Review: treatment options for benzodiazepine dependence

(HealthDay)—Effective treatment of benzodiazepine dependence includes cognitive behavioral therapy and motivational approaches, according to a study published in the March 22 issue of the New England Journal of Medicine.

Noting that benzodiazepines are relatively safe for short-term use, but that their safety has not been established beyond that period and that dependence often develops with use for more than one month, Michael Soyka, M.D., from Ludwig Maximilian University in Munich, addresses the issues relating to benzodiazepine dependence and subsequent treatment strategies.

Soyka notes that benzodiazepine prescriptions lasting two to three months or more and marked dose increases should be avoided, and that intervals of treatment may be advisable for some patients, especially those with sleep disorders. The indication for a prescription should be evaluated and reevaluated, while adherence to dosing, avoidance of multiple prescriptions, and timely discontinuation are essential. Clear and evidence-based standards for medication withdrawal are available for benzodiazepine-dependent patients, with good evidence for cognitive behavioral therapy and motivational approaches, and for provision of psychoeducation. Benzodiazepine withdrawal does not have to be attempted in every case; stabilization may be warranted before withdrawal treatment for patients without any motivation for withdrawal or with a severe depressive episode or other major mental disorder. If complete discontinuation of benzodiazepines is unlikely, reducing the dose can be a harm-reduction strategy.

"Additional studies on adequate pharmacotherapy during and after benzodiazepine withdrawal and more evidence-based strategies clearly are required," Soyka writes.

The author disclosed financial ties to the pharmaceutical industry.