[La...] Posted June 27, 2020 Share Posted June 27, 2020 The full title of this Canadian study is "Understanding the Effects of Chronic Benzodiazepine Use in Depression: A Focus on Neuropharmacology ". Note: I tried unsuccessfully to find the full study for this one, since the topic is likely of interest to many around here. If anyone is able to track it down, please share it! Thanks. https://pubmed.ncbi.nlm.nih.gov/32459725/ Abstract Benzodiazepines are frequently prescribed on an ongoing basis to individuals with depression, mainly to alleviate anxiety or insomnia, despite current guideline recommendations that continuous use should not exceed 4 weeks. Currently, there are no efficacy trials published beyond 8 weeks. Several antidepressant trials demonstrate that the concomitant use of a benzodiazepine is associated with poorer depressive outcomes and functional status; however, it is unclear why this is the case. Patients with depression receiving a benzodiazepine may reflect a more ill or high anxiety group, although even within anxiety disorders, the use of a benzodiazepine is associated with poorer outcomes. The neuroadaptive consequences of long-term benzodiazepine use may be a factor underlying these findings. Chronic benzodiazepine use results in decreased gamma-aminobutyric acid and monoaminergic function, as well as interference with neurogenesis, which are all purported to play a role in antidepressant efficacy. This review will discuss the oppositional neuropharmacological interactions between chronic benzodiazepine use and antidepressant mechanism of action, which could result in reduced antidepressant efficacy and function in depression. Link to comment Share on other sites More sharing options...
[Li...] Posted June 27, 2020 Share Posted June 27, 2020 Yet another great find and share, Lapis2. Thank you! I’ve looked for the full paper as well with no success. Let’s hope another member can find it. The following quote from the abstract is intriguing: “The neuroadaptive consequences of long-term benzodiazepine use may be a factor underlying these findings. Chronic benzodiazepine use results in decreased gamma-aminobutyric acid and monoaminergic function, as well as interference with neurogenesis ...” Link to comment Share on other sites More sharing options...
[La...] Posted June 27, 2020 Author Share Posted June 27, 2020 You're welcome, Libertas! Yes, definitely intriguing. I should have shared the definition of "monoaminergic" too. Here it is, from Wikipedia: Monoaminergic means "working on monoamine neurotransmitters", which include serotonin, dopamine, norepinephrine, epinephrine, and histamine. A monoaminergic, or monoaminergic drug, is a chemical which functions to directly modulate the serotonin, dopamine, norepinephrine, epinephrine, and/or histamine neurotransmitter systems in the brain. Monoaminergics include catecholaminergics (which can be further divided into adrenergics and dopaminergics), serotonergics, and histaminergics. An example of a class of monoaminergic drugs is monoamine oxidase inhibitors (MAOIs). https://en.wikipedia.org/wiki/Monoaminergic Link to comment Share on other sites More sharing options...
[Li...] Posted June 27, 2020 Share Posted June 27, 2020 Is “mind-reader” on your long list of talents, Lapis2? How did you know that my next action item was to look up the definition of “monoaminergic”? Link to comment Share on other sites More sharing options...
[La...] Posted June 27, 2020 Author Share Posted June 27, 2020 Is “mind-reader” on your long list of talents, Lapis2? How did you know that my next action item was to look up the definition of “monoaminergic”? Well, my dear Libertas, I would say that you and I are the curious type and, as they say, "Curious minds wanna know!" Do "they" say that?! I can't remember if they do, but someone says that. Link to comment Share on other sites More sharing options...
[La...] Posted June 28, 2020 Author Share Posted June 28, 2020 Is “mind-reader” on your long list of talents, Lapis2? How did you know that my next action item was to look up the definition of “monoaminergic”? Well, my dear Libertas, I would say that you and I are the curious type and, as they say, "Curious minds wanna know!" Do "they" say that?! I can't remember if they do, but someone says that. Well, I went looking for more info and found this: https://www.quora.com/Where-did-the-phrase-inquiring-minds-want-to-know-come-from ;D Link to comment Share on other sites More sharing options...
[Li...] Posted June 28, 2020 Share Posted June 28, 2020 I agree with you, Lapis2 — you and I are indeed the curious type. I too searched for the origins of the phrase “Inquiring minds want to know.” after your last post. Libertas Link to comment Share on other sites More sharing options...
[La...] Posted June 28, 2020 Author Share Posted June 28, 2020 I agree with you, Lapis2 — you and I are indeed the curious type. I too searched for the origins of the phrase “Inquiring minds want to know.” after your last post. Libertas Well, according to that quora thing I found, it should read "Enquiring minds want to know", which comes from an ad for the National Enquirer. Link to comment Share on other sites More sharing options...
[La...] Posted September 20, 2020 Author Share Posted September 20, 2020 I finally found the full study for this one here on SciHub: https://sci-hub.tw/https://www.researchgate.net/publication/341688809_Understanding_the_effects_of_chronic_benzodiazepine_use_in_depression_a_focus_on_neuropharmacology I'm just reading it now, and I do think others would be very interested in it as well. There's excellent information on long-term benzodiazepine use. Check out Figure 1 and Table 1. Link to comment Share on other sites More sharing options...
[La...] Posted September 20, 2020 Author Share Posted September 20, 2020 Introduction Benzodiazepines are sedative anxiolytics that are prescribed for the treatment of anxiety, insomnia, pain, or as anesthetic or anticonvulsant agents. Prescribing benzodiazepines for chronic use is not recommended due to their addictive potential, negative cognitive effects, increased risk of dementia and injurious falls, and lack of demonstrated efficacy beyond 4 weeks in prospective trials (Lader, 2011; Federico et al., 2017; Islam et al., 2016; Picton et al., 2018; He et al., 2019). Importantly, in the treatment of major depressive disorder (MDD), there is a consensus among international guidelines that there is a limited role for benzodiazepines. Prominent guidelines caution against long-term benzodiazepine use, and recommend that benzodiazepines only be used short-term (~4 weeks) with an antidepressant if symptoms of anxiety, insomnia, or agitation are present (Davidson, 2010; Higuchi, 2010; Kennedy et al., 2016). Nonetheless, long-term benzodiazepine prescription accounts for up to one-third of all benzodiazepine prescriptions for elderly individuals (Zhang, 2010; Lai et al., 2011; Olfson et al., 2015; Bushnell et al., 2017; Zhong et al., 2019), and have increased over time (Kaufmann et al., 2018). Data from the Canadian National Population Health Survey revealed that 2–3% of individuals in the general community are receiving benzodiazepine (Patten et al., of whom 80% received prescriptions for more than 1 year (Esposito et al., 2009). In Canada and Brazil, among those who have had a major depressive episode in the last 12 months, 50% are prescribed concomitant benzodiazepine therapy (Sanyal et al., 2011; Fulone et al., 2018). Estimates from European countries reveal 14–16% of the adult population reported receiving at least one benzodiazepine prescription annually, with the majority considered to be long-term users (Petitjean et al., 2007; Cloos et al., 2015). In the USA, the number of benzodiazepine prescriptions has increased three or more fold in the past decade, driven mainly by long-term users (Bachhuber et al., 2016; Agarwal and Landon, 2019; Johansen and Niforatos, 2019). Predictors of long-term benzodiazepine use include older age, female sex, presence of MDD or an anxiety disorder, antidepressant initiation and pain (Liu et al., 2010; Patten et al., 2010; Manthey et al., 2011; Préville et al., 2011; Hawkins et al., 2012; ). Given that benzodiazepines and antidepressants are frequently co-prescribed, it is important to evaluate the potential pharmacologic interactions of benzodiazepines with common antidepressants prescribed for depression; especially considering evidence that long-term benzodiazepine use is associated with treatment resistance (Rizvi et al., 2014; Parker and Graham, 2015). The aim of this narrative review is to elucidate the potential interaction of long-term benzodiazepine use with antidepressant treatment outcomes, the neuropharmacological and neurobiological effects of long-term benzodiazepine use, efficacy, and the clinical implications of continued benzodiazepine use. Link to comment Share on other sites More sharing options...
[La...] Posted September 28, 2020 Author Share Posted September 28, 2020 And now it looks like that SciHub link to the full study is no longer working. Very frustrating. It was a really interesting study. If anyone does, indeed, have access to a medical library and can track this one down, it would be great if they could share it here. Link to comment Share on other sites More sharing options...
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