Benzodiazepine Discontinuation: Two Meta-Analyses

Jan 23, 2013

Parr, et al. (2008) and Voshaar, et al. (2006) conducted meta-analyses of treatment approaches to assist benzodiazepine (BZD) discontinuation. Both reviews included the results of 22 studies; Parr examined a total of 32 studies while Vooshaar examined a total of 29 studies, so there is considerable overlap in their data.

Compared to routine care, a brief intervention such as a letter from the primary care provider or a large group lecture giving simple advice on discontinuing BZD use was significantly more effective in reducing and ending BZD, with 15–20% of subjects discontinuing BZD use without further assistance. Supervised systematic dose reduction alone and in conjunction with psychological interventions such as relaxation training, psycho-education for BZD withdrawal, and therapeutic strategies to address insomnia was also significantly more effective than routine care, with evidence that the psychological interventions provide a small but significant additional benefit over gradual dose reduction alone. About 50% of the subjects in the taper treatment and 85% of the subjects in the combined treatment succeeded in discontinuing hypnotic use.

Based on these results Voshaar, et al (2006) propose a stepped care approach to BZD discontinuation, beginning with minimal and brief interventions and followed by systematic gradual dose reduction strategies with psycho-educational interventions.

Parr, J. M., Kavanagh, D. J., Cahill, L., Mitchell, G., & Young, R. M. (2008). Effectiveness of current treatment approaches for benzodiazepine discontinuation: a meta‐analysis. Addiction104, 13-24.

Voshaar, R. C. O., Couvée, J. E., Van Balkom, A. J., Mulder, P. G., & Zitman, F. G. (2006). Strategies for discontinuing long-term benzodiazepine use Meta-analysis. The British Journal of Psychiatry189, 213-220.

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