A new review finds evidence that benzodiazepine drugs are not effective for posttraumatic stress disorder (PTSD) and may even be harmful.
Benzodiazepines are used to relieve anxiety by slowing the central nervous system. Common brand names include Ativan (lorazepam), Dalmane (flurazepam) and Diastat or Valium (diazepam).
The new evidence stems from a systematic review and meta-analysis published in the Journal of Psychiatric Practice.
“Benzodiazepines are ineffective for PTSD treatment and prevention, and risks associated with their use tend to outweigh potential short-term benefits,” writes Dr. Jeffrey Guina and colleagues from Wright State University, Dayton, Ohio.
They also find evidence to suggest that using benzodiazepines in patients with recent trauma can even increase the risk of developing PTSD.
The researchers performed a systematic review to identify clinical trials or observational studies concerning the use of benzodiazepines in patients with PTSD, or in patients with recent trauma evaluated for possible PTSD.
The study was the first comprehensive review and meta-analysis (pooled data analysis) to focus on this issue.
Benzodiazepines are a “common and controversial” treatment for PTSD. Some mental health professionals argue that benzodiazepines can reduce anxiety, insomnia, and irritability associated with PTSD.
Others suggest that benzodiazepines may actually prolong and worsen the disorder. “With all the news stories today pertaining to the inadequate treatment and mistreatment of military veterans with PTSD, it is important that the health care community continues to analyze what we are doing,” said Guina.
The review identified 18 studies including more than 5,200 participants who survived one or more traumas, including physical injuries, life-threatening medical conditions, combat-related trauma, sexual trauma, and disasters. Based on evidence from these studies, benzodiazepines were associated with no improvement in or worsening of overall severity, psychotherapy outcomes, aggression, depression, and substance use in PTSD patients.
Twelve studies provided data sufficient for a meta-analysis. The results suggested that benzodiazepines were associated with no improvement in PTSD-related outcomes, and that using benzodiazepines in patients with recent trauma actually increased PTSD risk.
“Those studies providing sufficient data suggest that the risk of developing PTSD is two to five times higher in groups receiving benzodiazepines than in control groups,” Guina and coauthors write.
Benzodiazepines have some efficacy for other anxiety disorders; so why are they unhelpful, or even harmful, in PTSD? It may be because anxiety in PTSD develops differently than in other anxiety disorders.
“Benzodiazepines might be effective if they selectively inhibited the stress and anxiety centers of the brain that are often hyperactive in PTSD,” Guina said. “Instead, they indiscriminately target the entire brain, including areas that are already hypoactive in PTSD, such as the cognitive and memory centers.”
Because benzodiazepines have ongoing effects on memory, they may hinder patients from learning how to cope with PTSD symptoms.
“Evidence-based trauma-focused psychotherapies require that patients experience and then master anxiety,” Guina and colleagues write. “Benzodiazepines can impair that experience by numbing emotions, decreasing learning efficiency, and inhibiting memory processing of material learned in therapy.”
Given that just four randomized trials have been performed to date, the authors conclude that more studies are needed to conclude that benzodiazepines consistently worsen PTSD.
Nevertheless, based on little evidence of efficacy and stronger evidence of potential risks, Guina and colleagues conclude that benzodiazepines are “relatively contraindicated” in trauma patients.
The researchers emphasize that there are now many different evidence-based treatments for PTSD, including psychotherapy, antidepressants, and adrenergic inhibitors — “all of which should be exhausted before benzodiazepines are considered.”
Source: Wolters Kluwer Health/EurekAlert