Co-prescribed Benzodiazepines in Older Adults Receiving Antidepressants for Anxiety and Depressive Disorders: Association with Treatment Outcomes

THE PROBLEM:  Prescription of benzodiazepines increases with age, and adults 60 and older are the age group most likely to be prescribed benzodiazepines. While benzodiazepines can be useful in carefully selected older adults, their potential benefits must be balanced with their well-established risks, including falls, fractures, cognitive impairment, and delirium. Approximately 12.5% of adult American patients are co-prescribed benzodiazepines prior to, or while receiving antidepressant pharmacotherapy; however, there is a paucity of data on how benzodiazepine co-prescription impacts antidepressant outcomes in depressed and anxious older adults.

WHAT DID WE STUDY?:  We used data from two clinical trials of antidepressant pharmacotherapy for generalized anxiety disorder (GAD) or Major Depressive Disorder (MDD) in older adults to address the following questions: 1) Are co-prescribed benzodiazepines associated with treatment response, antidepressant medication adherence, and dropout?;  2) Is benzodiazepine use predictive of receiving a lower dose of antidepressant medications?; and 3) Do patients co-prescribed benzodiazepines report more antidepressant-related adverse effects?  

WHAT WE FOUND:  Older depressed participants with GAD and co-prescribed benzodiazepines were treated with a lower mean dosage of escitalopram and were less likely to complete the trial; there was no difference in adherence or treatment response. Older depressed participants with MDD and co-prescribed benzodiazepines were less likely to tolerate a therapeutic dose of venlafaxine and reported more medication-related adverse effects; there was no difference in adherence, drop-out, or treatment response.

WHAT DOES THIS MEAN?:  Older patients with GAD or MDD who receive a co-prescribed benzodiazepine are sicker and harder to treat. However, with the systematic approach and clinical attention offered in a clinical trial, they can experience a similar treatment response. Clinicians should be aware that a co-prescribed benzodiazepine may be a marker of a more challenging treatment course.

Altmann H, Stahl ST, Gebara MA, Lenze EJ, Mulsant BH, Blumberger DM, Reynolds CF, Karp JF.  Co-prescribed Benzodiazepines in Older Adults Receiving Antidepressants for Anxiety and Depressive Disorders: Association with Treatment Outcomes. In press: Journal of Clinical Psychiatry.