[Benzodiazepine cessation in ambulatory practice. A review]

Area of Science:

• Pharmacology and Behavioral Science
• Sleep Medicine
• Public Health

Background:

• Benzodiazepine dependence is a significant clinical challenge.
• Discontinuation of benzodiazepines requires effective treatment strategies.
• Current evidence on interventions for benzodiazepine cessation is varied.

Purpose of the Study:

• To systematically review pharmacological and non-pharmacological interventions for benzodiazepine discontinuation.
• To identify effective strategies for patients undergoing benzodiazepine cessation.
• To assess the efficacy and cost-effectiveness of different interventions.

Main Methods:

• A systematic review of seven studies on pharmacological treatments.
• A systematic review of 12 studies on non-pharmacological interventions, including Cognitive Behavioural Therapy (CBT), minimal interventions, and dedicated visits.
• Analysis of efficacy, self-efficacy, and cost-effectiveness.

Main Results:

• Melatonin demonstrated significant efficacy for benzodiazepine cessation in patients with insomnia.
• Cognitive Behavioural Therapy (CBT) improved self-efficacy and was effective in patients with sleep disorders.
• Minimal interventions and dedicated visits were efficacious and cost-effective.

Conclusions:

• Pharmacological interventions like melatonin show promise for specific patient groups.
• Non-pharmacological approaches, particularly CBT and minimal interventions, are effective and cost-efficient for benzodiazepine cessation.
• Further research is needed for patients with high-dose benzodiazepine use, addiction, or comorbid psychiatric/somatic disorders.