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Strategies for discontinuing long-term benzodiazepine use

Meta-analysis

Department of Psychiatry, Radboud University Nijmegen Medical Center, Nijmegen

Jaap E. Couvée, PhD

GlaxoSmithKline, Zeist

Anton J. L. M. Van Balkom, MD, PhD

Department of Psychiatry and Institute for Research and Extramural Medicine, Free University Medical Centre, Amsterdam

Paul G. H. Mulder, PhD

Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam

Frans G. Zitman, MD, PhD

Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands

Correspondence: Dr J. E. Couvée, Head Clinical Development CNS, Anti-Infectives and Oncology, GlaxoSmithKline, Medical Department, Huis ter Heideweg 62, 3705 LZ Zeist, The Netherlands. Tel: +31 30 6938145; fax: +31 30 6938459; email: jaap.e.couvee{at}gsk.com

Declaration of interest None.

Background The prevalence of benzodiazepine consumption in European countries remains at 2-3% of the general population despite the well-documented disadvantages of long-term use.

Aims To review systematically the success rates of different benzodiazepine discontinuation strategies.

Method Meta-analysis of comparable intervention studies.

Results Twenty-nine articles met inclusion criteria. Two groups of interventions were identified; minimal intervention (e.g. giving simple advice in the form of a letter or meeting to a large group of people; n=3), and systematic discontinuation (defined as treatment programmes led by a physician or psychologist; n=26). Both were found to be significantly more effective than treatment as usual: minimal interventions (pooled OR=2.8, 95% CI 1.6-5.1); systematic discontinuation alone (one study, OR=6.1, 95% CI 2.0-18.6). Augmentation of systematic discontinuation with imipramine (two studies, OR=3.1, 95% CI 1.1-9.4) or group cognitive-behavioural therapy for patients with insomnia (two studies, OR=5.5, 95% CI 2.3-14.2) was superior to systematic discontinuation alone.

Conclusions Evidence was found for the efficacy of stepped care (minimal intervention followed by systematic discontinuation alone) in discontinuing long-term benzodiazepine use.