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Initiation and long-term use of benzodiazepines and Z-drugs in bipolar disorder
Karolinska Inst, Karolinska Univ Hosp, Dept Med, Ctr Pharmacoepidemiol CPE, Stockholm, Sweden.
Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, Stockholm, Sweden;Univ Eastern Finland, Niuvanniemi Hosp, Dept Forens Psychiat, Kuopio, Finland;Univ Eastern Finland, Sch Pharm, Kuopio, Finland.
Karolinska Inst, Karolinska Univ Hosp, Dept Med, Ctr Pharmacoepidemiol CPE, Stockholm, Sweden.
Karolinska Inst, Karolinska Univ Hosp, Dept Med, Ctr Pharmacoepidemiol CPE, Stockholm, Sweden.
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2018 (English)In: Bipolar Disorders, ISSN 1398-5647, E-ISSN 1399-5618, Vol. 20, no 7, p. 634-646Article in journal (Refereed) Published
Abstract [en]

Objectives

Increasing evidence points to the harmful effects of long‐term benzodiazepine treatment. Our objective was to study the incidence of, and predictors for, long‐term use of benzodiazepines and Z‐drugs in bipolar disorder.

Methods

We conducted a population‐based cohort study, using data from Swedish national registers. Swedish residents aged 18‐75 years with a recorded diagnosis of bipolar disorder or mania between July 2006 and December 2012, and no history of benzodiazepine/Z‐drug use in the past year, were included. Patients were followed for 1 year with regard to prescription fills of benzodiazepines/Z‐drugs. Initiators were followed for another year during which continuous use for >6 months was defined as “long‐term”. Patient and prescription characteristics were investigated as potential predictors for long‐term use in multivariate logistic regression models.

Results

Out of the 21 883 patients included, 29% started benzodiazepine/Z‐drug treatment, of whom one in five became long‐term users. Patients who were prescribed clonazepam or alprazolam had high odds for subsequent long‐term use (adjusted odds ratios [aORs] 3.78 [95% confidence interval (CI) 2.24‐6.38] and 2.03 [95% CI 1.30‐3.18], respectively), compared to those prescribed diazepam. Polytherapy with benzodiazepines/Z‐drugs also predicted long‐term use (aOR 2.46, 95% CI 1.79‐3.38), as did age ≥60 years (aOR 1.93, 95% CI 1.46‐2.53, compared to age <30 years), and concomitant treatment with psychostimulants (aOR 1.78, 95% CI 1.33‐2.39).

Conclusions

The incidence of subsequent long‐term use among bipolar benzodiazepine initiators is high. Patients on clonazepam, alprazolam or benzodiazepine/Z‐drug polytherapy have the highest risk of becoming long‐term users, suggesting that these treatments should be used restrictively.

Place, publisher, year, edition, pages
2018. Vol. 20, no 7, p. 634-646
Keywords [en]
benzodiazepines, bipolar disorder, cohort study, drug utilization study, prescription drug misuse, zaleplon, zolpidem, zopiclone
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-369593DOI: 10.1111/bdi.12626ISI: 000448841100008PubMedID: 29450954OAI: oai:DiVA.org:uu-369593DiVA, id: diva2:1272476
Funder
Swedish Research Council, 2016-02362Novo Nordisk, NNF15SA0018404Swedish Society of Medicine, SLS-502541Swedish Society of Medicine, SLS-587661The Karolinska Institutet's Research Foundation, 2013-37903Fredrik och Ingrid Thurings Stiftelse, 2015-00114Available from: 2018-12-19 Created: 2018-12-19 Last updated: 2018-12-19Bibliographically approved

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