Simultaneous benzodiazepine, SSRI initiation fairly common for anxiety

Simultaneous initiation of benzodiazepine and selective serotonin reuptake inhibitor treatment was somewhat common among young adults with anxiety disorders, according to study results published in Journal of Clinical Psychiatry.

This initiation was not linked to longer SSRI persistence.

“We knew that co-prescribing benzodiazepines and SSRI antidepressants was a treatment strategy for anxiety disorders, but it was not clear how often this treatment strategy was used,” Greta A. Bushnell, PhD, assistant professor of epidemiology at Rutgers School of Public Health in New Jersey, told Healio Psychiatry. “We were specifically interested in looking at adolescents and young adults given concerns around benzodiazepine misuse and little evidence on the efficacy of benzodiazepines and co-prescribing in this age group.”

Bushnell and colleagues used a U.S. commercial claims database to obtain data from between 2008 and 2018 of 94,399 adolescents aged 10 to 17 years and 130,971 young adults aged 18 to 24 years with ICD-9-CM/ICD-10-CM anxiety disorder diagnoses. Included participants had initiated SSRI treatment and did not have past-year SSRI and benzodiazepine treatment. The researchers defined simultaneous initiation as filling a new benzodiazepine prescription on the data of SSRI initiation. They calculated time to discontinuation of SSRI treatment and used stabilized inverse probability of treatment weighting for adjusted estimates.

Results showed 4% of adolescents and 17% of young adults had simultaneous initiation of benzodiazepine treatment, with variance by age, anxiety disorder, comorbidities, health care utilization and provider type. Simultaneous benzodiazepine initiation among those who initiated SSRIs decreased between 2008 and 2016. The researchers noted similar duration of SSRI treatment duration among initiators of simultaneous therapy compared with SSRI monotherapy, which was 6 months or longer among adolescents (55% compared with 56%, respectively) and young adults (39% compared with 40%, respectively). Nine percent of those with simultaneous initiation continued benzodiazepines for 6 months or longer.

“Careful consideration of the benefits and harms of co-prescribing benzodiazepines at SSRI initiation is needed in young populations, particularly since no increase in SSRI duration was observed,” Bushnell said. “Further, by detailing how frequently co-prescribing benzodiazepines with SSRIs occurs in young populations, these findings will hopefully encourage development of specific recommendations around co-prescribing in young populations.”