Benzodiazepines as a Monotherapy in Depressive Disorders: A Systematic Review

Area of Science:

• Psychiatry
• Pharmacology
• Clinical Trials

Background:

• Depression and anxiety disorders are common mental health conditions.
• Pharmacological treatments, including antidepressants and benzodiazepines, are widely used.
• The comparative efficacy of benzodiazepines versus antidepressants requires systematic evaluation.

Purpose of the Study:

• To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs).
• To compare benzodiazepines (BZD) monotherapy with placebo, antidepressant drugs (AD), or both in depression treatment.
• To assess the efficacy of BZD in anxious depression.

Main Methods:

• Systematic review and meta-analysis of RCTs identified through electronic databases up to April 2017.
• Inclusion criteria: RCTs comparing BZD with AD and/or placebo in adult patients with primary depressive disorder or anxious depression.
• Meta-analysis focused on response rates from 22 RCTs (8 BZD vs. placebo, 20 BZD vs. TCA).

Main Results:

• 38 studies were included in the systematic review; only one involved a newer AD (fluvoxamine).
• No significant difference in response rates between BZD and placebo, or between BZD and TCAs.
• Individual study analysis indicated BZD were more effective than placebo and as effective as TCAs in over half of comparisons.

Conclusions:

• Benzodiazepines (BZD) are a valid therapeutic option for anxious depression.
• Current evidence does not suggest antidepressant drugs (AD) are definitively preferable to BZD for anxious depression.
• There is a need for high-quality RCTs comparing BZD with second-generation ADs and placebo in anxious depression.