Study, May/18: Review of adjunctive pharmacologic approaches for benzo tapers

https://www.ncbi.nlm.nih.gov/pubmed/29906718 

 

2018 May 31;189:96-107. doi: 10.1016/j.drugalcdep.2018.04.028. [Epub ahead of print]

 

Review: Adjunctive pharmacologic approaches for benzodiazepine tapers.

 

Welsh JW1, Tretyak V2, McHugh RK3, Weiss RD3, Bogunovic O3.

 

Author information

 

1

    Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Dr. NE, Suite 200, Atlanta, GA 30329, USA. Electronic address: Justine.Welsh@Emory.edu.

2

    Department of Psychology, University of Texas at Austin, 108 E Dean Keeton St, Austin, TX 78712, USA.

3

    Division of Alcohol and Drug Abuse, McLean Hospital, Harvard Medical School, 115 Mill St, Belmont, MA 02478, USA.

 

Abstract

 

BACKGROUND:

 

Many patients require discontinuation of benzodiazepines due to a reduction in drug efficacy over time, the development of a sedative use disorder, or unwanted side effects. Benzodiazepine discontinuation can pose a significant challenge for prescribing clinicians due to potential withdrawal symptoms and a recurrence of psychiatric complaints.

 

METHODS:

 

A PubMed literature search was conducted using the medical subject heading of benzodiazepines in combination with the following key words: discontinuation, withdrawal, detoxification, cessation, dependence, addiction, substance use disorders, or long term. Twenty-one studies met the search criteria.

 

RESULTS:

 

Few medications facilitated the successful discontinuation of benzodiazepines or relief from benzodiazepine withdrawal symptoms.

 

CONCLUSIONS:

 

Studies were heterogeneous with respect to sample selection, sample size, and outcome measures. Medications targeting insomnia yielded mixed results. Similarly, studies of agents targeting anxiety symptoms demonstrated inconsistent findings in the reduction of anxiety, improvement in withdrawal symptoms, or enhancement of benzodiazepine completion rates. Anticonvulsants have supporting evidence from small case reports; carbamazepine shows some potential in assisting taper completion and reducing withdrawal severity. These conclusions should be considered in light of a number of inconsistencies across studies in the literature. The results of this review article highlight the need for additional research on optimal strategies for facilitating successful benzodiazepine tapers.

 

WOW! Thanks so much for this, Lapis! Finally, something that points to how very difficult withdrawal can be. I'm hoping that this will lead to more studies and research. Maybe I'm being overly optimistic, but I believe the time has come to find answers we so desperately need.

You're welcome, Terry. I know everyone wants to find some sort of miracle drug or cure to make withdrawal easier, but from the available studies, it appears that that is elusive. Maybe the brain just needs time to heal on its own -- that is, without additional chemical inputs. I do hope there will be more studies, and perhaps, some helpful options.

It's so hard for all of us to keep playing the waiting game. If the researchers find out the time is the only answer, hopefully it will filter down to the doctors who see patients so that they won't prescribe these pills long-term. In my mind a person can become dependent earlier than the four-week outer time period. I think they should only be prescribed for one week max. But the problem is that, being in the honeymoon period of one week, the patient tends to think it's a wonder drug and wouldn't want to part with it. Then there are those people who come away unscathed. I think genetic research would be ideal, but where is the funding for that?

It's so hard for all of us to keep playing the waiting game. If the researchers find out the time is the only answer, hopefully it will filter down to the doctors who see patients so that they won't prescribe these pills long-term. In my mind a person can become dependent earlier than the four-week outer time period. I think they should only be prescribed for one week max. But the problem is that, being in the honeymoon period of one week, the patient tends to think it's a wonder drug and wouldn't want to part with it. Then there are those people who come away unscathed. I think genetic research would be ideal, but where is the funding for that?

 

I think that it would be good to press the issue with the medical community that even many people who walked away from benzos unscathed earlier in their life can get very sick the next time around when those pills are prescribed. People come off fine with this illusion of safety, only to be trapped the next time around.

Yes, it would be helpful if the prescribing doctors understood the concepts of kindling, tolerance and dependence with regards to benzos. With all of the literature that's currently out there, there's no excuse not to. Pharmacists, too, should be well-versed in this information and should be actively teaching it to each and every person who arrives with a benzo prescription.

I agree with both of you. There's no reason why doctors should be in the dark about this. And so many people have taken a benzo one time or a couple of times and thought it was a good drug, then were slammed with symptoms that could take months or years to diminish. A very good point to bring up, Loraz!