COMMENTARY

What Is the Best Way to Discontinue Benzodiazepines?

Peter M. Yellowlees, MBBS, MD

Disclosures

August 22, 2018

Editor's Note: The use of benzodiazepines is very common among patients with a variety of conditions, but clinician guidance on their use is lacking. What do you prescribe these medications for, and what is your approach to deprescribing them? Let us know in the comments section.

This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees. Approximately 4% of the population use benzodiazepines, and prolonged treatment is common despite clinical recommendations for short-term use. Discontinuing benzodiazepines is difficult for many patients and it is unclear which pharmacologic interventions are best to facilitate tapering.

To examine this question, a team of investigators from Glostrup, Denmark, conducted a systematic review using standard Cochrane methods.[1] Data from 2295 patients were extracted from 35 trials. Of 18 comparison interventions, no single intervention was assessed in more than four trials. Furthermore, the authors found that, partly because of the very low quality of evidence for the reported outcomes, it was not possible to draw firm conclusions regarding pharmacologic interventions for facilitating benzodiazepine discontinuation in chronic benzodiazepine users.

So where does this leave us? In short, we have a huge clinical problem. All we know is that weaning patients from benzodiazepines is best done very slowly and is often painful for our patients. In my own practice, I often manage very slow tapers that last between 6 months and a year. It seems that most patients can manage this, but I have no evidence beyond my clinical impression to back up my opinion.

Given the millions of people worldwide who take benzodiazepines long-term, we are desperately short of data and high-quality randomized trials aimed at developing evidence-based withdrawal protocols. These need to occur.

Thank you for listening to this Medscape Psychiatry Minute. Do continue to enjoy your practice.

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