Effectiveness of current treatment approaches for benzodiazepine discontinuation: a meta-analysis
- PMID: 18983627
- DOI: 10.1111/j.1360-0443.2008.02364.x
Effectiveness of current treatment approaches for benzodiazepine discontinuation: a meta-analysis
Abstract
Aims: To assess the effectiveness of current treatment approaches to assist benzodiazepine discontinuation.
Methods: A systematic review of approaches to benzodiazepine discontinuation in general practice and out-patient settings was undertaken. Routine care was compared with three treatment approaches: brief interventions, gradual dose reduction (GDR) and psychological interventions. GDR was compared with GDR plus psychological interventions or substitutive pharmacotherapies.
Results: Inclusion criteria were met by 24 studies, and a further eight were identified by future search. GDR [odds ratio (OR) = 5.96, confidence interval (CI) = 2.08-17.11] and brief interventions (OR = 4.37, CI = 2.28-8.40) provided superior cessation rates at post-treatment to routine care. Psychological treatment plus GDR were superior to both routine care (OR = 3.38, CI = 1.86-6.12) and GDR alone (OR = 1.82, CI = 1.25-2.67). However, substitutive pharmacotherapies did not add to the impact of GDR (OR = 1.30, CI = 0.97-1.73), and abrupt substitution of benzodiazepines by other pharmacotherapy was less effective than GDR alone (OR = 0.30, CI = 0.14-0.64). Few studies on any technique had significantly greater benzodiazepine discontinuation than controls at follow-up.
Conclusions: Providing an intervention is more effective than routine care. Psychological interventions may improve discontinuation above GDR alone. While some substitutive pharmacotherapies may have promise, current evidence is insufficient to support their use.
Comment in
-
Coming off tranquillizers: a Sisyphean toil.Addiction. 2009 Jan;104(1):25-6. doi: 10.1111/j.1360-0443.2008.02402.x. Addiction. 2009. PMID: 19133885 No abstract available.
-
Review: brief interventions, gradual dose reduction and psychological interventions increase benzodiazepine cessation compared with routine care.Evid Based Ment Health. 2009 Aug;12(3):91. doi: 10.1136/ebmh.12.3.91. Evid Based Ment Health. 2009. PMID: 19633259 No abstract available.
Similar articles
-
Pregabalin as adjunctive therapy in benzodiazepine discontinuation.Am J Health Syst Pharm. 2018 Jan 15;75(2):67-71. doi: 10.2146/ajhp160712. Am J Health Syst Pharm. 2018. PMID: 29317396 Review.
-
Interventions for reducing benzodiazepine use in older people: meta-analysis of randomised controlled trials.Br J Psychiatry. 2014 Feb;204(2):98-107. doi: 10.1192/bjp.bp.113.126003. Br J Psychiatry. 2014. PMID: 24493654 Review.
-
Withdrawal from long-term benzodiazepine use: randomised trial in family practice.Br J Gen Pract. 2006 Dec;56(533):958-63. Br J Gen Pract. 2006. PMID: 17132385 Free PMC article. Clinical Trial.
-
Strategies for discontinuing long-term benzodiazepine use: meta-analysis.Br J Psychiatry. 2006 Sep;189:213-20. doi: 10.1192/bjp.189.3.213. Br J Psychiatry. 2006. PMID: 16946355 Review.
-
Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia.Am J Psychiatry. 2004 Feb;161(2):332-42. doi: 10.1176/appi.ajp.161.2.332. Am J Psychiatry. 2004. PMID: 14754783 Clinical Trial.
Cited by
-
Discontinuation of psychotropic medication: a synthesis of evidence across medication classes.Mol Psychiatry. 2024 Mar 19. doi: 10.1038/s41380-024-02445-4. Online ahead of print. Mol Psychiatry. 2024. PMID: 38503923 Review.
-
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 Apr 1;20(4):603-613. doi: 10.5664/jcsm.10946. J Clin Sleep Med. 2024. PMID: 38063235
-
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 Nov 4;23(1):1205. doi: 10.1186/s12913-023-10201-7. BMC Health Serv Res. 2023. PMID: 37925423 Free PMC article.
-
Reduction of Sleep Medications via a Combined Digital Insomnia and Pharmacist-Led Deprescribing Intervention: Protocol for a Feasibility Trial.JMIR Res Protoc. 2023 Jul 20;12:e47636. doi: 10.2196/47636. JMIR Res Protoc. 2023. PMID: 37471122 Free PMC article.
-
"Stabilise-reduce, stabilise-reduce": A survey of the common practices of deprescribing services and recommendations for future services.PLoS One. 2023 Mar 15;18(3):e0282988. doi: 10.1371/journal.pone.0282988. eCollection 2023. PLoS One. 2023. PMID: 36920968 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Miscellaneous