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Nearly 1 in 10 patients treated for MDD receive benzodiazepine monotherapy

Researchers found that nearly one in 10 patients receiving treatment for depression were prescribed benzodiazepine monotherapy.

Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, mirtazapine, bupropion, and, more recently, Trintellix (vortioxetine, Takeda) are recognized as first-line pharmacotherapeutic options for major depression disorder; however evidence supporting the use of benzodiazepines as an antidepressant is conflicting, Mate M. Soric, PharmD, BCPS, from Northeast Ohio Medical University College of Pharmacy, and colleagues wrote in Journal of Clinical Psychiatry.

“Whereas practice guidelines consider antidepressants and psychotherapy as primary treatment options, they either do not mention or fail to endorse benzodiazepine monotherapy for the treatment of MDD,” Soric and colleagues wrote.

The researchers analyzed data from the National Ambulatory Medical Care Survey (2012 to 2015) to determine the prevalence and predictors of prescribing benzodiazepine monotherapy to adults with depression. Specifically, they examined the benzodiazepine monotherapy prescribing rate, defined as starting or continuing benzodiazepine in the absence of any antidepressant agent, and identified variables linked to benzodiazepine monotherapy using a multivariate logistic regression model.

Of 9,426 patients treated for MDD included in this analysis, Soric and colleagues identified benzodiazepine monotherapy in 9.3% of patients (95% CI, 8.2%–10.6%). Predictors of benzodiazepine monotherapy among patients treated for depression were:

• being aged 45 to 64 years (OR = 1.39; 95% CI, 1.01-1.91) vs. age 25 to 44 years;
• having Medicare (OR = 1.4; 95% CI, 1.01-1.94) vs. private insurance;
• epilepsy (OR = 5.34; 95% CI, 1.39-20.44);
• anxiety (OR = 1.67; 95% CI, 1.23-2.27);
• underlying pulmonary disease (OR = 1.43; 95% CI, 1.09-1.87); and
• concurrent opiate prescribing (OR = 2.86; 95% CI, 2.01-4.06).

However, patients completing a depression screen (OR = 0.68; 95% CI, 0.46-1) and those seen by psychiatrists were less likely to be prescribed benzodiazepine monotherapy (OR = 0.42; 95% CI, 0.29-0.61).

“For patients treated for MDD, benzodiazepine monotherapy very likely continues to be utilized in a guideline-discordant manner,” Soric and colleagues wrote. “On the basis of this study, educational or technological interventions to minimize benzodiazepine monotherapy utilization should be implemented to raise awareness of the impact of this treatment modality on patients with MDD.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.