Long-Term Benzodiazepine Use Still Ill Advised: Learning Impairments Associated with the Drugs Diminish Effects of Cognitive-Behavioral Therapy

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EXPERT ANALYSIS FROM THE ANNUAL CONFERENCE OF THE ANXIETY DISORDERS ASSOCIATION OF AMERICA

ARLINGTON, VA.-- Widespread long-term use of benzodiazepines for anxiety remains a reality, despite guidelines that recommend against the practice, according to speakers participating in a roundtable discussion at the meeting.

Benzodiazepines alleviate anxiety symptoms, but they do not help to resolve anxiety disorders in the long term, with posttreatment relapse rates reported as high as 63%. Learning impairment associated with benzodiazepines is the side effect that "significantly diminishes the effects" of cognitive-behavioral therapy (CBT), said Dominic A. Candido, Ph.D., a psychologist in the department of psychiatry at the Dartmouth Geisel School of Medicine, Hanover, N.H.

But widespread long-term benzodiazepine use for anxiety disorders remains a reality, he pointed out, citing a study published in 2010. In that study, benzodiazepine usage rates in the general population ranged from about 2% to almost 18%. About one-third of people who received an initial prescription stayed on the drug long term--despite the recommendation in treatment guidelines that suggest limited short-term use. Recently, the departments of Veterans Affairs and Defense guidelines recommended against the use of benzodiazepines for posttraumatic stress disorder--in part because benzodiazepines increase the likelihood of stress symptoms.

"When practitioners do not have alternatives, they tend to go to these agents that will give them short-term relief but often at long-term detriment to the patient," he said.

Sharma Treworgy, Psy.D., also at Geisel, said the impact on procedural memory "perhaps is the worst side effect" of benzodiazepines in the treatment of anxiety "Research that has successfully pulled apart explicit and implicit memory has demonstrated significant effects on procedural learning and memory" during treatment with benzodiazepines, she said. …