Prior Benzodiazepine Exposure and Benzodiazepine Treatment Outcome
J Clin Psychiatry 2000;61(6):409-413
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Background: We examined discontinuation symptoms
following brief benzodiazepine therapy (8 weeks) and intermittent
benzodiazepine therapy (2 weeks with at least 2 weeks without
drug) and associations with prior benzodiazepine use. The
hypothesis was that prior benzodiazepine use would predispose
patients to more severe discontinuation symptoms.
Method: Data were drawn from 3
double-blind, randomized, placebo-controlled, published treatment
trials: alprazolam for patients with premenstrual syndrome (PMS)
and diazepam and lorazepam for patients with generalized anxiety
disorder (GAD). The PMS group provided prospective daily symptom
ratings, which allowed ongoing investigation of effects of prior
treatment. In the GAD groups, taper outcome was examined after 8
weeks of benzodiazepine therapy as a function of prior
benzodiazepine use and as a function of time since last prior
benzodiazepine use. Symptom scores were analyzed using t
statistics in the PMS group and analysis of covariance with
8-week scores as the covariate in the GAD groups.
Results: The PMS subjects reported no increase
in symptom scores and no significant difference from
placebo-treated subjects during taper and discontinuation of
alprazolam in the follicular phase of each treatment cycle. In
the GAD trials, the results of treatment discontinuation did not
differ significantly as a function of presence or absence of
prior benzodiazepine use or as a function of time since last
Conclusion: These preliminary data fail
to support the hypothesis that prior benzodiazepine use
predisposes patients to more severe discontinuation symptoms when
treatment is brief and doses are low.