Patients suffered from Depressive or Anxiety disorders are at high risk for Benzodiazepines (BZDs) long term use and overdose. Daily dose of BZDs consumption is concerned for criteria of appropriate BZDs use and have been recommended not to exceed. It is found that high dose of BZDs was associated with more adverse physical condition and cognitive function in terms of prolonged reaction time for long term users. The purpose of this study is to examine factors associated with high dose of BZDs use among BZDs long term users with Depression or Anxiety diagnoses.
Methods:
We have conducted a cross-sectional study from outpatient department of two hospitals, including one medical center and one psychiatric hospital. Patients who suffered from Depressive or Anxiety disorders and have taken BZDs daily for more than 3 months were recruited. The types and dosage of prescribed BZDs were collected. The defined daily dose (DDD) was used as a unit to measure patients’ consumption of BZDs, and dose were summed up when more than one type were used. Other measured data include physical diseases, anxiety and depression state, insomnia state and sleeping quality, pattern of healthy life activity, social-related factors such as perceived stress and social support, risk awareness of BZDs use in terms of the necessity versus the concerns of using BZDs, and severity of BZDs dependence. Hierarchical logistic regression was applied to determine factors associated with high dose of BZDs use (daily dose >1 DDD).
Results:
A total of 332 patients were agreed and recruited, with 33% of men and almost 67% women. Up to 40 % of the participants were aged 60 and older, and about 36% were employed. Most of them (88%) lived with families, and 68% lived with their spouses. More than half (59%) of the participants exercised regularly in the past 2 weeks. About 77% patients received antidepressants treatment. More than one third of the patients were comorbid with chronic diseases. Results of the PSQI showed 93% of the patients suffered from bad sleep quality; 36% failed to fall asleep within 30 minutes (sleep latency), over 75% patients slept less than 7 hours in average at night and more than 62% experienced midnight or early morning wake up 3 times or more per week. The average score of BAI and BDI were 8.41 and 9.54, 60% and almost 72% and 60% of the patients were in minimal anxiety and depression state separately. The average length of BZDs use was 7.1 years, and up to 89% use BZDs more than 6 months. About one third of patients used BZDs more than 1 DDD daily. Clonazepam was the most commonly prescribed BZDs (38.9%). Results from univariate analysis showed patients characteristics significantly related to BZDs daily dose more than 1 DDD were aged less than 60 years old (OR=0.57, 95%CI=0.34-0.92), not regularly exercised (OR=0.58, 95%CI=0.36-0.92), felt needs more than concerned of BZDs use (OR=0.47, 95%CI=0.29-0.80), more suffered from insomnia(OR=1.05, 95%CI=1.01-1.09), higher level of anxiety (OR=1.04, 95%CI=1.02-1.07), higher level of depression (OR=1.04, 95%CI=1.02-1.06), perceived more stress (OR=1.09, 95%CI=1.03-1.15), higher dependence on BZDs use (OR=1.14, 95%CI=1.05-1.25), and took more BZDs than prescribed (OR=1.92, 95%CI=1.40-2.62). Multiple logistic regression was performed by selecting significant variables (P<.05) from univariate analysis. Results showed that patients who felt more need than concern of BZDs use (AOR=0.44, 95% CI=0.25-0.77) and took BZDs more than prescribed (AOR=1.59, 95% CI=1.14-2.24) were independently associated with BZDs use >1 DDD. Higher level of depression were nearly associated with BZDs use > 1 DDD (AOR=1.03, 95% CI=1-1.06).
Conclusion:
Gradual dose reduction of BZDs use along or combined with other psychological intervention have been applied to help patients on discontinuing the use of BZDs. Therefore understanding the factors that motivate patients and barriers in reduction of BZDs use is critical. In our study, poor risk awareness and taking BZDs more than described were two strongest factors that related to higher dose of BZDs use. Previous studies have found that withdrawal symptom was the most difficult situation and resulted in searching for pharmacotherapy from clinics. Our study reveals the phenomenon patients with higher dose of BZDs use were more dependent on it, and patients chose to take BZDs additionally first when they feel need. Providing alternative treatment instead of taking medicine is suggested when patients feel anxious or have problem in maintaining sleep quality. Healthcare providers might need to help patients to aware of their attitude and myths in BZDs use, and understanding the potential harm for high dose use of BZDs. Additional strategy such as establishing regular exercise, stress management and adopting useful coping skill might be helpful for reduction of BZDs dose. We expect the result of this study provide more information for healthcare providers in developing intervention for discontinuation of BZDs use.