Pill Problems: Some Patients May Not Need Anti-Anxiety Rx

Benzodiazepine use was high in older adults and increased with age, despite safety concerns

(RxWiki News) They relieve anxiety and help many patients sleep, but benzodiazepines might not be the best choice for many patients — especially over the long term. Still, many older patients were taking these medications. 

A new study found that, despite concerns about use in older patients, anti-anxiety benzodiazepines are used most often by people older than 65.

"Anxiety is perhaps one of the most common emotional states experienced by older adults. The reasons are many and include issues relating to stage of life, physical health problems, isolation and demoralization," said Psychiatrist Radha K. Kambhampati, MD, MPH, is medical director of senior behavioral health at Baylor Medical Center at Irving.

"Benzodiazepines are very effective in reducing anxiety, but their use is associated with several problems or side effects," said Dr. Kambhampati, who was not involved in this study. "The risk of falls, impaired concentration and memory issues are chief among them. Some benzodiazepines have long half lives (they stay in the system for extended periods of time) and can cause significant side effects."

All benzodiazepines can be habit forming, Dr. Kambhampati told dailyRx News. "Once addicted, it is not easy to come off of them. Stopping them abruptly can lead to withdrawal symptoms, including potential for seizures," he said.

"Use of these medicines should be limited to short periods. If one needs to use a medication to control anxiety for a longer period, there are better options. Many antidepressants are also very good at helping with anxiety and should be considered for long-term maintenance," he said.

The authors of this new study, which was led by Mark Olfson, MD, of the New York State Psychiatric Institute in New York City, said that more patient education and periodic assessments of whether benzodiazepines are still necessary could cut down use of these medications in older patients.

Dr. Olfson and colleagues wanted to gain a better understanding of patterns of benzodiazepine use in the US. To do so, they looked at data from the 2008 LifeLink LRx Longitudinal Prescription database. This database included information from around 60 percent of retail pharmacies in the US.

Dr. Olfson and team identified adults who filled one or more benzodiazepine prescription during 2008 and separated them into age groups. This data was then combined with population data to provide benzodiazepine use estimates for the entire US.

Benzodiazepines are a type of medication often used to treat anxiety and sleep problems. Common benzodiazepines include alprazolam (brand name Xanax), clonazepam (Klonopin) and diazepam (Valium).

These researchers estimated that, overall, 5.2 percent of all adults in the US between the ages of 18 to 80 used benzodiazepines. As they looked at different age groups, the rate appeared to increase with age.

Among adults between the ages of 18 and 35, 2.6 percent used the medications. The same was true of 5.4 percent of adults between the ages of 36 and 50, 7.4 percent of adults between the ages of 51 and 64, and 8.7 percent of adults between the ages of 65 and 80.

Among benzodiazepine users, rates of long-term use (use for more than 120 days) also increased with age — from 14.7 percent of users between ages 18 and 35 up to 31.4 percent of users between ages 65 and 80.

In an editorial about this study, Nicholas Moore, MD, PhD, of the Université De Bordeaux in France, and colleagues suggested that benzodiazepines should be more strongly regulated.

"Benzodiazepines are drugs that should be used at most for a few days or weeks in selected patients, carefully monitored, and stopped as soon as possible ..." Dr. Moore and team wrote.

Patients should speak with their doctors before starting or stopping benzodiazepine use.

The study and editorial were published online Dec. 17 in JAMA Psychiatry.

A number of sources funded the study, such as the National Institutes of Health and the New York State Psychiatric Institute. The authors disclosed no conflicts of interest.


Review Date: 
December 16, 2014