Co-prescribed benzodiazepines present risks among older adults with depression, anxiety

Co-prescribed benzodiazepines appeared to present treatment challenges among older adults with generalized anxiety disorder or major depressive disorder, according to study results published in Journal of Clinical Psychiatry.

“In midlife adults, several trials have shown that benzodiazepine use does not worsen antidepressant treatment outcomes and may actually improve antidepressant treatment outcomes,” Helene Altmann, BA, of the department of psychiatry at the University of Pittsburgh School of Medicine, and colleagues wrote. “Similar results have been reported in [one] trial in older adults co-prescribed lorazepam with nortriptyline pharmacotherapy.28 However, there is a paucity of data on how benzodiazepine co-prescription impacts antidepressant outcomes in depressed and anxious older adults.”

Late-life antidepressant pharmacotherapy is recommended as a first-line treatment for anxiety and depressive disorders, with approximately 12.5% of adult patients in the United States who receive antidepressant pharmacotherapy co-prescribed benzodiazepines.

In the current transdiagnostic analysis, Altmann and colleagues aimed to assess the effect of benzodiazepines on treatment outcomes among older patients with generalized anxiety disorder and MDD. They conducted secondary analyses of data from two clinical trials of antidepressant pharmacotherapy for generalized anxiety disorder, which compared escitalopram with placebo, and MDD, which involved open treatment with venlafaxine. They analyzed data of 177 participants with generalized anxiety disorder and 463 participants with MDD according to DSM-IV criteria. Participants were aged 60 years or older. The researchers collected benzodiazepine data at baseline and assessed adherence and treatment response over 12 weeks. In the analysis, they assessed whether co-prescription of benzodiazepines was associated with antidepressant medication adherence, dropout, treatment response, final dose of antidepressant medication and report of antidepressant-related adverse events.

Results showed a lower likelihood for trial completion among participants with generalized anxiety disorder who were co-prescribed benzodiazepines, and these participants were treated with a lower mean dosage of escitalopram. However, the investigators observed no difference in adherence or treatment response. Those with MDD who were co-prescribed benzodiazepines were less likely to tolerate a therapeutic dose of venlafaxine and reported higher rates of adverse events related to the medication. However, Altmann and colleagues reported no difference in adherence, dropout or treatment response.

“This analysis could not clarify the direction of the causal relationships underlying these findings,” they wrote. “In light of the risks of benzodiazepines in older adults, their potential benefits (e.g., acute relief of anxiety or insomnia and prevention of early dropouts) continue to require a judicious individual assessment and decision in each older patient.”