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Benzodiazepine Use in Veterans with PTSD

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Updated November 28, 2012

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There are a number of treatments available for people with PTSD, including both psychological treatments (often referred to as "talk therapy") and medications. With regard to medications, the American Psychiatric Association recommends selective serotonin reuptake inhibitors (SSRIs) for the treatment of PTSD.

SSRIs are generally considered "anti-depressant medications." Serotonin is a chemical in your brain that's involved in regulating mood, as well as other functions. Some people have imbalances in the serotonin systems in their brains, contributing to feelings of depression and/or anxiety. SSRIs prevent the breakdown, or "reuptake," of serotonin by your brain — increasing the available levels of serotonin, which is thought to eventually improve mood. Several studies have found that selective serotonin reuptake inhibitors (SSRIs) may be useful in the treatment of PTSD.

Benzodiazepines are another medication that may be prescribed for PTSD. The term benzodiazepines refers to a class of drugs that have a sedative effect, and are therefore often used to successfully alleviate anxiety. These drugs, often referred to as tranquilizers, result in a relatively quick reduction in anxiety.

Although benzodiazepines may be prescribed for PTSD, certain organizations, including the Department of Veterans Affairs (VA) and the Department of Defense (DoD), do not recommend benzodiazepines for the long-term management of PTSD. While these medications may be useful for some symptoms of PTSD, such as anxiety and difficulty sleeping, studies do not support their usefulness in the treatment of most PTSD symptoms, including avoidance symptoms.

In addition, when not taken properly, there's potential for dependence on, or abuse of, benzodiazepines. People with PTSD and substance-abuse problems (two conditions which frequently co-occur) may be particularly at risk. Finally, certain uses of benzodiazepines may also interfere with psychological treatments for PTSD, such as Exposure therapy, in which people are instructed to confront feared situations, thoughts, and feelings, and are then taught to maintain contact with these things until the fear and anxiety naturally lessen. The decision to use a benzodiazepine to instead reduce this anxiety would interfere with this process.

Benzodiazepine Use in Veterans

Given that the VA and DoD do not recommend the use of benzodiazepines for the long-term management of PTSD symptoms, a group of researchers from the Iowa City VA Medical Center wanted to see if benzodiazepine use in veterans changed over the course of 11 years. They looked at medical records (from 1998 to 2009) of a large number of veterans with PTSD and found that, although the number of veterans with PTSD being treated in the VA increased, the frequency of benzodiazepine use among veterans with PTSD decreased from around 37% to 31%. New patients were the least likely to be prescribed benzodiazepines, and those who did receive a benzodiazepine received a low dose. Finally, the number of long-term users of benzodiazepines also decreased.

Addressing Your PTSD Symptoms

The results of this study show that mental health professionals appear to be prescribing benzodiazepines less for the treatment of PTSD. Although the exact reasons for this are not clear from this study, the findings are promising. They may suggest that mental health professionals are more aware of the potential risks of prescribing benzodiazepines for PTSD, and they may also suggest that mental health professionals are relying more on the wide variety of other treatments or medications that have been found useful for people with PTSD.

Although the long-term use of benzodiazepines may be associated with some risks, it's important to remember that no treatments for PTSD are risk-free. Even psychological treatments for PTSD are associated with some side effects, such as a potential initial increase in anxiety. In addition, your doctor may recommend the short-term management of certain symptoms of PTSD with benzodiazepines. In getting treatment for your PTSD, it's important to work with your doctor or other health professional to identify the best treatment for your symptoms. In addition, it's incredibly important to make sure you follow the guidelines set up by your doctor or other health professional, especially when it comes to medications. Doing so can help minimize risks, as well as maximize the benefits of any treatment.

Sources:

Brady, K., Pearlstein, T., Asnis, G.M., Baker, D., Rothbaum, B., Sikes, C.R., & Farfel, G.M. (2000). Efficacy and safety of sertraline treatment of posttraumatic stress disorder: A randomized controlled trial. Journal of the American Medical Association, 283, 1837-1844.

Cates, M.E., Bishop, M.H., Davis, L.L., et al. (2004). Clonazepam for treatment of sleep disturbances associated with combat-related posttraumatic stress disorder. Annals of Pharmacotherapy, 38, 1395-1399.

Davidson, J., Pearlstein, T., Londborg, P., Brady, K.T., Rothbaum, B., Bell, J. et al. (2001). Efficacy of sertraline in preventing relapse of posttraumatic stress disorder: Results of a 28-week double-blind, placebo-controlled study. American Journal of Psychiatry, 158, 1974-1981.

Keane, T.M., & Barlow, D.H. (2002). Posttraumatic stress disorder. In D.H. Barlow (Ed.), Anxiety and its disorders, 2nd edition (pp. 418-453). New York, NY: The Guilford Press.

Lund, B. C., Bernardy, N. C., Alexander, B., & Friedman, M. J. (2012). Declining benzodiazepine use in veterans with posttraumatic stress disorder. Journal of Clinical Psychiatry, 73, 292-296.

Pollack, M.H., Hoge, , E.A., Worthington, J.J., et al. (2011). Eszopiclone for the treatment of posttraumatic stress disroder and associated insomnia: A randomized, double-blind, placebo-controlled trial. Journal of Clinical Psychiatry, 72, 892-897.

van Minnen, A., Arntz, A., & Keijsers, G.P. (2002). Prolonged exposure in patients with chronic PTSD: Predictors of treatment outcome and dropout. Behaviour Research and Therapy, 40, 439-457.

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  5. Benzodiazepine Use in PTSD - Benzodiazepine Use

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