Long-Term Use of Benzodiazepines and Related Drugs in Persons With Major Depressive Disorder

Benzodiazepines and related drugs (BZDRs) may be prescribed to treat anxiety and insomnia in persons with depression. Although BZDRs are recommended for short-term use only, their use may be prolonged. Despite research on the use of BZDRs in depression, to our knowledge, long-term use and its predictors have not been previously studied. The aim of this study was to estimate the incidence of long-term BZDR use in persons with depression and to identify sociodemographic and clinical factors associated with prolonged use.

Data were extracted from Finnish nationwide registers. The study focused on persons with depression aged 16-65 years who initiated BZDR use between July 1, 2015 and June 30, 2018. Persons with a previous diagnosis of bipolar disorder, schizophrenia-spectrum disorder, or dementia, or those who did not have at least 180 days of follow-up, were excluded from the study. Sociodemographic and clinical factors associated with long-term (≥180 days) versus shorter use were compared with logistic regression. The final study sample included 11,303 BZDR initiators.

A total of 849 (7.5%, CI 95% 7.0-8.0) BZDR initiators became long-term users. The mean age of long-term users was 39.8 years (SD 13.3), and more than half of them were females (58.9%). Factors associated with long-term BZDR use included age over 45 years (45-54: aOR 1.56, 95% CI 1.22-1.99, ≥55: 1.72, 1.32-2.25 compared to ≤24 years), male gender (1.49, 1.28-1.73), substance use disorder (excl. alcohol) (1.79, 1.27-2.29), use of opioid (1.75, 1.38-2.21) or quetiapine (1.65, 1.18-2.27), ≥3 antidepressants used in the previous year (1.63, 1.22-2.19), socioeconomic status other than employed, the use of antidepressants with hypnotic effects (1.25, 1.06-1.47) and anxiety disorder (1.16, 1.00-1.35).

This Finnish population-based cohort study identified sociodemographic and clinical factors that should be considered in the initiation and monitoring of BZDR treatment among persons with depression.