Article Recommended by Dr. Brianna McQuade: Complex Persistent Benzodiazepine Dependence - When Benzodiazepine Prescribing Goes Awry

This article discusses the historical context and current challenges surrounding the use of benzodiazepines, highlighting their initial popularity as safer alternatives to barbiturates and subsequent recognition of risks such as dependence, misuse, and addiction. Despite decreased enthusiasm among clinicians, benzodiazepines remain popular among patients due to their rapid relief of symptoms. However, they contribute significantly to the public health crisis of drug overdose deaths, often overshadowed by the opioid crisis. While benzodiazepines have appropriate clinical uses, concerns arise when adverse outcomes such as falls, cognitive impairment, or medication interactions occur, prompting the need for deprescribing in some cases.

Deprescribing benzodiazepines can be challenging, as patients may resist discontinuation due to perceived necessity or fear of withdrawal symptoms. Physiological dependence can develop rapidly, complicating tapering efforts and leading to prolonged withdrawal symptoms, including post-acute withdrawal syndrome (PAWS). Proposed treatments for PAWS include pharmacotherapies and psychotherapies targeting original and rebound symptoms.

The article introduces the concept of complex persistent benzodiazepine dependence (CPBD) to describe patients experiencing significant psychological or functional decline during or after benzodiazepine tapering, distinct from benzodiazepine use disorder (BUD). CPBD is characterized by psychiatric instability and functional decline during deprescribing attempts, often without addiction-related behaviors seen in BUD. Differentiating between CPBD and BUD is crucial for appropriate treatment planning, as interventions may vary significantly.

Further research is needed to validate the concept of CPBD, define its prevalence, clinical characteristics, and optimal treatment approaches. Descriptive studies are essential to inform clinical practice and improve outcomes for patients undergoing benzodiazepine deprescribing.

https://pubmed.ncbi.nlm.nih.gov/35583897/