Question

Benzodiazepines are commonly prescribed medications for several indications, including anxiety and sleep disorders. Let's discuss their use in our health care systems and the impact on our patients.

Things to consider might include :

Safety: How could the side effect profile affect your patients?

Efficacy: Are benzodiazepines efficacious for anxiety and sleep?

Use: Are they under or over prescribed? How can we ensure safe use of these medications?

Consider the following case:

A 49-year-old male who suffered a myocardial infarction one week ago. Upon discharge, it was noted that he appeared depressed. At a follow-up visit with his physician a week later, he met criteria for a diagnosis of major depressive disorder. His past medical history includes: treatment refractory hypertension, diabetes mellitus (type II), and severe uncontrolled narrow angle glaucoma

• How would you help him assuming he meets the criteria for Major Depressive Disorder?

Answer 1

1.Safety :

Among all BZDs, common side effects include drowsiness, lethargy and fatigue. Impaired muscle control, dizziness, vertigo, slurred speech, distorted vision, mood swings, and euphoria can occur at higher dosages, as may in some cases be aggressive or abnormal behaviour.

2.Efficacy :

BZDs have been shown to be reasonably efficacious for the short-term treatment of GAD, PD, SAD and insomnia, but long-term effectiveness is unproven while the risk of physical dependency and addiction is.

3.

It is advised that doctors not prescribe a benzodiazepine for more than two weeks due to its highly addictive nature. Unfortunately not always met this norm. After a few weeks, doctors can also raise the dose as tolerance thresholds are reached.

The effects are also expressed in the form of a strong addiction to benzodiazepines, thanks to a growing tolerance.Many that have reached this degree of dependency face a long recovery journey. It's also virtually impossible to go cold-turkey. This results in severe symptoms of withdrawal.

These include anxiety, weakening panic, anxiety, sleep disturbance, problems with memory, extreme depression, weakness , fatigue and dizziness.

Usually, incremental reduction is advised when working on breaking a benzo dependency.

4.

Duringthe 2-week duration, the person must experience five or more symptoms and at least one of the symptoms should be either (1) depressed mood or (2) lack of interest or pleasure.

Depressed environment most of the day, almost every day.

Interest or enjoyment in all, or almost all, tasks declined markedly most of the day, almost every day.

Depressed environment most of the day, almost every day.

Interest or enjoyment in all, or almost all, tasks declined markedly most of the day, almost every day.

Tiredness or lack of energy almost every day.

Nearly every day, feelings of worthlessness or unnecessary or improper remorse.

Decreased ability to focus or concentrate almost every day, or indecisiveness.

Recurrent thoughts of death, recurrent ideation of suicide without a concrete plan, or attempted suicide or a specific plan to commit suicide.