ABSTRACT
SUMMARY: We propose that discussions of benzodiazepines in the current psychiatric literature have become negatively biased and have strayed from the scientific evidence base. We advocate returning to the evidence in discussing benzodiazepines and adhering to clear definitions and conceptual rigour in commentary about them.
Subject(s)
Anti-Anxiety Agents , Substance-Related Disorders , Anti-Anxiety Agents/therapeutic use , Benzodiazepines/adverse effects , Humans , Substance-Related Disorders/drug therapySubject(s)
Alzheimer Disease , Anti-Anxiety Agents , Cognitive Dysfunction , Benzodiazepines , Case-Control Studies , HumansABSTRACT
BACKGROUND: Benzodiazepines (BZs) and selective serotonin reuptake inhibitors (SSRIs) are effective in the pharmacologic treatment of panic disorder (PD). However, treatment guidelines favor SSRIs over BZs based on the belief that BZs are associated with more adverse effects than SSRIs. This belief, however, is currently supported only by opinion and anecdotes. AIM: The aim of this review and meta-analysis was to determine if there truly is evidence that BZs cause more adverse effects than SSRIs in acute PD treatment. METHODS: We systematically searched Web of Science, PubMed, Cochrane Central Register of Controlled Trials, and clinical trials register databases. Short randomized clinical trials of a minimum of four weeks and a maximum of 12 weeks that studied SSRIs or BZs compared to placebo in acute PD treatment were included in a meta-analysis. The primary outcome was all-cause adverse event rate in participants who received SSRIs, BZs, or placebo. RESULTS: Overall, the meta-analysis showed that SSRIs cause more adverse events than BZs in short-term PD treatment. Specifically, SSRI treatment was a risk factor for diaphoresis, fatigue, nausea, diarrhea, and insomnia, whereas BZ treatment was a risk factor for memory problems, constipation, and dry mouth. Both classes of drugs were associated with somnolence. SSRIs were associated with abnormal ejaculation, while BZs were associated with libido reduction. BZs were protective against tachycardia, diaphoresis, fatigue, and insomnia. CONCLUSION: Randomized, blinded studies comparing SSRIs and BZs for the short-term treatment of PD should be performed. Clinical guidelines based on incontrovertible evidence are needed.
Subject(s)
Benzodiazepines/administration & dosage , Panic Disorder/drug therapy , Selective Serotonin Reuptake Inhibitors/administration & dosage , Benzodiazepines/adverse effects , Humans , Randomized Controlled Trials as Topic , Selective Serotonin Reuptake Inhibitors/adverse effects , Time FactorsABSTRACT
Experienced clinicians are aware that the results from clinical drug trials do not always translate to office practice. This essay suggests that clinicians use their own diagnostic and interviewing skills when treating with medications rather than simply relying on published data or suggested treatment algorithms.
Subject(s)
Mental Disorders/drug therapy , Psychopharmacology , Psychotropic Drugs/therapeutic use , Humans , Mental Disorders/diagnosis , Psychopharmacology/methods , Therapeutic AllianceABSTRACT
This commentary focuses on psychopharmacology teachers and their teaching. The authors offer broadly based pedagogic suggestions on how to deliver evidence-based and neurobiologically informed prescribing information to clinicians at all levels of experience. They argue that teaching essential psychopharmacology knowledge and practice must be up-to-date, accurate, and consistent with the reality of an individual patient's life experience and beliefs. They stress that educators must teach that nonpsychopharmacological factors in a patient's life may be as relevant to the treatment setting as the actual pharmacological basis of psychotropic drug therapeutics.
