Are BZDs a Good or a Bad Idea? Rakesh Jain, MD, MPH Lightening strike - http://www.shelbourn.com/gazette/2010/ Idea - https://welovelocalgovernment.wordpress.com/2012/04/18/stirring-the-pot/ Benzos are ALWAYS a good idea and we are way under prescribing it – Benzos are ALWAYS a bad idea and we are way over prescribing it –

Can Long-Term BZD Treatment “Harm” the Brain Can Long-Term BZD Treatment “Harm” the Brain? Results from an NIMH Study There was no significant association between VBR and age (r = - .06, P = NS), panic attacks within the past month (r = .04, P = NS), or state anxiety (r = .19, P = NS) There was a significant association between VBR and duration of BZD use (r = .51, P < .02) and percent of time ill treated with BZDs (r = .67, P < .001) VBR = ventricle to brain ratio. Uhde T et al. J Affect Disord. 1987;12(12):175-178.

Does Cognition Improve after Withdrawal from Long-Term BZD Use? Improvement in cognitive function does occur following withdrawal from long-term BZD use Patients withdrawn from long-term BZD use continued to perform more poorly than controls across all cognitive categories, except sensory processing As age increased post-withdrawal cognitive recovery decreased on tasks of attention/concentration Articles: http://www.thesmartkitchenblog.com/wp-content/uploads/2013/12/IMG_9114-1024x683.jpg Barker MJ et al. Arch Clin Neuropsychol. 2004;19(3):437-454.

Higher risk for long-acting formulations BZD Use & Association with Alzheimer’s Disease – Emerging Data is Concerning Dose-effect relationship between BZD use and increased risk of Alzheimer’s disease in older people treated previously for >3 months Higher risk for long-acting formulations Nature of the link cannot be definitively established BZD use may be an early marker of a condition associated with an increased risk of dementia Recommend shortest duration + short half-life formulations Billioti de Gage S et al. BMJ. 2014;349:g5205.

Top 3 Practical Take-Aways Before using benzodiazepines in any patient, a careful short- and long-term assessment of the risk-benefit is a necessity Data is accumulating that risk of addiction and physical dependence of this class of medications is higher than originally anticipated If a decision to slowly reduce or stop these medications is made in conjunction with the patient, there are now several well studied pathways available to achieve this goal