Study, May/19: Prevalence of Benzodiazepine Monotherapy in Depressed Patients

The full title of this American study is "Prevalence and Predictors of Benzodiazepine Monotherapy in Patients With Depression: A National Cross-Sectional Study".

https://www.ncbi.nlm.nih.gov/pubmed/31120203 

Abstract

OBJECTIVE:

Depression guidelines discourage benzodiazepine monotherapy and limit use to short-term adjunctive therapy with antidepressants; however, patients with depression continue to receive benzodiazepine monotherapy. The prevalence and predictors of this prescribing pattern have not been described previously and are warranted to assist clinicians in identifying patients at highest risk of receiving benzodiazepine monotherapy.

METHODS:

A national, cross-sectional analysis of the National Ambulatory Medical Care Survey from 2012 to 2015 was performed for adults treated for depression. Depression was identified using a survey item specifically assessing the presence of depression. Office visits involving patients with bipolar disorder, schizoaffective disorder, or pregnancy were identified by ICD-9 code or specific survey item and were excluded. The primary endpoint was benzodiazepine monotherapy prescribing rate defined as initiation or continuation of a benzodiazepine in the absence of any antidepressant agent. A multivariate logistic regression model was created to identify variables associated with benzodiazepine monotherapy.

RESULTS:

In total, 9,426 unweighted visits were eligible for inclusion. Benzodiazepine monotherapy was identified in 9.3% of patients treated for depression (95% CI, 8.2%-10.6%). Predictors of benzodiazepine monotherapy included age of 45-64 years (OR = 1.39; 95% CI, 1.01-1.91), epilepsy-related office visit (OR = 5.34; 95% CI, 1.39-20.44), anxiety-related office visit (OR = 1.67; 95% CI, 1.23-2.27), underlying pulmonary disease (OR = 1.43; 95% CI, 1.09-1.87), and concomitant opiate prescribing (OR = 2.86; 95% CI, 2.01-4.06). Psychiatrists were less likely to prescribe benzodiazepine monotherapy than were other providers (OR = 0.42; 95% CI, 0.29-0.61).

CONCLUSIONS:

Benzodiazepine monotherapy is utilized in nearly 1 in 10 patients treated for depression. Adults aged 45 to 65 years, patients prescribed opioids, patients seen by primary care providers, and those with underlying anxiety, epilepsy, or pulmonary disorders are at highest risk.

Learning the hard way about interplay of withdrawal, and hypothyroidism. I think Ive learned info that is applicable here, and generally to all in withdrawal.

Never knew this before, but thyroid hormone acts on some of the same receptors as SSRIs.  In other words, proper levels of thyroid help prevent depression, etc.  Most people report issues with panic attacks, and depression following huge life events- divorce, death, or severe physical ailments.  All of these stressors can severely diminish the thyroid's ability to cope. If thyroid drops, you can't sleep, no energy, weight gain, can't think. When that fails, the adrenals try to take over.  This can cause huge surges of adrenalin into the system.  The effects: sudden high blood pressure, increased heart rate, sweating, shaking, anxiety, panic.  Indirectly it can drop blood sugar, which causes more of the same symptoms. Sound familiar?

Cortisol levels may initially rise in response to stress, but eventually become low if stressors continue long enough...like in withdrawal.  Cortisol evens out the blood sugar levels in response to insulin.  The cortisol cycle rises in the morning between 3-4AM to prepare you for the day.  If it is either too low or too high, it malfunctions.  In withdrawal, most people speak of the early morning jolt out of bed.  Again, if the thyroid becomes compromised, it sets off this cycle.  It may cause the blood sugar to drop when the cortisol attempts to kick on.  Low BS can result in someone being suddenly jolted awake.

Over 45yo, we all suffer decreasing thyroid function. It worsens with age.  Women are more likely than men to have issues because the estrogen can compete at thyroid receptors, effectively decreasing the available hormone.

It seems that a more reasoned approach when patients report panic, anxiety, or depression would be a thorough work-up with cortisol saliva tests, blood sugar monitoring,  complete thyroid panels  including iron levels, and BP monitoring.  The thyroid might be the trigger for this cascade of symptoms.  It also might be why people on the meds have to keep increasing the doses or get to the point they no longer work. If the thyroid has been deficient all along, eventually the side step to moderate receptors by meds won't work. It could also be a major factor in the symptoms reported in prolonged withdrawal.

Interesting points. I think one of the things people often run into when it comes to seeking medical help during withdrawal is that the symptoms can be similar to symptoms of other illnesses. There's much crossover and confusion, and of course, there's no definitive test for withdrawal. I do think people should be properly assessed in order to rule out other causes of whatever the significant symptoms are.

In my case, I've got severe disequilibrium, and that can be a symptom of a number of things. So it required many different kinds of checks (hearing, vision, neurological, vestibular, etc.).

I'm not personally familiar with thyroid issues, so I can't weigh in on that.