-2020), followed by sertraline, citalopram, and acetaminophen-hydrocodone (each ~2%). The most common categories were antidepressants (13.7% in 2017-2020), followed by opioids (5.1% in 2017-2020). CONCLUSIONS CNS-active medications are increasingly common, particularly gabapentin, and use of any CNS-active medication increased by 12%. Numerous CNS-active classes also increased in older adults throughout the years. Increasing suboptimal medication use highlight the need for further investigation into causes for potentially inappropriate prescribing, particularly for older adults.
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Affiliation(s)
- Samuel W Terman
- Department of Neurology, University of Michigan, Taubman 1st Floor, Reception C, 1500 E Medical Center Dr, SPC 5316, Ann Arbor, MI, 48109, USA.
| | - Joshua D Niznik
- Division of Geriatric Medicine, Center for Aging and Health, School of Medicine, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Matthew E Growdon
- Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA
| | - Lauren B Gerlach
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - James F Burke
- Department of Neurology, The Ohio State University, Columbus, OH, USA
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15
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Drager LF, Assis M, Bacelar AFR, Poyares DLR, Conway SG, Pires GN, de Azevedo AP, Carissimi A, Eckeli AL, Pentagna Á, Almeida CMO, Franco CMR, Sobreira EST, Stelzer FG, Mendes GM, Minhoto GR, Linares IMP, Sousa KMM, Gitaí LLG, Sukys-Claudino L, Sobreira-Neto MA, Zanini MA, Margis R, Martinez SCG. 2023 Guidelines on the Diagnosis and Treatment of Insomnia in Adults - Brazilian Sleep Association. Sleep Sci 2023; 16:507-549. [PMID: 38370879 PMCID: PMC10869237 DOI: 10.1055/s-0043-1776281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Chronic insomnia disorder (simplified in this document as insomnia) is an increasingly common clinical condition in society and a frequent complaint at the offices of different areas of health practice (particularly Medicine and Psychology). This scenario has been accompanied by a significant evolution in treatment, as well as challenges in approaching patients in an appropriately way. This clinical guideline, coordinated by the Brazilian Sleep Association and the Brazilian Association of Sleep Medicine and counting on the active participation of various specialists in the area, encompasses an update on the diagnosis and treatment of insomnia in adults. To this end, it followed a structured methodology. Topics of interest related to diagnosis were written based on theoretical framework, evidence in the literature, and professional experience. As for the topics related to the treatment of insomnia, a series of questions were developed based on the PICO acronym (P - Patient, problem, or population; I - Intervention; C - Comparison, control, or comparator; O - Outcome). The work groups defined the eligible options within each of these parameters. Regarding pharmacological interventions, only the ones currently available in Brazil or possibly becoming available in the upcoming years were considered eligible. Systematic reviews were conducted to help prepare the texts and define the level of evidence for each intervention. The final result is an objective and practical document providing recommendations with the best scientific support available to professionals involved in the management of insomnia.
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Affiliation(s)
- Luciano Ferreira Drager
- Associação Brasileira do Sono, São Paulo, SP, Brazil.
- Unidades de HipertenSão, Instituto do Coração (InCor) e Disciplina de Nefrologia, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Márcia Assis
- Associação Brasileira do Sono, São Paulo, SP, Brazil.
- Clínica do Sono de Curitiba, Hospital São Lucas, Curitiba, Brazil.
| | - Andrea Frota Rego Bacelar
- Associação Brasileira do Sono, São Paulo, SP, Brazil.
- Clínica Bacelar - Neuro e Sono, Rio de Janeiro, RJ, Brazil.
| | - Dalva Lucia Rollemberg Poyares
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
- Instituto do Sono, São Paulo, SP, Brazil.
| | - Silvia Gonçalves Conway
- Instituto de Psiquiatria (IPq), Universidade de São Paulo, São Paulo, SP, Brazil.
- Departamento de Otoneurologia, Universidade de São Paulo, São Paulo, SP, Brazil.
- AkasA - Formação e Conhecimento, São Paulo, SP, Brazil.
| | - Gabriel Natan Pires
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
- Instituto do Sono, São Paulo, SP, Brazil.
| | | | - Alicia Carissimi
- Faculdade Dom Bosco, Porto Alegre, RS, Brazil.
- Cronosul Clínica de Psicologia do Sono, Psicoterapia e Neuropsicologia, Porto Alegre, RS, Brazil.
| | - Allan Luiz Eckeli
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Álvaro Pentagna
- Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Emmanuelle Silva Tavares Sobreira
- AkasA - Formação e Conhecimento, São Paulo, SP, Brazil.
- Universidade Federal do Ceará, Fortaleza, CE, Brazil.
- Clínica Sinapse Diagnóstico, Fortaleza, CE, Brazil.
| | - Fernando Gustavo Stelzer
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | | | | | - Ila Marques Porto Linares
- Instituto de Psiquiatria (IPq), Universidade de São Paulo, São Paulo, SP, Brazil.
- Instituto da Criança, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
| | - Ksdy Maiara Moura Sousa
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
- SleepUp Tecnologia e Saúde LTDA, São Paulo, SP, Brazil.
| | | | - Lucia Sukys-Claudino
- Disciplina de Neurologia, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.
| | | | - Marcio Andrei Zanini
- Instituto de Assistência Médica ao Servidor Público Estadual (IAMPSE), São Paulo, SP, Brazil.
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Soyka M, Wild I, Caulet B, Leontiou C, Lugoboni F, Hajak G. Long-term use of benzodiazepines in chronic insomnia: a European perspective. Front Psychiatry 2023; 14:1212028. [PMID: 37599882 PMCID: PMC10433200 DOI: 10.3389/fpsyt.2023.1212028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Chronic insomnia occurs in ~10% of the general population and has numerous negative health effects. The recommended first line treatment of cognitive behavior therapy for insomnia is not widely available for patients in Europe, so pharmacotherapies such as benzodiazepine receptor agonist agents (benzodiazepines and Z-drugs) are commonly used. However, their use is only recommended for ≤4 weeks due to unproven long-term efficacy in treatment of chronic insomnia, and the risk of tolerance, and the potential for dependence and misuse. In Europe, recommendations limiting the use of benzodiazepines (lowest dose and shortest duration) in chronic insomnia are not always followed, likely due to the lack of approved effective alternative therapies. Here we present a recent pilot survey of the pharmacological treatment landscape in chronic insomnia in five European countries (France, Germany, Italy, Spain, and the United Kingdom) and physicians' attitude toward treatment. The results suggest that benzodiazepines and Z-drugs are the most widely used treatments in chronic insomnia and are being used for longer than their recommended duration. Country variations in prescription rates were observed. Due to the known association between long-term benzodiazepine use and potential for developing dependence, further analysis of the literature was performed on the use and misuse of benzodiazepines. The results show that long-term use of benzodiazepines is associated with multiple consequences of treatment, including dependence, but also that previous use of benzodiazepines may increase the risk of opioid use disorder.
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Affiliation(s)
- Michael Soyka
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Imane Wild
- Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | | | | | - Fabio Lugoboni
- Department of Internal Medicine, Addiction Unit, Verona University Hospital, Verona, Italy
| | - Göran Hajak
- University of Regensburg, Regensburg, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Teaching Hospital of the University of Erlangen, Bamberg, Germany
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Ritvo AD, Foster DE, Huff C, Finlayson AJR, Silvernail B, Martin PR. Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey. PLoS One 2023; 18:e0285584. [PMID: 37384788 PMCID: PMC10309976 DOI: 10.1371/journal.pone.0285584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/27/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Acute benzodiazepine withdrawal has been described, but literature regarding the benzodiazepine-induced neurological injury that may result in enduring symptoms and life consequences is scant. OBJECTIVE We conducted an internet survey of current and former benzodiazepine users and asked about their symptoms and adverse life events attributed to benzodiazepine use. METHODS This is a secondary analysis of the largest survey ever conducted with 1,207 benzodiazepine users from benzodiazepine support groups and health/wellness sites who completed the survey. Respondents included those still taking benzodiazepines (n = 136), tapering (n = 294), or fully discontinued (n = 763). RESULTS The survey asked about 23 specific symptoms and more than half of the respondents who experienced low energy, distractedness, memory loss, nervousness, anxiety, and other symptoms stated that these symptoms lasted a year or longer. These symptoms were often reported as de novo and distinct from the symptoms for which the benzodiazepines were originally prescribed. A subset of respondents stated that symptoms persisted even after benzodiazepines had been discontinued for a year or more. Adverse life consequences were reported by many respondents as well. LIMITATIONS This was a self-selected internet survey with no control group. No independent psychiatric diagnoses could be made in participants. CONCLUSIONS Many prolonged symptoms subsequent to benzodiazepine use and discontinuation (benzodiazepine-induced neurological dysfunction) have been shown in a large survey of benzodiazepine users. Benzodiazepine-induced neurological dysfunction (BIND) has been proposed as a term to describe symptoms and associated adverse life consequences that may emerge during benzodiazepine use, tapering, and continue after benzodiazepine discontinuation. Not all people who take benzodiazepines will develop BIND and risk factors for BIND remain to be elucidated. Further pathogenic and clinical study of BIND is needed.
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Affiliation(s)
- Alexis D. Ritvo
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - D. E. Foster
- Benzodiazepine Action Work Group, Colorado Consortium for Prescription Drug Abuse Prevention, Aurora, Colorado, United States of America
| | - Christy Huff
- Benzodiazepine Information Coalition, Midvale, Utah, United States of America
| | - A. J. Reid Finlayson
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Bernard Silvernail
- Alliance for Benzodiazepine Best Practices, Portland, Oregon, United States of America
| | - Peter R. Martin
- Department of Psychiatry and Behavioral Sciences and Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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Cutler AJ, Mattingly GW, Maletic V. Understanding the mechanism of action and clinical effects of neuroactive steroids and GABAergic compounds in major depressive disorder. Transl Psychiatry 2023; 13:228. [PMID: 37365161 DOI: 10.1038/s41398-023-02514-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 05/12/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023] Open
Abstract
The pathophysiology of major depressive disorder (MDD) is thought to result from impaired connectivity between key brain networks. Gamma-aminobutyric acid (GABA) is the key inhibitory neurotransmitter in the brain, working primarily via GABAA receptors, with an important role in virtually all physiologic functions in the brain. Some neuroactive steroids (NASs) are positive allosteric modulators (PAMs) of GABAA receptors and potentiate phasic and tonic inhibitory responses via activation of synaptic and extrasynaptic GABAA receptors, respectively. This review first discusses preclinical and clinical data that support the association of depression with diverse defects in the GABAergic system of neurotransmission. Decreased levels of GABA and NASs have been observed in adults with depression compared with healthy controls, while treatment with antidepressants normalized the altered levels of GABA and NASs. Second, as there has been intense interest in treatment approaches for depression that target dysregulated GABAergic neurotransmission, we discuss NASs approved or currently in clinical development for the treatment of depression. Brexanolone, an intravenous NAS and a GABAA receptor PAM, is approved by the U.S. Food and Drug Administration for the treatment of postpartum depression (PPD) in patients 15 years and older. Other NASs include zuranolone, an investigational oral GABAA receptor PAM, and PH10, which acts on nasal chemosensory receptors; clinical data to date have shown improvement in depressive symptoms with these investigational NASs in adults with MDD or PPD. Finally, the review discusses how NAS GABAA receptor PAMs may potentially address the unmet need for novel and effective treatments with rapid and sustained antidepressant effects in patients with MDD.
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Ganjali Koli M, Eshaghi Malekshah R, Hajiabadi H. Insights from molecular dynamics and DFT calculations into the interaction of 1,4-benzodiazepines with 2-hydroxypropyl-βCD in a theoretical study. Sci Rep 2023; 13:9866. [PMID: 37332009 DOI: 10.1038/s41598-023-36385-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/02/2023] [Indexed: 06/20/2023] Open
Abstract
This study delves into the interaction between benzodiazepine (BZD) drugs and 2-hydroxypropyl-β-cyclodextrin (2HPβCD), a cyclodextrin (CD) known to improve drug delivery and enhance therapeutic outcomes. We find that the 2HPβCD's atoms become more rigid in the presence of chlordiazepoxide (CDP), clonazepam (CLZ), and diazepam (DZM), whereas they become more flexible in the presence of nordazepam (NDM) and nitrazepam (NZP). We also investigated the structure of 2HPβCD and found that loading these drugs increases both the area and volume of the 2HPβCD cavity, making it more suitable for drug delivery. Moreover, this research found that all drugs exhibited negative values for the binding free energy, indicating thermodynamic favorability and improved solubility. The binding free energy order of the BZDs was consistent in both molecular dynamics and Monte Carlo methods, with CDP and DZM having the highest affinity for binding. We also analyzed the contribution of different interaction energies in binding between the carrier and the drugs and found that Van der Waals energy is the primary component. Our results indicate that the number of hydrogen bonds between 2HPβCD/water slightly decreases in the presence of BZDs, but the hydrogen bond's quality remains constant.
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Affiliation(s)
- Mokhtar Ganjali Koli
- InSilicoSci Computational Research Centre, Nikopardazesh Ltd., Karaj, Iran
- Department of Chemistry, University of Kurdistan, Sanandaj, Iran
| | | | - Hossein Hajiabadi
- InSilicoSci Computational Research Centre, Nikopardazesh Ltd., Karaj, Iran
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Kujala E, Hakko H, Riipinen P, Riala K. Associations of adolescent psychosocial factors to later benzodiazepine use: a population-based follow-up study of adolescent psychiatric inpatients in Northern Finland. Int Clin Psychopharmacol 2023; 38:146-153. [PMID: 36730677 PMCID: PMC10063188 DOI: 10.1097/yic.0000000000000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/21/2022] [Indexed: 02/04/2023]
Abstract
We investigated factors associated with benzodiazepine (BZD) use during late adolescence and early adulthood. The study population consisted of 508 adolescents admitted to psychiatric inpatient care between April 2001 and March 2006. Information on adolescents' family- and school-related factors, suicidality and psychiatric disorders were obtained by semistructured interviews. Data on BZD prescriptions from 1999 to 2012 were collected from the Social Insurance Institution of Finland. In males heavy BZD use associated with adolescent substance-use disorder (OR, 3.5; P < 0.004) and parents' psychiatric problems (OR, 3.5; P = 0.029). Among females, conduct disorder (OR, 3.3; P = 0.016), being a bully/bully-victim (OR, 3.3; P = 0.019) and parental substance-use problems (OR, 2.6; P = 0.024) were related to heavy BZD use. The mean (±SD) age of first BZD prescription was significantly lower in heavy, compared with mild users (men: 19.3 ± 2.5 vs. 21.0 ± 2.5 years, P = 0.027; women: 19.7 ± 2.6 vs. 21.5 ± 3.4 years, P = 0.027). Heavy, compared with mild, BZD use is associated with female suicide attempts (OR, 5.0; P = 0.049). Physicians should be cautious when prescribing BZDs to young adults and must allocate treatment to those with carefully evaluated clinical indications.
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Affiliation(s)
- Emmi Kujala
- Faculty of Medicine, Research Unit of Clinical Medicine, Psychiatry, University of Oulu
| | - Helinä Hakko
- Oulu University Hospital, Psychiatry, Oulu, Finland
| | - Pirkko Riipinen
- Faculty of Medicine, Research Unit of Clinical Medicine, Psychiatry, University of Oulu
| | - Kaisa Riala
- Faculty of Medicine, Research Unit of Clinical Medicine, Psychiatry, University of Oulu
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Williams SG, Rodriguez-Cué D. Use of Daridorexant among Patients with Chronic Insomnia: A Retrospective Observational Analysis. J Clin Med 2023; 12:jcm12093240. [PMID: 37176680 PMCID: PMC10179592 DOI: 10.3390/jcm12093240] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Insomnia is the most prevalent sleep disorder, affecting millions worldwide and taking a heavy toll on patient health with significant social and economic impact. Even though there are multiple different types of insomnia medications and behavioral therapies, there are still many individuals for whom treatment remains ineffective. The objective of this retrospective study was to analyze the effectiveness of daridorexant in a cohort of chronic insomnia patients largely transitioned from GABA-A positive allosteric modulators (benzodiazepines, zolpidem or eszopiclone) or other frequently prescribed insomnia medications (including trazodone, atypical antipsychotics or tricyclic antidepressants). A total of 86 patients were treated in the course of ordinary practice and the primary analytic endpoint was the change in Insomnia Severity Index (ISI) score following ≥ 30 nights of treatment with daridorexant. Results from 80 of the 86 patients with full data (65% female, mean age 53.5 years, 18.8% with comorbid obstructive sleep apnea, 91.3% transitioned from a different medication) showed a mean improvement in ISI score of 7.0 ± 0.54 points (SEM) (p < 0.0001) from 18.0 to 11.0. Overall, 78% of the cohort demonstrated a clinically meaningful improvement as defined by at least a six-point drop in ISI. Total sleep time increased by 54 ± 1.0 min (SEM) (p < 0.0001) from 6.0 h to 6.9 h. Mean sleep latency decreased by 23.9 ± 2.4 min (SEM) (p < 0.0001) from 58.8 min to 34.9 min. Wake after sleep onset decreased by 31.6 ± 3.2 min (SEM) (p < 0.001) from 42.8 min to 11.3 min. Sleep efficiency improved by 10.5 ± 1.1% (SEM) (p < 0.0001) from 79.3% to 89.8%. No significant adverse events were noted during the study duration. Keeping in mind this study's limitations, these data suggest that for insomnia patients with an incomplete response to current therapy, switching to daridorexant is safe and may be an effective alternative treatment.
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Affiliation(s)
- Scott G Williams
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
- Departments of Medicine and Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Fond G, Faugere M, Boyer L, Peri P, Stephan F, Moliere F, Anguill L, Bennabi D, Haffen E, Bouvard A, Walter M, Samalin L, Llorca PM, Genty JB, Leboyer M, Holtzmann J, Nguon AS, Rey R, Horn M, Vaiva G, Hennion V, Etain B, El-Hage W, Camus V, Courtet P, Aouizerate B, Yrondi A, Lancon C, Richieri R. Long-term benzodiazepine prescription in treatment-resistant depression: A national FACE-TRD prospective study. Prog Neuropsychopharmacol Biol Psychiatry 2023; 126:110779. [PMID: 37120004 DOI: 10.1016/j.pnpbp.2023.110779] [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] [Received: 03/10/2023] [Revised: 04/22/2023] [Accepted: 04/22/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Benzodiazepine long-term use (BLTU) is a public health challenge. We lack data on the consequences of LBTU on the trajectory of treatment-resistant depression (TRD). OBJECTIVE To determine the prevalence of BLTU in a nationwide non-selected population of patients with TRD, to determine the rate of patients succeeding at withdrawing benzodiazepines at one year and to determine if persistent BLTU is associated with poorer mental health outcomes. METHOD The FACE-TRD cohort is a national cohort of TRD patients recruited in 13 resistant depression expert centers between 2014 and 2021 and followed-up at one year. A standardized one-day long comprehensive battery was carried out, including trained-clinician and patient-reported outcomes, and patients were reevaluated at one year. RESULTS At baseline, 45.2% of the patients were classified in the BLTU group. In multivariate analysis, compared to patients without BLTU, patients with BLTU were more frequently classified in the "low physical activity" group (adjusted odds ratio (aOR) = 1.885, p = 0.036), and had higher primary healthcare consumption (B = 0.158, p = 0.031) independently of age, sex and antipsychotic consumption. We found no significant difference for personality traits, suicidal ideation, impulsivity, childhood trauma exposure, earlier age at first major depressive episode, anxiety and sleep disorders (all p > 0.05). Despite recommendations for withdrawal, <5% of BLTU patients withdraw benzodiazepines during the one-year follow-up. Persistent BLTU at one-year was associated with higher depression severity (B = 0.189, p = 0.029), higher clinical global severity (B = 0.210, p = 0.016), higher state-anxiety (B = 0.266, p = 0.003), impaired sleep quality (B = 0.249, p = 0.008), increased peripheral inflammation (B = 0.241, p = 0.027), lower functioning level (B = -0.240, p = 0.006), decreased processing speed (B = -0.195, p = 0.020) and verbal episodic memory (B = -0.178, p = 0.048), higher absenteeism and productivity loss (B = 0.595, p = 0.016) and lower subjective global health status (B = -0.198, p = 0.028). CONCLUSION Benzodiazepines are over-prescribed in TRD (in almost a half of the patients). Despite recommendations for withdrawal and psychiatric follow-up, <5% of patients successfully stopped taking benzodiazepines at one-year. Maintaining BLTU may contribute to the worsening of clinical and cognitive symptoms and of daily functioning in TRD patients. Progressive and planed withdrawal of benzodiazepines seems therefore strongly recommended in TRD patients with BLTU. Pharmacological and non-pharmacological alternatives should be promoted when possible.
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Affiliation(s)
- Guillaume Fond
- Fondation FondaMental, Créteil, France; Service des urgences psychiatriques, Infinity (Toulouse Institute for Infectious and Inflammatory Diseases), INSERM UMR1291, CNRS UMR5051, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Faculté de Médecine, Marseille Univ, EA 3279, Service d'Épidémiologie et d'Économie de la Santé, Marseille, France; Service Universitaire de santé mentale et physique, Centre Expert Dépression Résistante, CHU Sainte-Marguerite, APHM, Université Aix-Marseille, F-13009 Marseille, France; Aix Marseille Univ, CNRS, Centrale Marseille, Institut Fresnel, Marseille, France.
| | - Mélanie Faugere
- Fondation FondaMental, Créteil, France; Service Universitaire de santé mentale et physique, Centre Expert Dépression Résistante, CHU Sainte-Marguerite, APHM, Université Aix-Marseille, F-13009 Marseille, France
| | - Laurent Boyer
- Fondation FondaMental, Créteil, France; Faculté de Médecine, Marseille Univ, EA 3279, Service d'Épidémiologie et d'Économie de la Santé, Marseille, France; Service Universitaire de santé mentale et physique, Centre Expert Dépression Résistante, CHU Sainte-Marguerite, APHM, Université Aix-Marseille, F-13009 Marseille, France
| | - Pauline Peri
- Fondation FondaMental, Créteil, France; Service Universitaire de santé mentale et physique, Centre Expert Dépression Résistante, CHU Sainte-Marguerite, APHM, Université Aix-Marseille, F-13009 Marseille, France
| | - Florian Stephan
- Fondation FondaMental, Créteil, France; Service Hospitalo-Universitaire de Psychiatrie Générale et de Réhabilitation Psycho Sociale 29G01 et 29G02, Centre Expert Depression Résistante FondaMental, EA 7479, CHRU de Brest, Hôpital de Bohars, Brest, France
| | - Fanny Moliere
- Fondation FondaMental, Créteil, France; Department of Emergency Psychiatry and Acute Care, CHU Montpellier, INSERM U1061, Montpellier University, Montpellier, France
| | - Loic Anguill
- Fondation FondaMental, Créteil, France; Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Djamila Bennabi
- Fondation FondaMental, Créteil, France; Service de Psychiatrie, Centre Expert Dépression Résistante FondaMental, CIC-1431 INSERM, CHU de Besançon, EA 481 Neurosciences, Université de Bourgogne Franche Comté, Besançon, France
| | - Emmanuel Haffen
- Fondation FondaMental, Créteil, France; Service de Psychiatrie, Centre Expert Dépression Résistante FondaMental, CIC-1431 INSERM, CHU de Besançon, EA 481 Neurosciences, Université de Bourgogne Franche Comté, Besançon, France
| | - Alexandra Bouvard
- Fondation FondaMental, Créteil, France; Pôle de Psychiatrie Générale et Universitaire,Centre de référence régional des pathologies anxieuses et de la dépression, Centre Expert Dépression Résistante FondaMental, CH Charles Perrens, Bordeaux, Laboratoire Nutrition et Neurobiologie intégrée (UMR INRAE 1286), Université de Bordeaux, Bordeaux, France
| | - Michel Walter
- Fondation FondaMental, Créteil, France; Service Hospitalo-Universitaire de Psychiatrie Générale et de Réhabilitation Psycho Sociale 29G01 et 29G02, Centre Expert Depression Résistante FondaMental, EA 7479, CHRU de Brest, Hôpital de Bohars, Brest, France
| | - Ludovic Samalin
- Fondation FondaMental, Créteil, France; Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, UMR 6602 Institut Pascal (IP), Clermont-Ferrand, France
| | - Pierre Michel Llorca
- Fondation FondaMental, Créteil, France; Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, UMR 6602 Institut Pascal (IP), Clermont-Ferrand, France
| | - Jean Baptiste Genty
- Fondation FondaMental, Créteil, France; Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie, Créteil, France Fondation FondaMental, Fondation de Cooperation Scientifique, Créteil, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France; Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie, Créteil, France Fondation FondaMental, Fondation de Cooperation Scientifique, Créteil, France
| | - Jérôme Holtzmann
- Fondation FondaMental, Créteil, France; Service de Psychiatrie de l'adulte, Centre Expert Dépression Résistante FondaMental, CHU de Grenoble-Alpes, Hôpital Nord, Grenoble, CS 10217, France
| | - Anne Sophie Nguon
- Fondation FondaMental, Créteil, France; Service de Psychiatrie de l'adulte, Centre Expert Dépression Résistante FondaMental, CHU de Grenoble-Alpes, Hôpital Nord, Grenoble, CS 10217, France
| | - Romain Rey
- Fondation FondaMental, Créteil, France; INSERM U1028, CNRS UMR5292, University Lyon 1, Lyon Neuroscience Research Centre, Psychiatric Disorders: from Resistance to Response ΨR2 Team, Centre Hospitalier Le Vinatier, Bron, France
| | - Mathilde Horn
- Fondation FondaMental, Créteil, France; Service de Psychiatrie adulte (Department of Adult Psychiatry), Centre Expert Dépression Résistante FondaMental, CHRU de Lille, Hôpital Fontan 1, Lille, France
| | - Guillaume Vaiva
- Fondation FondaMental, Créteil, France; Service de Psychiatrie adulte (Department of Adult Psychiatry), Centre Expert Dépression Résistante FondaMental, CHRU de Lille, Hôpital Fontan 1, Lille, France; Centre National de Ressources et Résilience pour les psychotraumatismes (Cn2r Lille Paris), Lille, France
| | - Vincent Hennion
- Fondation FondaMental, Créteil, France; Département de Psychiatrie et de Médecine Addictologique, Lariboisière-Fernand Widal GHU APHP Nord Université Paris cité Paris, France
| | - Bruno Etain
- Fondation FondaMental, Créteil, France; Département de Psychiatrie et de Médecine Addictologique, Lariboisière-Fernand Widal GHU APHP Nord Université Paris cité Paris, France; Université Paris Cité, INSERM UMR-S 1144, Optimisation Thérapeutique en Neurospsychopharmacologie, OTeN, F-75006 Paris, France
| | - Wissam El-Hage
- Fondation FondaMental, Créteil, France; U1253, iBrain, CIC1415, Inserm, Pôle psychiatrie-Addictologie,CHRU de Tours, Université de Tours, Tours, France
| | - Vincent Camus
- Fondation FondaMental, Créteil, France; U1253, iBrain, CIC1415, Inserm, Pôle psychiatrie-Addictologie,CHRU de Tours, Université de Tours, Tours, France
| | - Philippe Courtet
- Fondation FondaMental, Créteil, France; Department of Emergency Psychiatry and Acute Care, CHU Montpellier, INSERM U1061, Montpellier University, Montpellier, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France; Pôle de Psychiatrie Générale et Universitaire,Centre de référence régional des pathologies anxieuses et de la dépression, Centre Expert Dépression Résistante FondaMental, CH Charles Perrens, Bordeaux, Laboratoire Nutrition et Neurobiologie intégrée (UMR INRAE 1286), Université de Bordeaux, Bordeaux, France
| | - Antoine Yrondi
- Fondation FondaMental, Créteil, France; Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Christophe Lancon
- Fondation FondaMental, Créteil, France; Service Universitaire de santé mentale et physique, Centre Expert Dépression Résistante, CHU Sainte-Marguerite, APHM, Université Aix-Marseille, F-13009 Marseille, France
| | - Raphaelle Richieri
- Fondation FondaMental, Créteil, France; Service Universitaire de santé mentale et physique, Centre Expert Dépression Résistante, CHU Sainte-Marguerite, APHM, Université Aix-Marseille, F-13009 Marseille, France
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Haq FU, Shoaib M, Ali Shah SW, Hussain H, Zahoor M, Ullah R, Bari A, Alotaibi A, Hayat MF. Antidepressant Activities of Synthesized Benzodiazepine Analogues in Mice. Brain Sci 2023; 13:brainsci13030523. [PMID: 36979333 PMCID: PMC10046342 DOI: 10.3390/brainsci13030523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/20/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Depression is a serious psychological disorder which negatively affects human feelings and actions. The use of antidepressants is the therapy of choice while treating depression. However, such drugs are associated with severe side effects. There is a need for efficient and harmless drugs. In this connection, the present study was designed to synthesize several substituted benzodiazepine derivatives and explore their antidepressant potentials in an animal model. The chalcone backbone was initially synthesized, which was then converted into several substituted benzodiazepine derivatives designated as 1-6. The synthesized compounds were identified using spectroscopic techniques. The experimental animals (mice) after acclimatation were subjected to forced swim test (FST) and tail suspension test (TST) after oral administration of the synthesized compounds to evaluate their antidepressant potentials. At the completion of the mentioned test, the animals were sacrificed to determine GABA level in their brain hippocampus. The chloro-substituent compound (2) significantly reduced the immobility time (80.81 ± 1.14 s; p < 0.001 at 1.25 mg/kg body weight and 75.68 ± 3.73 s with p < 0.001 at 2.5 mg/kg body weight dose), whereas nitro-substituent compound (5) reduced the immobility time to 118.95 ± 1.31 and 106.69 ± 3.62 s (p < 0.001), respectively, at the tested doses (FST). For control groups, the recorded immobility time recorded was 177.24 ± 1.82 s. The standard drug diazepam significantly reduced immobility time to 70.13 ± 4.12 s while imipramine reduced it to 65.45 ± 2.81 s (p < 0.001). Similarly, in the TST, the compound 2 reduced immobility time to 74.93 ± 1.14 s (p < 0.001) and 70.38 ± 1.43 s (p < 0.001), while compound 5 reduced it to 88.23 ± 1.89 s (p < 0.001) and 91.31 ± 1.73 s (p < 0.001) at the tested doses, respectively, as compared to the control group immobility time (166.13 ± 2.18 s). The compounds 1, 3, 4, and 6 showed weak antidepressant responses as compared to compounds 2 and 5. The compounds 2 and 5 also significantly enhanced the GABA level in the brain's hippocampus of experimental animals, indicating the possible involvement of GABAergic mechanism in alleviating the depression which is evident from the significant increase in mRNA levels for the α subunit of the GABAA receptors in the prefrontal cortex of mice as well. From the results, it can be concluded that compound 2 and 5 could be used as alternative drugs of depression. However, further exploration in this connection is needed in other animal models in order to confirm the observed results in this study.
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Affiliation(s)
- Faizan Ul Haq
- Department of Pharmacy, University of Malakand, Chakdara, Lower Dir 18800, Khyber Pakhtunkhwa, Pakistan
| | - Mohammad Shoaib
- Department of Pharmacy, University of Malakand, Chakdara, Lower Dir 18800, Khyber Pakhtunkhwa, Pakistan
| | - Syed Wadood Ali Shah
- Department of Pharmacy, University of Malakand, Chakdara, Lower Dir 18800, Khyber Pakhtunkhwa, Pakistan
| | - Haya Hussain
- Department of Pharmacy, Shaheed Benazir Bhutto University, Sheringal 18000, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Zahoor
- Department of Biochemistry, University of Malakand, Chakdara, Lower Dir 18800, Khyber Pakhtunkhwa, Pakistan
| | - Riaz Ullah
- Medicinal Aromatic and Poisonous Plants Research Center, Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ahmed Bari
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Amal Alotaibi
- Department of Basic Science, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Muhammad Faisal Hayat
- North West Institute of Health and Sciences, Peshawar 25100, Khyber Pakhtunkhwa, Pakistan
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Kinney KL, Zheng Y, Morris MC, Schumacher JA, Bhardwaj SB, Rowlett JK. Predicting benzodiazepine prescriptions: A proof-of-concept machine learning approach. Front Psychiatry 2023; 14:1087879. [PMID: 36970256 PMCID: PMC10036348 DOI: 10.3389/fpsyt.2023.1087879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
Introduction Benzodiazepines are the most commonly prescribed psychotropic medications, but they may place users at risk of serious adverse effects. Developing a method to predict benzodiazepine prescriptions could assist in prevention efforts. Methods The present study applies machine learning methods to de-identified electronic health record data, in order to develop algorithms for predicting benzodiazepine prescription receipt (yes/no) and number of benzodiazepine prescriptions (0, 1, 2+) at a given encounter. Support-vector machine (SVM) and random forest (RF) approaches were applied to outpatient psychiatry, family medicine, and geriatric medicine data from a large academic medical center. The training sample comprised encounters taking place between January 2020 and December 2021 (N = 204,723 encounters); the testing sample comprised data from encounters taking place between January and March 2022 (N = 28,631 encounters). The following empirically-supported features were evaluated: anxiety and sleep disorders (primary anxiety diagnosis, any anxiety diagnosis, primary sleep diagnosis, any sleep diagnosis), demographic characteristics (age, gender, race), medications (opioid prescription, number of opioid prescriptions, antidepressant prescription, antipsychotic prescription), other clinical variables (mood disorder, psychotic disorder, neurocognitive disorder, prescriber specialty), and insurance status (any insurance, type of insurance). We took a step-wise approach to developing a prediction model, wherein Model 1 included only anxiety and sleep diagnoses, and each subsequent model included an additional group of features. Results For predicting benzodiazepine prescription receipt (yes/no), all models showed good to excellent overall accuracy and area under the receiver operating characteristic curve (AUC) for both SVM (Accuracy = 0.868-0.883; AUC = 0.864-0.924) and RF (Accuracy = 0.860-0.887; AUC = 0.877-0.953). Overall accuracy was also high for predicting number of benzodiazepine prescriptions (0, 1, 2+) for both SVM (Accuracy = 0.861-0.877) and RF (Accuracy = 0.846-0.878). Discussion Results suggest SVM and RF algorithms can accurately classify individuals who receive a benzodiazepine prescription and can separate patients by the number of benzodiazepine prescriptions received at a given encounter. If replicated, these predictive models could inform system-level interventions to reduce the public health burden of benzodiazepines.
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Affiliation(s)
- Kerry L. Kinney
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
| | - Yufeng Zheng
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, United States
| | - Matthew C. Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
| | - Julie A. Schumacher
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
| | - Saurabh B. Bhardwaj
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
| | - James K. Rowlett
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
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25
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Erickson BR, Ehrie J, Murray S, Dougherty RJ, Wainberg ML, Dixon LB, Goldman ML. A Rapid Review of "Low-Threshold" Psychiatric Medication Prescribing: Considerations for Street Medicine and Beyond. Psychiatr Serv 2023; 74:282-291. [PMID: 36039554 PMCID: PMC9971341 DOI: 10.1176/appi.ps.20220196] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE No widely accepted clinical guidelines, and scant directly applicable pragmatic research, are available to guide the prescription of psychiatric medications in "low-threshold" outpatient settings, such as street outreach, urgent care, and crisis care, as well as walk-in, shelter, and bridge and transition clinics. Providers frequently prescribe medications in these settings without patients' having firm psychiatric diagnoses and without medical records to guide clinical decision making. Persons who receive medications in these settings often seek help voluntarily and intermittently for mental illness symptoms. However, because of structural and individual factors, such patients may not engage in longitudinal outpatient psychiatric care. The authors reviewed the literature on psychiatric medication prescribing in low-threshold settings and offer clinical considerations for such prescribing. METHODS The authors conducted a rapid literature review (N=2,215 abstracts), which was augmented with up-to-date clinical prescribing literature, the authors' collective clinical experience, and DSM-5 section II diagnostic criteria to provide considerations for prescribing medications in low-threshold settings. RESULTS For individuals for whom diagnostic uncertainty is prominent, a symptom-based diagnostic and treatment approach may be best suited to weigh the risks and benefits of medication use in low-threshold settings. Practical considerations for treating patients with clinical presentations of psychosis and trauma, as well as mood, anxiety, and substance use disorders, in low-threshold settings are discussed. CONCLUSIONS An urgent need exists to invest in pragmatic research and guideline development to delineate best-practice prescribing in low-threshold settings.
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Affiliation(s)
- Blake R Erickson
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Jarrod Ehrie
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Samuel Murray
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Ryan J Dougherty
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Milton L Wainberg
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Lisa B Dixon
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Matthew L Goldman
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
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Zee PC, Bertisch SM, Morin CM, Pelayo R, Watson NF, Winkelman JW, Krystal AD. Long-Term Use of Insomnia Medications: An Appraisal of the Current Clinical and Scientific Evidence. J Clin Med 2023; 12:jcm12041629. [PMID: 36836164 PMCID: PMC9959182 DOI: 10.3390/jcm12041629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
While evidence supports the benefits of medications for the treatment of chronic insomnia, there is ongoing debate regarding their appropriate duration of use. A panel of sleep experts conducted a clinical appraisal regarding the use of insomnia medications, as it relates to the evidence supporting the focus statement, "No insomnia medication should be used on a daily basis for durations longer than 3 weeks at a time". The panelists' assessment was also compared to findings from a national survey of practicing physicians, psychiatrists, and sleep specialists. Survey respondents revealed a wide range of opinions regarding the appropriateness of using the US Food and Drug Administration (FDA)-approved medications for the treatment of insomnia lasting more than 3 weeks. After discussion of the literature, the panel unanimously agreed that some classes of insomnia medications, such as non-benzodiazepines hypnotics, have been shown to be effective and safe for long-term use in the appropriate clinical setting. For eszopiclone, doxepin, ramelteon and the newer class of dual orexin receptor antagonists, the FDA label does not specify that their use should be of a limited duration. Thus, an evaluation of evidence supporting the long-term safety and efficacy of newer non-benzodiazepine hypnotics is timely and should be considered in practice recommendations for the duration of pharmacologic treatment of chronic insomnia.
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Affiliation(s)
- Phyllis C. Zee
- Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL 60611, USA
- Correspondence: ; Tel.: +1-312-503-4409
| | - Suzanne M. Bertisch
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Charles M. Morin
- Department of Psychology, Cervo Brain Research Centre, Laval University, Québec City, QC G1V 0A6, Canada
| | - Rafael Pelayo
- Department of Psychiatry and Behavioral Sciences, Stanford University Sleep Medicine Center, Redwood City, CA 94305, USA
| | - Nathaniel F. Watson
- Department of Neurology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - John W. Winkelman
- Department of Psychiatry and Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Andrew D. Krystal
- Department of Psychiatry and Neurology, UCSF Weill Institute for Neurosciences, San Francisco, CA 94158, USA
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Liu D, Zhang Q, Zhao Z, Chen M, Hou Y, Wang G, Shen H, Zhu H, Ji Y, Ruan L, Lou Z. Benzodiazepine-Receptor Agonist Utilization in Outpatients with Anxiety Disorder: A Retrospective Study Based on Electronic Healthcare Data from a Large General Tertiary Hospital. Healthcare (Basel) 2023; 11:healthcare11040554. [PMID: 36833088 PMCID: PMC9956167 DOI: 10.3390/healthcare11040554] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
Benzodiazepine-receptor agonists (BZRAs), including benzodiazepines (BZDs) and drugs related to BZDs (Z-drugs), are commonly used for anxiety, but often have side effects. We retrospectively investigated the utilization and prescription characteristics of BZRAs for patients with anxiety disorders in a large tertiary care general hospital between 2018 and 2021, based on electronic healthcare records. We also examined the pattern of simultaneous consumption of multiple BZRA drugs, and the diseases coexisting with anxiety that are associated with this. The numbers of patients and BZRA prescriptions increased over the 4 years. Moreover, 7195 prescriptions from 694 patients contained two or more BZRAs, of which 78.08% contained both BZDs and Z-drugs, 19.78% contained multiple BZDs, and 2.14% contained multiple Z-drugs. For anxiety patients with concomitant Alzheimer's disease or Parkinson's disease, and dyslipidemia, they were more likely to consume multiple BZRAs simultaneously, whereas patients with concomitant insomnia, depression, hypertension, diabetes, or tumors were less likely to consume multiple BZRAs (all p < 0.05). Furthermore, older patients who consume multiple BZRAs simultaneously may have higher probabilities of long-term drug use. Better interventions supporting standardized BZD utilization may be needed to minimize the side effects of inappropriate BZRA administration.
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Affiliation(s)
- Denong Liu
- School of Medicine, Ningbo University, Ningbo 315211, China
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
| | - Qingyu Zhang
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
| | - Zhijia Zhao
- School of Medicine, Ningbo University, Ningbo 315211, China
| | - Mengjia Chen
- Department of Pharmacy, Ningbo Yinzhou No.2 Hospital, Ningbo 315199, China
| | - Yanbin Hou
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
| | - Guanjun Wang
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
| | - Haowei Shen
- School of Medicine, Ningbo University, Ningbo 315211, China
| | - Huaqiang Zhu
- Department of Pharmaceutical Engineering, Zhejiang Pharmaceutical University, Ningbo 315199, China
| | - Yunxin Ji
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
| | - Liemin Ruan
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
- Correspondence: (L.R.); (Z.L.)
| | - Zhongze Lou
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
- Zhejiang Key Laboratory of Precision Medicine for Atherosclerotic Diseases, Central Laboratory of the Medical Research Center, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
- Correspondence: (L.R.); (Z.L.)
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Anderson IM. Re-evaluating benzodiazepines for anxiety disorders – déjà-vu all over again? BJPSYCH ADVANCES 2023. [DOI: 10.1192/bja.2022.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
SUMMARY
Benzodiazepines have attracted controversy from shortly after their introduction. They have been subject to periodic calls for their use to be re-evaluated on the basis that their risks have been overstated and their benefits underappreciated. Claims made in recent editorials from the International Task Force on Benzodiazepines in support of their wider use are critiqued in this issue. I examine here whether there is a case to change the conclusions of previous reconsiderations of the question.
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Melatonin for Insomnia in Medical Inpatients: A Narrative Review. J Clin Med 2022; 12:jcm12010256. [PMID: 36615056 PMCID: PMC9821578 DOI: 10.3390/jcm12010256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/07/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
In this narrative review, we describe what is known about non-pharmacological and pharmacological treatments for insomnia in medical inpatients, with a focus on melatonin. Hospital-acquired insomnia is common, resulting in shortened total sleep time and more nighttime awakenings. Sleep disturbance has been shown to increase systemic inflammation, pain, and the likelihood of developing delirium in hospital. Treatment for insomnia includes both non-pharmacological and pharmacological interventions, the latter of which requires careful consideration of risks and benefits given the known adverse effects. Though benzodiazepines and non-benzodiazepine benzodiazepine receptor agonists are commonly prescribed (i.e., sedative-hypnotics), they are relatively contraindicated for patients over the age of 65 due to the risk of increased falls, cognitive decline, and potential for withdrawal symptoms after long-term use. Exogenous melatonin has a comparatively low likelihood of adverse effects and drug-drug interactions and is at least as effective as other sedative-hypnotics. Though more research is needed on both its effectiveness and relative safety for inpatients, small doses of melatonin before bedtime may be an appropriate choice for inpatients when insomnia persists despite non-pharmacological interventions.
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30
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Zubiaur P, Abad-Santos F. Use of pharmacogenetics for benzodiazepine prescription: state of the art and expectations. Pharmacogenomics 2022; 23:949-952. [PMID: 36412207 DOI: 10.2217/pgs-2022-0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Pablo Zubiaur
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, 28029, Spain.,Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children's Mercy Research Institute, Kansas City, MO 64108, USA
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, 28029, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, 28200, Spain
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31
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Bajor LA, Balsara C, Osser DN. An evidence-based approach to psychopharmacology for posttraumatic stress disorder (PTSD) - 2022 update. Psychiatry Res 2022; 317:114840. [PMID: 36162349 DOI: 10.1016/j.psychres.2022.114840] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 01/04/2023]
Abstract
Algorithms for posttraumatic stress disorder were published by this team in 1999 and 2011. Developments since then warrant revision. New studies and review articles from January 2011 to November 2021 were identified via PubMed and analyzed for evidence supporting changes. Following consideration of variations required by special patient populations, treatment of sleep impairments remains as the first recommended step. Nightmares and non-nightmare disturbed awakenings are best addressed with the anti-adrenergic agent prazosin, with doxazosin and clonidine as alternatives. First choices for difficulty initiating sleep include hydroxyzine and trazodone. If significant non-sleep PTSD symptoms remain, an SSRI should be tried, followed by a second SSRI or venlafaxine as a third step. Second generation antipsychotics can be considered, particularly for SSRI augmentation when PTSD-associated psychotic symptoms are present, with the caveat that positive evidence is limited and side effects are considerable. Anti-adrenergic agents can also be considered for general PTSD symptoms if not already tried, though evidence for daytime use lags that available for sleep. Regarding other pharmacological and procedural options, e.g., transcranial magnetic stimulation, cannabinoids, ketamine, psychedelics, and stellate ganglion block, evidence does not yet support firm inclusion in the algorithm. An interactive version of this work can be found at www.psychopharm.mobi.
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Affiliation(s)
- Laura A Bajor
- James A. Haley VA Hospital, Tampa, FL, United States; University of South Florida Morsani School of Medicine, Tampa, FL, United States; VA Boston Healthcare System and Harvard South Shore Psychiatry Residency Training Program, Brockton, MA, United States.
| | - Charmi Balsara
- HCA Healthcare East Florida Division GME/HCA FL Aventura Hospital, United States
| | - David N Osser
- VA Boston Healthcare System and Harvard South Shore Psychiatry Residency Training Program, Brockton, MA, United States
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32
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Cucciare MA, Abraham TH, Kemp L, White P, Marchant K, Hagedorn HJ, Humphreys K. Adapting the Eliminating Medications Through Patient Ownership of End Results Protocol to Promote Benzodiazepine Cessation Among US Military Veterans: Focus Group Study With US Military Veterans and National Veterans Health Administration Leaders. J Med Internet Res 2022; 24:e35514. [PMID: 36121697 PMCID: PMC9531005 DOI: 10.2196/35514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 07/21/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Long-term dependence on prescribed benzodiazepines is a public health problem. Eliminating Medications Through Patient Ownership of End Results (EMPOWER) is a promising self-management intervention, delivered directly to patients as a printed booklet, that is effective in promoting benzodiazepine reduction and cessation in older adults. EMPOWER has high potential to benefit large health care systems such as the US Veterans Health Administration (VHA), which cares for many veterans who use benzodiazepines for extended periods. Objective We aimed to adapt the original EMPOWER booklet materials for electronic delivery and for use among US military veterans receiving VHA care who were long-term benzodiazepine users. Methods We used elements of Analysis, Design, Development, Implementation, and Evaluation, a framework commonly used in the field of instructional design, to guide a qualitative approach to iteratively adapting EMPOWER Electronic Delivery (EMPOWER-ED). We conducted 3 waves of focus groups with the same 2 groups of VHA stakeholders. Stakeholders were VHA-enrolled veterans (n=16) with medical chart evidence of long-term benzodiazepine use and national VHA leaders (n=7) with expertise in setting VHA policy for prescription benzodiazepine use and developing electronically delivered educational tools for veterans. Qualitative data collected from each wave of focus groups were analyzed using template analysis. Results Themes that emerged from the initial focus groups included veterans’ anxiety about self-tapering from benzodiazepines and prior negative experiences attempting to self-taper without support. Participants also provided feedback on the protocol’s look and feel, educational content, the tapering protocol, and website functionality; for example, feedback from policy leaders included listing, on the cover page, the most commonly prescribed benzodiazepines to ensure that veterans were aware of medications that qualify for self-taper using the EMPOWER-ED protocol. Both groups of stakeholders identified the importance of having access to supportive resources to help veterans manage sleep and anxiety in the absence of taking benzodiazepines. Both groups also emphasized the importance of ensuring that the self-taper could be personalized and that the taper instructions were clear. The policy leaders emphasized the importance of encouraging veterans to notify their provider of their decision to self-taper to help facilitate provider assistance, if needed, with the taper process and to help prevent medication stockpiling. Conclusions EMPOWER-ED is the first direct-to-patient electronically delivered protocol designed to help US military veterans self-taper from long-term benzodiazepine use. We used the Analysis, Design, Development, Implementation, and Evaluation framework to guide the successful adaption of the original EMPOWER booklet for use with this population and for electronic delivery. The next step in this line of research is to evaluate EMPOWER-ED in a randomized controlled trial.
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Affiliation(s)
- Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, United States.,Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Traci H Abraham
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, United States.,Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Lakiesha Kemp
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, United States
| | - Penny White
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Kathy Marchant
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, United States
| | - Hildi J Hagedorn
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Keith Humphreys
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Department of Psychiatry, Stanford University, Menlo Park, CA, United States
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Basińska-Szafrańska A. Use of a long-acting substitute in detoxification from benzodiazepines: safety (accumulation) problems and proposed mitigation procedure. Eur J Clin Pharmacol 2022; 78:1833-1841. [PMID: 36114834 PMCID: PMC9546953 DOI: 10.1007/s00228-022-03388-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 09/07/2022] [Indexed: 12/04/2022]
Abstract
Objective In the majority of approaches, detoxification of patients with benzodiazepine (BZD) addiction is preceded by conversion to long-acting BZDs. Resulting BZD accumulation, however, is neither monitored nor prevented. An unrecognized shift of the key low-concentration phase beyond the nominal treatment period may underlie delayed unassisted crises and treatment failures. This open, single-arm, semi-naturalistic study examines the anti-accumulation paradigm to minimize the high-concentration treatment phase and to regain time for medical assistance during the low-concentration phase. Methods In 133 of 165 patients with BZD dependency, after conversion to diazepam by titration up to the satiation state, the loading dose and satiating concentration were recorded. The subsequent anti-accumulation procedure consisted of aggressive daily dose reductions under laboratory feedback (serum BZD concentration, radioimmunoassay) until accumulation stopped. The final overaccumulation ratio (OA) and maintenance-dose/loading-dose ratio (MTN) were estimated. The post-conversion peak-concentration/loading-dose ratio was illustratively compared with the concentration/dose ratio in 32 long-term diazepam users demonstrating the natural plateau. Results Despite gender- and age-related differences in loading and maintenance doses and in satiating and peak concentrations (higher in younger and male patients), their quotients remained similar. The MTN ratio had an average value of 0.29 and a median value of 0.25, with OA ratios of 1.54 and 1.39, respectively. The concentration/dose ratio was approximately 3 times lower than that in regular diazepam users. With effective elimination starting (on average) from the 6th day, the treatment, including post-elimination recovery, lasted on average 52 days. Conclusions The MTN values show how harmfully popular tapering schedules intensify and extend the high-concentration stage during alleged detoxification, leading to unrecognized delays in elimination, and delayed withdrawal crises. The common errors are discussed. An individual MTN, estimated from laboratory feedback (the anti-accumulation paradigm), expeditiously moves patients to the onset of actual detoxification. This action regains time to maintain medical assistance until treatment is properly completed. Supplementary Information The online version contains supplementary material available at 10.1007/s00228-022-03388-x.
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A protocol for a randomized controlled trial comparing Sleepwell, EMPOWER, and treatment-as-usual for benzodiazepine receptor agonist discontinuation in older adults: the your answers when needing sleep in New Brunswick (YAWNS NB) study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 7:100164. [PMID: 36045710 PMCID: PMC9420952 DOI: 10.1016/j.rcsop.2022.100164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Chronic benzodiazepine receptor agonist (BZRA) use among older adults is a public health concern given cognitive and physical risks. One in four older adults in New Brunswick, Canada, is a long-term user of BZRAs. Previous studies using a direct-to-patient approach as the primary intervention target have shown promise in reducing BZRA use. The Your Answers When Needing Sleep in New Brunswick (YAWNS NB) study aims to reduce the long-term use of BZRAs in older adults and increase the use of cognitive behavioural therapy for insomnia (CBTi), which is the recommended first line treatment. Methods The trial (ClinicalTrials.gov registration NCT04406103) is a three arm, open-label, parallel randomized controlled trial in NB, Canada. Eligible participants 65 years and older using BZRAs long-term will be randomly allocated to: the Eliminating Medications through Patient Ownership of End Results (EMPOWER) information package group; the Sleepwell information package group; or treatment-as-usual (TAU). Information packages will be mailed via Canada Post. The primary outcome of BZRA discontinuation at 6 months will be compared across groups. Secondary outcomes include participants with ≥25% BZRA dose reduction, and switching to newly prescribed alternate sedative-hypnotics. Several exploratory outcomes will also be examined. Discussion Targeting participants with information packages informing them of appropriate use, dangers, and approaches to reducing BZRA use and increasing CBTi use may be beneficial in a region of Canada with the highest rate of chronic BZRA use in older adults. Comparing information packages and TAU will provide insights into the effectiveness of direct-to-patient interventions for BZRA reduction.
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Matheson C, Robertson R. An avoidable crisis. Harm Reduct J 2022; 19:98. [PMID: 36038934 PMCID: PMC9422131 DOI: 10.1186/s12954-022-00680-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
In Scotland drug policy and consequently the progress of evidence-based treatment options has been struggling for many years. Political inaction is brought about by a complex chain of legal and operational obstructions with local authorities deferring to national Government which in turn is paralysed by international convention. Scotland represents a case study demonstrating the adverse consequences of management by non medical requirements rather than implementation of a clinically proven progressive policy. The difficulty of translating theory and evidence into practice is acknowledged but suggestions are made for pragmatic and humanitarian initiatives.
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Jones JD, Campbell AN, Brandt L, Metz VE, Martinez S, Wall M, Corbeil T, Andrews H, Castillo F, Neale J, Strang J, Ross S, Comer SD. A randomized clinical trial of the effects of brief versus extended opioid overdose education on naloxone utilization outcomes by individuals with opioid use disorder. Drug Alcohol Depend 2022; 237:109505. [PMID: 35709575 PMCID: PMC9472254 DOI: 10.1016/j.drugalcdep.2022.109505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Overdose education and naloxone distribution (OEND) trains people who use opioids (PWUO) in how to intervene in cases of opioid overdose but best practices have not been assessed empirically. METHODS PWUO along with a significant other (SO) were randomized to one of three training conditions. In the Treatment-as-Usual (TAU) condition, participants were randomized to receive minimal overdose-related education. In the extended training (ET) condition, PWUO received an extended training, while their SO received no overdose training. In the final condition, both the participant and SO received the extended overdose training (ETwSO). Outcome measures were naloxone use and overdose knowledge and competency assessed immediately before and after training, and at 1-, 3-, 6-, and 12-month timepoints following training. RESULTS Three hundred and twenty-one PWUO (w/ a SO) were randomized. All intensities of OD training were associated with sustained increases in OD knowledge/ competency (versus pre-training baseline p's < 0.01). PWUO intervened in 166 ODs. The 12-month incidence of naloxone use did not significantly differ between groups. Extended training (ET + ETwSO) compared to TAU resulted in significantly greater naloxone utilization by: 30 days (10.1% vs 4.1%, p = 0.041), 60 days (16.4% vs 5.2%, p<0.001) and 90 days (17.9% vs 9.5%, p = 0.039). CONCLUSIONS All intensities of OD training were associated with sustained increases in OD knowledge and competency, and equivalent rates of successful naloxone use. More extensive training increased naloxone utilization during the first 3 months. However, the benefits of more comprehensive training should be balanced against feasibility.
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Affiliation(s)
- Jermaine D. Jones
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA,Correspondence to: 1051 Riverside Drive, Unit 120, New York, NY 10032, USA. , (J.D. Jones)
| | - Aimee N. Campbell
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA
| | - Laura Brandt
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA
| | - Verena E. Metz
- Kaiser Permanente Division of Research, Center for Addiction and Mental Health Research, 2000 Broadway, Oakland, CA 94612, USA
| | - Suky Martinez
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA
| | - Melanie Wall
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Thomas Corbeil
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Felipe Castillo
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA
| | - Joanne Neale
- National Addiction Centre, King’s College London, 4 Windsor Walk, Denmark Hill, London SE5 8BB, United Kingdom
| | - John Strang
- National Addiction Centre, King’s College London, 4 Windsor Walk, Denmark Hill, London SE5 8BB, United Kingdom
| | - Stephen Ross
- Addictive Disorders and Experimental Therapeutics Research Laboratory, New York University Langone Health, New York, NY 10016, USA
| | - Sandra D. Comer
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA
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Wachełko O, Szpot P, Tusiewicz K, Nowak K, Chłopaś-Konowałek A, Zawadzki M. An ultra-sensitive UHPLC-QqQ-MS/MS method for determination of 54 benzodiazepines (pharmaceutical drugs, NPS and metabolites) and z-drugs in biological samples. Talanta 2022; 251:123816. [DOI: 10.1016/j.talanta.2022.123816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/25/2022] [Accepted: 08/02/2022] [Indexed: 11/28/2022]
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The Characteristics of Benzodiazepine Prescribing in the Republic of Srpska, Bosnia and Herzegovina. Medicina (B Aires) 2022; 58:medicina58080980. [PMID: 35893095 PMCID: PMC9332377 DOI: 10.3390/medicina58080980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Benzodiazepines (BZDs) are among the most prescribed psychotropic drugs and significant number of patients use these drugs for longer periods than recommended. The objective of this study was to determine the factors associated with prescribing of BZDs at the primary healthcare level. Materials and Methods: A retrospective analysis of family physicians’ prescriptions from the databases of family medicine teams of the Republic of Srpska was performed. The number of BZDs users, as well as the total number of prescriptions, were determined. Thereafter, it was determined which specific BZD had been prescribed, in which dose, for how long, as well as the specific social and demographic characteristics of patients to whom the drugs were prescribed. Results: The results showed that 38.47% of patients used the BZDs for a period longer than six months. The most frequent BZDs prescribed were the intermediate-acting BZDs, primarily bromazepam (58.69%). Two thirds of patients were women. The average age of the patients was 60, 60.46% of patients were single, and 69.68% lived in urban areas. The longer uses of BZDs were recorded in women, the elderly, single people and those who lived in urban areas, while higher doses of BZDs were prescribed to men, as well as younger and married people. The highest positive correlation was found between the dose and length of use of BZD. Conclusions: A significant percentage of patients used BZDs for a time period longer than recommended. Caution is necessary when prescribing BZDs to women, the elderly, patients that live in urban areas and patients who are single. When prescribing BZDs, family physicians should be aware of their potential interactions and addictive potentials.
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A double-blind randomised crossover trial of low-dose flumazenil for benzodiazepine withdrawal: A proof of concept. Drug Alcohol Depend 2022; 236:109501. [PMID: 35644071 DOI: 10.1016/j.drugalcdep.2022.109501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/11/2022] [Accepted: 05/14/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Benzodiazepines (BZD) are a class of anxiolytics with varying uses, which primarily act on the GABAA receptor resulting in hyperpolarisation. BZDs are often a difficult drug class to cease once neuroadaptation has occurred; recommendations usually involve gradual dose reductions at variable rates. A growing body of evidence has suggested that low-dose flumazenil, a GABAA receptor antagonist, may be a useful agent to allow for rapid detoxification. AIM To collect pilot data on the safety and efficacy of low-dose subcutaneous flumazenil to reduce BZD use, withdrawal symptoms, and craving in participants taking above and below the therapeutic maximum diazepam equivalent of 30 mg to inform on sample size for future trials. METHOD In a randomised double-blinded crossover study design, participants received low-dose flumazenil first (4 mg/24 h for approximately eight days) or placebo first. Groups were divided into those taking < 30 mg diazepam equivalent and ≥ 30 mg diazepam equivalent at baseline. Main outcome measures were percentage reduction in daily diazepam use, withdrawal symptoms, and craving scores from baseline, difference in diazepam use across the placebo first group, and flumazenil related adverse events. RESULTS Twenty-eight participants were recruited and randomised to flumazenil first (n = 14) and placebo first (n = 14). In participants taking ≥ 30 mg diazepam equivalent at baseline (n = 15), flumazenil significantly reduced diazepam use by 30.5% (p = 0.024) compared to placebo. CONCLUSION Low-dose flumazenil may aid in BZD detoxification in participants taking daily diazepam equivalent doses greater than or equal to the therapeutic maximum (≥30 mg) by reducing the need for diazepam.
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Grimmsmann T, Kostev K, Himmel W. The Role of Private Prescriptions in Benzodiazepine and Z-Drug Use. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:380-381. [PMID: 36045552 PMCID: PMC9487712 DOI: 10.3238/arztebl.m2022.0151] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 11/11/2021] [Accepted: 02/14/2022] [Indexed: 06/15/2023]
Affiliation(s)
| | | | - Wolfgang Himmel
- Department of General Practice, University Medical Center Göttingen
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Wurf G, O’Neal P. Community‐based
counselling for benzodiazepine withdrawal: A mixed‐methods study of client outcomes. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gerald Wurf
- School of Educational Psychology and Counselling Monash University Melbourne Victoria Australia
| | - Paul O’Neal
- School of Educational Psychology and Counselling Monash University Melbourne Victoria Australia
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Baldwin DS. Clinical management of withdrawal from benzodiazepine anxiolytic and hypnotic medications. Addiction 2022; 117:1472-1482. [PMID: 34542216 DOI: 10.1111/add.15695] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/22/2021] [Indexed: 11/30/2022]
Abstract
Benzodiazepines continue to be prescribed widely in the management of patients with insomnia or anxiety disorders, despite the availability and acceptability of alternative pharmacological and psychological treatments. Many patients will experience adverse effects during treatment and considerable distress when the dosage is reduced and stopped. Management of benzodiazepine withdrawal includes measures to prevent the development of dependence, careful attention to underlying medical conditions, medication consolidation and gradual dosage reduction, accompanying psychological interventions, occasional prescription of concomitant medication, and relapse prevention with on-going support to address psychosocial stressors. There are needs for easier patient access to services with refined expertise and for further research to optimise strategies for preventing dependence and facilitating withdrawal.
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Affiliation(s)
- David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Mood and Anxiety Disorders Service, Southern Health NHS Foundation Trust, Southampton, UK
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43
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Amundsen EJ, Bretteville-Jensen AL, Rossow I. Patients admitted to treatment for substance use disorder in Norway: a population-based case-control study of socio-demographic correlates and comparative analyses across substance use disorders. BMC Public Health 2022; 22:792. [PMID: 35443672 PMCID: PMC9020072 DOI: 10.1186/s12889-022-13199-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/30/2022] [Indexed: 11/26/2022] Open
Abstract
Background Improved knowledge regarding socio-demographic correlates of people with substance use disorders (SUDs) is essential to better plan and provide adequate services for SUD patients and their families, and to improve our understanding of the complex mechanisms underlying progression into and development of various SUDs. This study aimed to: i) describe demographic, economic, and social correlates of people with SUDs in comparison with those of the general population and ii) compare these correlates across SUDs from licit versus illicit substances, as well as across specific SUDs. Methods A national population-based case–control study included all SUD patients enrolled in specialized drug treatment in Norway in 2009–2010 (N = 31 245) and a population control sample, frequency-matched on age and gender (N = 31 275). Data on education level, labour market participation, income level and sources, and family/living arrangement were obtained by linkages to national registers. Results Demographic, economic, and social correlates of SUD patients differed substantially from those of the general population, and across specific SUDs. Among SUD patients, those with illicit – as compared to licit – SUDs were younger (mean quotient = 0.72 [0.71–0.72]), more often had low education level (RR = 1.68 [1.63–1.73]), were less often in paid work (RR = 0.74 [0.72–0.76]) and had lower income (mean quotient = 0.61 [0.60–0.62]). Comparison of patients with different SUD diagnoses revealed substantial demographic differences, including the relatively low mean age among cannabis patients and the high share of females among sedatives/hypnotics patients. Opioid patients stood out by being older, and more often out of work, receiving social security benefits, and living alone. Cocaine and alcohol patients were more often better educated, included in the work force, and had a better financial situation. Conclusion Findings revealed substantial and important differences in socio-demographic correlates between SUD patients and the general population, between SUD patients with illicit and with licit substance use, and across specific SUD patient groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13199-5.
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Affiliation(s)
- Ellen J Amundsen
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, POB 222 Skøyen, 0213, Oslo, Norway.
| | - Anne Line Bretteville-Jensen
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, POB 222 Skøyen, 0213, Oslo, Norway
| | - Ingeborg Rossow
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, POB 222 Skøyen, 0213, Oslo, Norway
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44
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The association between benzodiazepine use and greater risk of neurocognitive impairment is moderated by medical burden in people with HIV. J Neurovirol 2022; 28:410-421. [PMID: 35389174 PMCID: PMC9470605 DOI: 10.1007/s13365-022-01076-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 03/12/2022] [Accepted: 03/23/2022] [Indexed: 11/22/2022]
Abstract
Benzodiazepine use is linked to neurocognitive impairment (NCI) in the general population and people with HIV (PWH); however, this relationship may depend on age-related factors such as medical comorbidities, which occur at an elevated rate and manifest earlier in PWH. We retrospectively examined whether chronological age or medical burden, a clinical marker for aging, moderated the relationship between benzodiazepine use and NCI in PWH. Participants were 435 PWH on antiretroviral therapy who underwent neurocognitive and medical evaluations, including self-reported current benzodiazepine use. A medical burden index score (proportion of accumulated multisystem deficits) was calculated from 28 medical deficits. Demographically corrected cognitive deficit scores from 15 neuropsychological tests were used to calculate global and domain-specific NCI based on established cut-offs. Logistic regressions separately modeled global and domain-specific NCI as a function of benzodiazepine x age and benzodiazepine x medical burden interactions, adjusting for current affective symptoms and HIV disease characteristics. A statistically significant benzodiazepine x medical burden interaction (p = .006) revealed that current benzodiazepine use increased odds of global NCI only among those who had a high medical burden (index score > 0.3 as indicated by the Johnson–Neyman analysis), which was driven by the domains of processing speed, motor, and verbal fluency. No age x benzodiazepine interactive effects on NCI were present. Findings suggest that the relationship between BZD use and NCI among PWH is specific to those with greater medical burden, which may be a greater risk factor for BZD-related NCI than chronological age.
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Xu X, Ye Y, Wang X, Xu J, Li C, Wang G, Zhu Y, Jiang H, Zhong N. Effectiveness and utility of an electronic intervention for appropriate benzodiazepine and Z-drugs prescription in psychiatric clinics: protocol for a multicentric, real-world randomised controlled trial in China. BMJ Open 2022; 12:e055341. [PMID: 35383066 PMCID: PMC8984047 DOI: 10.1136/bmjopen-2021-055341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Benzodiazepine receptor agonists (BZRAs), which include benzodiazepines and Z-drugs, are the most commonly prescribed psychotropic drugs worldwide, and their inappropriate use places a significant burden on public health. Given the widespread use of BZRAs in psychiatric settings, this condition may result from doctors' improper prescribing. Researchers have developed an electronic intervention system to assist psychiatrists in prescribing BZRAs appropriately. This study aims to determine the efficacy and utility of electronic intervention in reducing improper BZRAs prescriptions in real-world psychiatric outpatient settings. METHODS AND ANALYSIS A multicentre randomised controlled research study will be conducted in real-world settings with licensed psychiatrists with prescription qualifications from five of Chinese most significant regional hospitals that provide high-quality mental healthcare. Participants will be 1:1 randomly assigned to receive a 3-month electronic intervention (11 related information pushing and 3 online lectures) or be placed on a waiting list. The primary outcome is the change in the proportion of inappropriate BZRAs prescriptions between the baseline period (3 months before the intervention) and 3 months after the intervention. Secondary outcomes will be examined at baseline, the third month and the sixth month. The secondary outcomes include psychiatrists' knowledge and attitudes about appropriate BZRAs prescription, the associated side effects of BZRAs among patients and self-efficacy. To measure the utility, intervention assessment and system utilisation data from the intervention group were collected. ETHICS AND DISSEMINATION The institutional review board and ethics committees of Shanghai Mental Health Center, Second Xiangya Hospital, West China Hospital, Guangji Hospital and Wuhan Mental Health Center approved the study. After the study is completed, the results will be published in peer-reviewed journals or presented at conferences. If the educational materials are effective, they are available to the general public. TRIAL REGISTRATION NUMBER NCT03724669; Pre-results.
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Affiliation(s)
- Xiaomin Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujian Ye
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuyi Wang
- Mental Health Institute, the Second Xiangya Hospital, Central-South University, Changsha, China
| | - Jiajun Xu
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Chuanwei Li
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Gang Wang
- Wuhan Mental Health Center, Wuhan, China
| | - Youwei Zhu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haifeng Jiang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Na Zhong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Lee SH, Jeon SW, Shin C, Pae CU, Patkar AA, Masand PS, An H, Han C. Acute Efficacy and Safety of Escitalopram Versus Desvenlafaxine and Vortioxetine in the Treatment of Depression With Cognitive Complaint: A Rater-Blinded Randomized Comparative Study. Psychiatry Investig 2022; 19:268-280. [PMID: 35500900 PMCID: PMC9058271 DOI: 10.30773/pi.2021.0368] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/17/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to compare the efficacy and safety of escitalopram, vortioxetine, and desvenlafaxine for acute treatment of major depressive disorder (MDD) with cognitive complaint (CC). METHODS A total of 129 patients with MDD who also complained of CC were randomized evenly to either escitalopram, vortioxetine, or desvenlafaxine group and underwent a multi-center, six-week, rater-blinded, and head-to-head comparative trial. Differences in depressive symptoms following treatment were measured using the Hamilton Depression Rating Scale (HAMD) and the Montgomery-Åsberg Depression Rating Scale (MADRS). Subjective cognitive function and the presence of adverse events were assessed. RESULTS The three antidepressant treatment groups did not show significant differences in the improvement of depressive symptoms as measured by HAMD and MADRS. Desvenlafaxine treatment was associated with a superior treatment response rate in depressive symptoms compared to vortioxetine or escitalopram treatment. However, no significant differences were found in the remission rate of depressive symptoms. The three antidepressant treatment groups did not show significant differences in the improvement of CC. Adverse profiles of each treatment group were tolerable, with no significant differences. CONCLUSION In acute antidepressant treatment for MDD with CC, escitalopram, vortioxetine, and desvenlafaxine presented similar efficacy in relief of depressive symptoms; however, desvenlafaxine was associated with a superior treatment. Further studies are needed to confirm these results by investigating the therapeutic efficacy and safety profile of long-term antidepressant treatment of MDD with CC (Clinical Trial Registry, http://cris.nih.go.kr/cris/en/: KCT0002173).
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Affiliation(s)
- Seung-Hoon Lee
- Department of Psychiatry, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Sang Won Jeon
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheolmin Shin
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Chi-Un Pae
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ashwin A Patkar
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | | | - Hyonggin An
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Davies SJC, Rudoler D, de Oliveira C, Huang A, Kurdyak P, Iaboni A. Comparative safety of chronic versus intermittent benzodiazepine prescribing in older adults: A population-based cohort study. J Psychopharmacol 2022; 36:460-469. [PMID: 35102786 PMCID: PMC9066681 DOI: 10.1177/02698811211069096] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Benzodiazepine treatment recommendations for older adults differ markedly between guidelines, especially their advice on the acceptability of long-term use. AIMS Using population-based data we compared risks associated with chronic versus intermittent benzodiazepine usage in older adults. The primary outcome was falls resulting in hospital/emergency department visits. METHODS We undertook a retrospective population-based cohort study using linked healthcare databases in adults aged ⩾ 66 years in Ontario, Canada, with a first prescription for benzodiazepines. Chronic and intermittent benzodiazepine users, based on the 180 days from index prescription, were matched (1:2 ratio) by sex, age and propensity score, then followed for up to 360 days. Hazard ratios (HRs) for outcomes were calculated from Cox regression models. RESULTS A total of 57,041 chronic and 113,839 matched intermittent users were included. Hospitalization/emergency department visits for falls occurred during follow up in 4.6% chronic versus 3.2% intermittent users (HR = 1.13, 95% confidence interval (CI): 1.08 to 1.19; p < 0.0001). There were significant excess risks in chronic users for most secondary outcomes: hip fractures, hospitalizations/emergency department visits, long-term care admission and death, but not wrist fractures. Adjustment for benzodiazepine dosage had minimal impact on HRs. CONCLUSION Our study demonstrates evidence of significant excess risks associated with chronic benzodiazepine use compared to intermittent use. The excess risks may inform decision-making by older adults and clinicians about whether short- or long-term benzodiazepine use is a reasonable option for symptom management.
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Affiliation(s)
- Simon JC Davies
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Simon JC Davies, Geriatric Psychiatry Division, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON M6J 1H4, Canada.
| | - David Rudoler
- Centre for Addiction and Mental Health, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Claire de Oliveira
- Centre for Addiction and Mental Health, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Centre for Health Economics, Hull York Medical School, University of York, York, UK
| | | | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Centre for Addiction and Mental Health, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,ICES, Toronto, ON, Canada
| | - Andrea Iaboni
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
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Bromazepam increases the error of the time interval judgments and modulates the EEG alpha asymmetry during time estimation. Conscious Cogn 2022; 100:103317. [PMID: 35364385 DOI: 10.1016/j.concog.2022.103317] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 03/19/2022] [Accepted: 03/23/2022] [Indexed: 11/23/2022]
Abstract
AIM This study investigated the bromazepam effects in male subjects during the time estimation performance and EEG alpha asymmetry in electrodes associated with the frontal and motor cortex. MATERIAL AND METHODS This is a double-blind, crossover study with a sample of 32 healthy adults under control (placebo) vs. experimental (bromazepam) during visual time-estimation task in combination with electroencephalographic analysis. RESULTS The results demonstrated that the bromazepam increased the relative error in the 4 s, 7 s, and 9 s intervals (p = 0.001). In addition, oral bromazepam modulated the EEG alpha asymmetry in cortical areas during the time judgment (p ≤ 0.025). CONCLUSION The bromazepam decreases the precision of time estimation judgments and modulates the EEG alpha asymmetry, with greater left hemispheric dominance during time perception. Our findings suggest that bromazepam influences internal clock synchronization via the modulation of GABAergic receptors, strongly relating to attention, conscious perception, and behavioral performance.
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Casari R, Zamboni L, Fusina F, Lugoboni F. Letter to editor, a comment to: Prevalence and concentrations of sedative-hypnotic drugs in blood of drivers involved in road traffic crashes in the Padova region of Italy - Not so easy to interpret. Forensic Sci Int 2022; 332:111204. [PMID: 35091158 DOI: 10.1016/j.forsciint.2022.111204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/20/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Rebecca Casari
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy
| | - Lorenzo Zamboni
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy; Department of Neurosciences, University of Verona, Verona, Italy.
| | - Francesca Fusina
- Padova Neuroscience Center, University of Padova, Italy; Department of General Psychology, University of Padova, Italy
| | - Fabio Lugoboni
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy
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Bråbäck M, Brantefors A, Franck J, Brådvik L, Isendahl P, Nilsson S, Troberg K, Håkansson A. Substance Use, Hospitalizations, and Co-Occurring Disorders among Patients Transferred from a Needle Exchange Program to Opioid Maintenance Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020697. [PMID: 35055519 PMCID: PMC8775654 DOI: 10.3390/ijerph19020697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Abstract
Opioid use disorders (OUD) is a relapsing condition with high mortality. Opioid maintenance treatment (OMT) reduces heroin use, and overall morbidity and mortality. The prevalence of psychiatric and substance use disorders, potential baseline predictors for psychiatric hospitalization, and psychiatric diagnoses at follow-up were investigated and may give hints about possible preventative strategies. The medical records for 71 patients were reviewed 36 months following referral to OMT from a needle exchange program (NEP). Their psychiatric diagnoses and hospitalizations were identified. Their baseline characteristics were assessed for potential differences between hospitalized versus non-hospitalized patients and between patients with and without psychiatric diagnoses in a longitudinal observational study without controls. A regression analysis was performed to identify predictors for hospitalization when controlling for OMT status. Sixty-five percent of the patients were hospitalized at least once with a psychiatric diagnosis. Substance-related reasons were prevalent, and detoxification occurred among 59% of patients, with sedative- hypnotics (benzodiazepines, zopiclone, zolpidem, and pregabalin) being the substance used by 52% of patients. Baseline use of these drugs and/or buprenorphine predicted for hospitalization when controlling for OMT status. During the follow-up period, 72% of patients met the criteria for a psychiatric diagnosis other than OUD. The prevalence of non-substance use disorders overlapping with SUD was 41%, and that overlapping with anxiety disorder was 27% of all participants. Increased attention to psychiatric co-occurring disorders in the treatment of OUD is required and the importance of addressing sedative-hypnotics use when initiating OMT is highlighted.
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Affiliation(s)
- Martin Bråbäck
- Department of Clinical Sciences Lund, Faculty of Medicine, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden; (M.B.); (A.B.); (L.B.); (K.T.); (A.H.)
- Addiction Center Malmö, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden;
| | - Anna Brantefors
- Department of Clinical Sciences Lund, Faculty of Medicine, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden; (M.B.); (A.B.); (L.B.); (K.T.); (A.H.)
- Addiction Center Malmö, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden;
| | - Johan Franck
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, SE171 77 Solna, Sweden;
| | - Louise Brådvik
- Department of Clinical Sciences Lund, Faculty of Medicine, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden; (M.B.); (A.B.); (L.B.); (K.T.); (A.H.)
- Correspondence: ; Tel.: +46-46-7332410
| | - Pernilla Isendahl
- Department of Infectious Diseases, University Hospital Skåne, SE205 02 Malmö, Sweden;
| | - Suzan Nilsson
- Addiction Center Malmö, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden;
| | - Katja Troberg
- Department of Clinical Sciences Lund, Faculty of Medicine, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden; (M.B.); (A.B.); (L.B.); (K.T.); (A.H.)
- Addiction Center Malmö, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden;
| | - Anders Håkansson
- Department of Clinical Sciences Lund, Faculty of Medicine, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden; (M.B.); (A.B.); (L.B.); (K.T.); (A.H.)
- Addiction Center Malmö, Division of Psychiatry, Lund University, SE222 41 Lund, Sweden;
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