Real-world benzodiazepine prescribing for anxiety disorders: A Retrospective study

Introduction

Prescribing of benzodiazepines (BDZs) has a role in the acute phase of anxiety disorders. While waiting for the onset of action of serotonergic drugs, benzodiazepines may be used and should be tapered off once the serotonergic drugs become effective. In the real world, benzodiazepines are often prescribed for long durations. We are concerned about adverse effects, tolerance, dependence, and evidence regarding benzodiazepine prescribing for anxiety disorders in Thailand is limited.

Aims

To describe prescription patterns of benzodiazepines (BDZs) in patients with generalized anxiety disorder, panic disorder, and social anxiety disorder, and to assess treatment duration, dosing relative to recommended ranges, short-term clinical outcomes, and reported adverse drug reactions at a tertiary teaching hospital.

Methods

We performed a retrospective cross-sectional review of electronic and paper medical records at Princess Maha Chakri Sirindhorn Medical Center. Adults (≥18 years) newly diagnosed with generalized anxiety disorder, panic disorder, or social anxiety disorder who received at least one benzodiazepine between 1 September 2017 and 30 September 2023 were included. Extracted data included age, sex, psychiatric diagnosis, type of benzodiazepines, daily dose, duration of use, concomitant psychotropic medications, documented clinical follow-up at weeks 4–6, and recorded adverse drug reactions. Descriptive statistics are reported as median (interquartile range, IQR) or mean ± standard deviation (SD) for continuous variables and frequency (%) for categorical variables. Where subgroup comparisons were performed, chi-square or Fisher’s exact test was used for categorical variables and Student’s t-test or Mann–Whitney U test for continuous variables, according to distribution. A two-sided p < 0.05 denoted statistical significance.

Results

One hundred seventy-nine patients were enrolled. The majority (59.8%) were diagnosed with panic disorder, while 12.3% were diagnosed with an anxiety disorder with major depressive disorder. Most patients were female (62.8%) and aged between 18 and 60 years(82.1%). Approximately 39.5% had medical comorbidities. The most commonly reported presenting symptoms among patients with generalized anxiety disorder, panic disorder, and social anxiety disorder were sleep disturbances , palpitations, and anxiety in situations involving possible scrutiny (56.1%, 58.9%, 100%, respectively). The most common prescribing pattern was a single benzodiazepine, accounting for 74.9%. Additionally, some patients received combinations of two or three BDZs. Among all prescribed BDZs, clonazepam was the most frequently prescribed (21.7%). The prescribed dosages were within the recommended therapeutic range. The average duration of BDZ use was 60(30-90) days. Follow-up assessments in weeks 4-6 showed a reduction in symptoms compared to baseline. Reported adverse drug reactions included drowsiness/sedation (1.1%), withdrawal symptoms on discontinuation(1.1%), and features suggestive of dependence (0.6%); severity and incidence were variably documented in clinical notes.

Conclusions

The prescription patterns of BDZs in this study indicate that most patients received medications approved by the FDA or supported by clinical evidence. Dosages and prescribing frequencies generally adhered to treatment guidelines, with a tendency for physicians to prescribe low doses. However, prolonged use of BDZs beyond the recommended duration was observed. Regarding safety concerns, adverse drug reactions such as drowsiness, withdrawal symptoms, and drug dependence were found.

References

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