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Chronic benzodiazepine use in general practice patients with depression: an evaluation of controlled treatment and taper-off

Report on behalf of the Dutch Chronic Benzodiazepine Working Group

Departments of Psychiatry, Leiden, and UMC St Radbond, Nijmegen, The Netherlands

JAAP E. COUVÉE, MSc

Medical Department, Smith Kline Beecham Farma bv, Rijswijk, The Netherlands

Correspondence: F.G. Zitman, LUMC, Department of Psychiatry, BIP, PO Box 9600, 2300 RC Leiden, The Netherlands. Tel: +31 71 526 3448; fax: +31 71 524 8156; e-mail: f.g.zitman{at}lumc.nl

Declaration of interest J.E.C. is employed by Smith Kline Beecham. Smith Kline Beecham Farma bv, The Netherlands, funded the study.

^1. For the purposes of this study, zopiclone prescribed as a hypnotic was included in the benzodiazepine group.

Background Many patients with depression take benzodiazepine drugs long term despite the absence of continuing therapeutic value.

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

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

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

Conclusions Transfer to diazepam followed by gradual withdrawal is an effective way of discontinuing chronic benzodiazepine use. The addition of SSRI treatment is of limited value.

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