Novel Program Reduces Depressive Symptoms, Benzo Use

AVENTURA, Florida ― A novel, community-based depression recovery program may help to decrease not only symptoms of the disorder but also benzodiazepine use, new research suggests.

Dr Francisco Ramirez

An observational study of more than 300 participants from 7 countries who had moderate depression and who acknowledged use of benzodiazepines at baseline showed significantly lower depression scores at the end of the 8-week program. Plus, 13% of those who had been taking benzodiazepines on an irregular basis stopped using them altogether, and 24% of those who had been taking them more than twice a month decreased or stopped use.

"Our focus in the program isn't on benzodiazepines, but this was a nice side effect," lead author Francisco Ramirez, MD, director of research at the Nedley Clinic in Ardmore, Oklahoma, told Medscape Medical News.

The findings were presented here at the American Academy of Addiction Psychiatry (AAAP) 25th Annual Meeting.

Lifestyle Intervention

According to the Centers for Disease Control and Prevention, 30% of the 22,114 deaths that were related to pharmaceutical overdose in 2012 involved benzodiazepines.

The study's 2-hour, once-weekly, lifestyle-focused depression treatment program teaches participants about exercise, rest, and nutrition, as well as temperance and the use of spiritual resources to improve depression and anxiety.

"Emphasis is also given to overcoming the usage of substances that can create an addictive relationship," write the investigators.

Dr Ramirez added that that section does mention benzodiazepines by name, as well as nicotine, alcohol, illegal drugs, and even caffeine.

"Overall, the program is a nice way to get people to implement good habits. We ask them about things like better exercise in a way that makes them feel like owners of the idea, which increases the odds that they will make changes permanently," said Dr Ramirez. 

The researchers examined data on 4271 adults (70.7% women; mean age, 53 years) who underwent the program at sites in seven countries: the United States, New Zealand, Australia, the United Kingdom, Norway, Canada, and Mexico.

At baseline and at the end of treatment all participants completed the "previously validated" 75-item Nedley DSM-Depression test to measure demographics and use of benzodiazepines. It also measures depression through a slightly modified version of the Patient Health Questionnaire.

Effective Tool

Results showed that at baseline, the group had an overall depression score of 13 (standard deviation [SD], 7.67), "which is equivalent to moderate depression," 7.8% of patients reported irregular use of benzodiazepines. A total of 6.8% reported using the medications more than twice a month.

At the end of the program, the overall depression score had dropped to 6.78 (SD, 6), 43 of the irregular users had completely quit benzodiazepines, and 70 of the previously dedicated users stopped altogether or cut down to less than twice a month.

"This study demonstrates that an 8-week community-based depression recovery program can be an effective tool to help participants overcome the usage of benzodiazepines," write the investigators.

However, they note that further studies are now needed to explore whether these results are long-lasting after program completion.

Dr Ramirez added that the program leaders urge participants to go to their regular clinicians to discuss all medication decisions.

Encouraging Findings

Ryan Caldeiro, MD, chief of chemical dependency services and consultative psychiatry for Group Health in Seattle, Washington, told Medscape Medical News that he thought the program was an interesting concept.

Dr Ryan Caldeiro

"The health system where I work has just rolled out a standard process for educating patients about the risk of benzodiazepines and to encourage them to get off of these medications," said Dr Caldeiro, who was not involved with this research.

"Seeing something like this [program] is really encouraging."

However, he noted that it "wasn't really a scientific study" and voiced concern about possible commercial biases.

"But the concept of having people engage in a fairly simple-sounding depression and anxiety group, which is fairly common in mental health settings throughout the country, and providing some education that might reduce benzodiazepine use is highly promising," said Dr Caldeiro.

"We know this is a class of medication that's overused, and there's really not a lot of clinical indications for long-term use," he said.

He added that he was pleased to see anyone putting up a poster presentation addressing this area, "because I think there's not a lot of good data about what some strategies are that we can employ."

The study authors and Dr Caldeiro report no relevant financial relationships.

American Academy of Addiction Psychiatry (AAAP) 25th Annual Meeting: Abstract 21, presented December 5, 2014.