Depressive Disorder Treatment Discrepancies

This proposed research will use a retrospective longitudinal methodology to describe the differences in those patients treated over extended periods with benzodiazepines in comparison with age and socioeconomically matched controls that were not exposed to this drug. Indicators of health and illness will include frequency of hospitalizations, concurrent self-reported substance abuse, subjective and objective evidence of cognitive impairment.

Depressive disorders are very common mental disorders that are normally accompanied by symptoms of anxiety disorders and antidepressants are medications that are prescribed by pharmacologists to treat depression. Most antidepressants are very effective in treating depression and anxiety. However, the beneficial effects of these antidepressants are not immediate, and most pharmacologists usually prescribe benzodiazepines to provide instant relief. Though this drug is being used in large proportions by patients suffering from depressive and anxiety disorders, the benefits of this drug are not very clear (Bartels, 1997). There are randomized trials that have been carried out to examine benzodiazepines as the basic treatment for depressive disorders and these trials have indicated that this drug is not as effective as antidepressants. This drug, according to scientists addresses very few symptoms like insomnia and restlessness but it does not address the serious symptoms of depressive and anxiety disorders. Very few studies have examined the effectiveness of a combination of antidepressants and benzodiazepines but a report from a meta-analysis carried out by scientists indicated that a combination of both drugs is more beneficial than a single drug.

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However, there are reports about the risks of long-term use of benzodiazepine and one of the most serious risks is the development of withdrawal symptoms if the administration of this drug is discontinued. Chronic use of this drug can lead to cognitive impairments and development of dementia, weakening of bones and many other psychomotor effects (Singer, 1996). A study was conducted by the national registry of depression which has a lot of data on depressive disorder diagnosis in mental health. The study population was put into three different groups. The first group had patients below the age of 44, the second had patients below the age of 64 and the third group had patients aged 65 and above (Taylor, 2001). All these patients had been using benzodiazepine as outpatients and the duration they had taken this drug was considered. An assumption was made that these patients took the maximum allowable dose though a room was created for overlapping prescriptions. A mean of prescribed benzodiazepine dose and the apparent dose for all the users was calculated and the doses were expressed in diazepam of equivalent amounts because this mean represents the dosing directions of the physician and in this study, the prescription for this drug was associated with a motley of patient-level factors because the physicians were responding to different presentations of symptoms and this enhanced the validity and the reliability of the results (Berk, 1991).

After the study was carried out, reports indicated that benzodiazepine use was more common among patients above the age of 65 and the usage reduced with age, whereby the rate of use was least common among the patients below the age of 44 (Blazer, 2000). Repeated studies gave similar results, and this led to a conclusion that physicians should therefore balance the risks and benefits of prescribing this drug because the risk, according to the study seems to increase in proportion to the age of the patients however, older patients seem to derive more benefits from the drugs (Mamdani, 2001). They find it difficult to discontinue the use of this medication and that is why withdrawal symptoms are more severe among older patients who have been using the drugs for a longer period and according to study, this drug ought to be prescribed to patients who have a larger scale medical comorbidity because they are more likely to be affected by distress than patients with lower levels of medical comorbidity. Patients with concurrent anxiety disorders may benefit from the prescription of this drug more than patients suffering from substance abuse disorders because this drug cannot relieve symptoms of substance abuse (Kirby, 1991).

The study also found out that the use of benzodiazepine increased the rates of hospitalization among the young users meaning that it is possible to disaggregate the relationship between the use of this drug and the severity of illnesses that lead to hospitalization, though this interpretation should be made cautiously (Birkenhager, 1995). The study also looked into the relationship between the use of this drug and health results and poor results were recorded among long term users because the drug-impaired them cognitively and weakened their bones which led to numerous hip fractures and falls, and this has been indicated in more than three studies.

This study may not be enough to lead us to an objective conclusion because it had certain limitations that may have affected the interpretation of the results meaning that the results cannot be relied upon to give a universal hypothesis. To start with, the sample population may have had some patients with chronic depressive disorders and patients who were new to this medication meaning that the results may not be indicative of the actual trends because of this disparity in the duration of administration (Doraiswamy, 2000). Secondly, the scientists carrying out the study did not know whether long term use of this drug was appropriate because some patients in the sample population have been benefitting from the benzodiazepine medication after using the drug for a long period meaning that we cannot easily conclude that the use of this universally affects patients negatively (Olfson, 2002). However, numerous studies have demonstrated negative medical outcomes especially among users who have been taking this drug for a long time but further research is needed so that an objective conclusion can be drawn.

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In conclusion, despite many cautionary guidelines that have been issued against the administration of benzodiazepine, prescription of this drug alongside antidepressants is still a common treatment pattern that is observable in most mental health settings especially among elderly patients who according to the report, receive more substantial benefits than the younger patients. the study was able to tom examine patients treated over extended periods with benzodiazepines in comparison with age and socioeconomically matched controls that were not exposed to this drug. Indicators of health and illness that have been used in the study are frequency of hospitalizations, concurrent self-reported substance abuse, subjective and objective evidence of cognitive impairment, however, the study was not able to identify the reasons for long term administration of this depressive disorder drug because the effectiveness of benzodiazepine is still in question.

References

Bartels, S.J. (1997). Treatment of depression in older primary care patients in health maintenance organizations. Int J Psychiatry Med 1997; 27:215–231.

Berk, M. (2000). Selective serotonin reuptake inhibitors in mixed anxiety- depression. Int Clin Psychopharmacol. 15: S41-S45.

Birkenhager, T.K. (1995). Benzodiazepines for depression? a review of the literature. Int Clin Psychopharmacol. 10:181–195.

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Blazer, D. (2000) Sedative, hypnotic, and antianxiety medication use in an ageing cohort over ten years: a racial comparison. J Am Geriatr Soc 2000; 48:1073– 1079.

Doraiswamy, P.M. (2001). Contemporary management of comorbid anxiety and depression in geriatric patients. J Clin Psychiatry. 62:30–35.

Kirby, M. (1991) Benzodiazepine use among the elderly in the community. Int J Geriatr Psychiatry. 14:280–284.

Mamdani, M.M, (2001). Trends in the prevalence of benzodiazepine prescribing in older people in Ontario, Canada. J Am Geriatr 49:1341–1345.

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Olfson, M, (2002): National trends in the outpatient treatment of depression. JAMA; 287:203–209.

Singer, G.E. (1996). Predictors of chronic benzodiazepine use in a health maintenance organization sample. J Clin Epidemiol.49:1067–1073.

Taylor, S (2001). Extent and appropriateness of benzodiazepine use: results from an elderly urban community. Br J Psychiatry. 173:433–438.

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