TY - JOUR
T1 - Coprescribed Benzodiazepines in Older Adults Receiving Antidepressants for Anxiety and Depressive Disorders
T2 - Association With Treatment Outcomes
AU - Altmann, Helene
AU - Stahl, Sarah T.
AU - Gebara, Marie Anne
AU - Lenze, Eric J.
AU - Mulsant, Benoit H.
AU - Blumberger, Daniel M.
AU - Reynolds, Charles F.
AU - Karp, Jordan F.
N1 - Funding Information:
Submitted: February 6, 2020; accepted May 14, 2020. Published online: September 29, 2020. Potential conflicts of interest: Dr Lenze reports research funding (current/past) from Janssen, Alkermes, Takeda, Lundbeck, Barnes Jewish Foundation, Patient-Centered Outcomes Research Institute, and Taylor Family Institute for Innovative Psychiatric Research and has been a consultant for Janssen and Jazz Pharmaceuticals. Dr Mulsant currently receives research funding from Brain Canada, Centre for Addiction and Mental Health (CAMH) Foundation, Canadian Institutes of Health Research, Patient-Centered Outcomes Research Institute, and US National Institutes of Health (NIH). During the last 5 years, he also received research support from Bristol-Myers Squibb (medications for a NIH-funded clinical trial), Eli Lilly (medications for a NIH-funded clinical trial), and Pfizer (medications for a NIH-funded clinical trial), and he directly owns stocks of General Electric (less than $5,000). Dr Blumberger has received research support from the Canadian Institutes of Health Research, NIH, Brain Canada, and the Temerty Family through the CAMH Foundation and the Campbell Research Institute; received research support and
Funding Information:
in-kind equipment support for an investigator-initiated study from Brainsway Ltd and is the site principal investigator for a sponsor-initiated study for Brainsway Ltd; receives in-kind equipment support from Magventure for investigator-initiated studies; and received medication supplies for an investigator-initiated trial from Indivior. Dr Reynolds has received research support from the NIH, Patient Centered Outcomes Research Institute, Center for Medicare and Medicaid Services, American Foundation for Suicide Prevention, Brain and Behavior Research Foundation, and the Commonwealth of Pennsylvania; Bristol-Myers Squibb and Pfizer have provided pharmaceutical supplies for his NIH-sponsored research; and he is a paid consultant for Merck. Dr Karp has received medication supplies for investigator-initiated trials from Pfizer and Indivior and receives honoraria from American Journal of Geriatric Psychiatry and Journal of Clinical Psychiatry. The other authors have nothing to disclose. Funding/support: Supported in part by grants P30 MH068579, P30 MH71944, P30 MH90333, R01 MH070547, R01 MH083660, R01 MH083648, R01 MH083643, and R01 MH118270 from the National Institutes of Health.
Publisher Copyright:
© Copyright 2020 Physicians Postgraduate Press, Inc.
PY - 2020/11
Y1 - 2020/11
N2 - Objective: There is a paucity of data on the effects of coprescribed benzodiazepines on treatment response variability and adherence to antidepressant pharmacotherapy for depression and anxiety in late life. The objective of this transdiagnostic analysis was to examine the effect of benzodiazepines on treatment outcomes in older patients with generalized anxiety disorder (GAD) or major depressive disorder (MDD). Methods: Secondary analyses of data from 2 clinical trials of antidepressant pharmacotherapy for GAD (escitalopram vs placebo, 2006-2009) or MDD (open treatment with venlafaxine, 2009-2014) were conducted. Participants included 640 adults aged 60+ years with DSM-IV-defined GAD (n = 177) or MDD (n = 463). Benzodiazepine data were collected at baseline. Adherence and treatment response were assessed over 12 weeks. The analysis addressed whether coprescribed benzodiazepines are associated with treatment response, antidepressant medication adherence, dropout, final dose of antidepressant medication, and report of antidepressant-related adverse effects. Results: Participants with GAD and coprescribed benzodiazepines were treated with a lower mean dosage of escitalopram and were less likely to complete the trial; there was no difference in adherence or treatment response. Participants with MDD and coprescribed benzodiazepines were less likely to tolerate a therapeutic dose of venlafaxine and reported more medication-related adverse effects; there was no difference in adherence, dropout, or treatment response. Conclusions: Coprescription of benzodiazepines was associated with increased dropout in older patients with GAD and more medication-related adverse effects in older patients with MDD. However, with the systematic clinical attention offered in a clinical trial, they do not impede treatment response. Clinicians should be aware that a coprescribed benzodiazepine may be a marker of a more challenging treatment course.
AB - Objective: There is a paucity of data on the effects of coprescribed benzodiazepines on treatment response variability and adherence to antidepressant pharmacotherapy for depression and anxiety in late life. The objective of this transdiagnostic analysis was to examine the effect of benzodiazepines on treatment outcomes in older patients with generalized anxiety disorder (GAD) or major depressive disorder (MDD). Methods: Secondary analyses of data from 2 clinical trials of antidepressant pharmacotherapy for GAD (escitalopram vs placebo, 2006-2009) or MDD (open treatment with venlafaxine, 2009-2014) were conducted. Participants included 640 adults aged 60+ years with DSM-IV-defined GAD (n = 177) or MDD (n = 463). Benzodiazepine data were collected at baseline. Adherence and treatment response were assessed over 12 weeks. The analysis addressed whether coprescribed benzodiazepines are associated with treatment response, antidepressant medication adherence, dropout, final dose of antidepressant medication, and report of antidepressant-related adverse effects. Results: Participants with GAD and coprescribed benzodiazepines were treated with a lower mean dosage of escitalopram and were less likely to complete the trial; there was no difference in adherence or treatment response. Participants with MDD and coprescribed benzodiazepines were less likely to tolerate a therapeutic dose of venlafaxine and reported more medication-related adverse effects; there was no difference in adherence, dropout, or treatment response. Conclusions: Coprescription of benzodiazepines was associated with increased dropout in older patients with GAD and more medication-related adverse effects in older patients with MDD. However, with the systematic clinical attention offered in a clinical trial, they do not impede treatment response. Clinicians should be aware that a coprescribed benzodiazepine may be a marker of a more challenging treatment course.
UR - http://www.scopus.com/inward/record.url?scp=85092333077&partnerID=8YFLogxK
U2 - 10.4088/JCP.20M13283
DO - 10.4088/JCP.20M13283
M3 - Article
C2 - 32991792
AN - SCOPUS:85092333077
SN - 0160-6689
VL - 81
JO - Journal of Clinical Psychiatry
JF - Journal of Clinical Psychiatry
IS - 6
M1 - 20M13283
ER -