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Long-term use of benzodiazepines: Definitions, prevalence and usage patterns – a systematic review of register-based studies

Published online by Cambridge University Press:  04 November 2015

T.A.T. Kurko ,
L.K. Saastamoinen ,
S. Tähkäpää ,
A. Tuulio-Henriksson ,
T. Taiminen ,
J. Tiihonen ,
M.S. Airaksinen  and
J. Hietala
T.A.T. Kurko*
Affiliation:
Department of Psychiatry, University of Turku, Turku University Central Hospital and Turku Psychiatry, Kiinamyllynkatu 4-8 (Building 11B), 20521Turku, Finland Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5, 00014Helsinki, Finland
L.K. Saastamoinen
Affiliation:
Research Department, Social Insurance Institution, Nordenskiöldinkatu 12, Helsinki, Finland
S. Tähkäpää
Affiliation:
Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5, 00014Helsinki, Finland
A. Tuulio-Henriksson
Affiliation:
Research Department, Social Insurance Institution, Nordenskiöldinkatu 12, Helsinki, Finland
T. Taiminen
Affiliation:
Department of Psychiatry, University of Turku, Turku University Central Hospital and Turku Psychiatry, Kiinamyllynkatu 4-8 (Building 11B), 20521Turku, Finland
J. Tiihonen
Affiliation:
Department of Clinical Neuroscience, Karolinska Institutet, Karolinska Universitetssjukhuset Solna, 17176Stockholm, Sweden Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
M.S. Airaksinen
Affiliation:
Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5, 00014Helsinki, Finland
J. Hietala
Affiliation:
Department of Psychiatry, University of Turku, Turku University Central Hospital and Turku Psychiatry, Kiinamyllynkatu 4-8 (Building 11B), 20521Turku, Finland
*
⁎Corresponding author. Department of Psychiatry, University of Turku, Turku University Central Hospital and Turku Psychiatry, Kiinamyllynkatu 4-8 (Building 11B), 20521 Turku, Finland. Tel.: +358 50 370 79 81. E-mail addresses:terhi.a.kurko@helsinki.fi, terhi.kurko@utu.fi (T.A.T. Kurko).
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Abstract

Background

Numerous treatment guidelines recommend that long-term use of benzodiazepines (BZD) should be avoided primarily due to development of tolerance and a risk for BZD dependence. Despite this, long-term BZD use remains a controversial subject in clinical patient care with “for and against” debates. However, there is no explicit understanding of what is meant by long-term BZD use in real world. The aim of this study was to assess different definitions, usage patterns, prevalence and other characteristics of long-term BZD use based on published register-based studies. Synthesis of these characteristics is essential to derive a meaningful definition of long-term BZD.

Methods

Systematic review of register-based studies on long-term BZD use published in 1994–2014.

Results

Fourty-one studies met our predetermined inclusion criteria. The length of BZD use defined as “long-term” varied in these studies ranging from one month to several years. The most common definition was six months or longer during a year. The prevalence of long-term BZD use in the general population was estimated to be about 3%. The relative proportion of long-term BZD users (all definitions) in adult BZD users ranged from 6% to 76% (mean 24%; 95% CL 13–36%). The estimates were higher in studies only on the elderly (47%; 95% CL 31–64%). Long-term use involved typically steady treatment with low BZD doses. However, in elderly patients long-term BZD use and exceeding recommended doses was relatively common. Several characteristics associated with long-term use were found.

Conclusions

Long-term BZD use is common and a clinical reality. Uniform definitions for “long-term”, which is in line with population-based evidence, is needed to have more comparable results between studies. Our systematic review suggests that duration of BZD treatment over six months, the most common definition for long-term BZD use in the included studies. As also recommended previously, it is a useful starting point for further analyses on disadvantages but also potential advantages associated with long-term BZD use.

Keywords

BenzodiazepinesLong-termUseSystematic reviewAnxiolyticsHypnotics
Type
Review
Information
European Psychiatry , Volume 30 , Issue 8 , November 2015 , pp. 1037 - 1047
Copyright
Copyright © European Psychiatric Association 2020

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