Do benzodiazepines reduce the effectiveness of exposure therapy for posttraumatic stress disorder? The use of benzodiazepine monotherapy for major depression before and after implementation of guidelines for benzodiazepine use. Treatment of recent trauma survivors with benzodiazepines: a prospective study. Benzodiazepine use in patients hospitalized in a department of internal medicine: frequency and clinical correlates. Benzodiazepine use in posttraumatic stress disorder among veterans with substance abuse. New evidence on benzodiazepine use and falls: the time factor. One-time counselling decreases the use of benzodiazepines and related drugs among community-dwelling older persons. Predictors of the incidence and discontinuation of long-term use of benzodiazepines: a population-based study. Efficacy of CBT for benzodiazepine discontinuation in patients with panic disorder: Further evaluation. Use of Benzodiazepines and Association with Falls in Older People Admitted to Hospital: A Prospective Cohort Study Effects of the benzodiazepine antagonist flumazenil in PTSD Treatment of Benzodiazepine Dependence in Methadone Maintenance Treatment Patients: A Comparison of Two Therapeutic Modalities and the Role of Psychiatric Comorbidity Factors Associated With Benzodiazepine Dependence Among Community-Dwelling Seniors World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision Comparison of nefazodone and sertraline for the treatment of posttraumatic stress disorder. Fast withdrawal from benzodiazepines in geriatric inpatients: a randomised double-blind, placebo-controlled trial Mirtazapine vs. placebo in posttraumatic stress disorder: a pilot trial
OBJECTIVE Benzodiazepines , other anxiolytics , or sedative hypnotics are prescribed for 30%-50 % of posttraumatic stress disorder ( PTSD ) patients . Prior data and theory suggest that these medications may inhibit response to exposure therapy , one of the most effective PTSD treatments . The present post hoc study reanalyzed results from a psychotherapy trial to assess whether benzodiazepine use was associated with reduced response to exposure therapy . METHOD Between August 2002 and October 2005 , 283 female veterans and soldiers meeting DSM-IV criteria for PTSD were r and omly assigned to 10 weekly 90-minute sessions of either prolonged exposure ( n = 140 ) or present-centered psychotherapy ( n = 143 ) . Benzodiazepine use ( n = 57 ) or non-use ( n = 226 ) at intake was not r and omly assigned . Multilevel modeling was used to assess the effects of benzodiazepine status , psychotherapy condition , and their interaction on changes on the Clinician-Administered PTSD Scale and the PTSD Checklist during the treatment and 6-month follow-up periods . RESULTS Consistent with prior reports from these data , prolonged exposure psychotherapy produced greater reductions per week in PTSD symptoms than did present-centered psychotherapy ( b = -0.48 , P = .02 ) . Patients prescribed benzodiazepines did not have weaker response to prolonged exposure , but demonstrated poorer posttreatment maintenance of gains from present-centered psychotherapy ( b = -0.78 , P < .001 ) . CONCLUSIONS Prolonged exposure is a sufficiently robust treatment that patients who are taking benzodiazepines  can benefit from it . It is unclear whether benzodiazepine use or other patient factors accounted for benzodiazepine recipients ' poorer maintenance of gains in  present-centered psychotherapy .  TRIAL REGISTRATION Clinical Trials.gov identifier : NCT00032617 WHAT IS KNOWN AND OBJECTIVE The Department of Health ( DOH ) in Taiwan issued the ' Guidelines for Benzodiazepine Use in Sedation and Hypnosis ' in March 2004 , which clearly stated that benzodiazepines ( BZDs ) should not be used alone for the treatment of depression . However , the extent to which clinicians comply with the BZD guidelines was not known . This study aim ed to evaluate whether sole prescribing of BZDs  for major depression decreased after the implementation of the BZD guidelines . METHODS This was a retrospective longitudinal trend analysis by analyzing the Longitudinal Health Insurance Data base ( LHID ) from September 2002 to September 2005 . The LHID contains all cl aims data from a r and om sample of 1,000,000 beneficiaries of the universal National Health Insurance programme in Taiwan . The 3-year study period was divided equally into six periods , before and after the implementation of the guidelines respectively . For each period , the proportion of patients with major depression ( ICD-9-CM code 296.2x , 296.3x ) treated with BZDs without any concomitant antidepressant was calculated in order to conduct a trend analysis . RESULTS AND DISCUSSION A total of 5463 prescriptions of BZDs solely used for major depression were observed in the entire study period . In more than 80 % of the BZD prescriptions in which BZDs were used alone for major depression , they were prescribed at doses higher than one prescribed daily dose/defined daily dose and were supplied for more than 7 days . The number of out patients with major depression  ranged from 2137 to 3326 during the 12 periods . The proportion of depressed patients treated with BZDs alone per 3 months ( i.e. , the non-compliance rate ) fluctuated from 6·7 % to 9·4 % before implementation of the guidelines , and from 8·0 % to 9·4 % after implementation , in outpatient setting s. In addition , the guideline non-adherence rates in inpatient setting s varied from 7·0 % to 11·8 % and from 7·8 % to 12·6 % before and after the implementation of the BZD guidelines respectively . Further trend analyses indicated that the implementation of the guidelines was not associated with a reduced rate of sole prescribing of BZDs for major depression in either inpatient ( P = 0·083 ) or outpatient setting s ( P = 0·925 ) . WHAT IS NEW AND CONCLUSION The formulation and implementation of the BZD guidelines appear not to be associated with a reduced rate of sole prescribing of BZDs for major depression , and more comprehensive efforts are required BACKGROUND Most types of psychotropic drugs have been tried in the treatment of chronic posttraumatic stress disorder ( PTSD ) , but have yielded limited results . Theory and retrospective research predict that early treatment may be more efficacious . Specifically , high-potency benzodiazepines have been recommended for the treatment of acute responses to trauma and for prevention of PTSD . This study prospect ively evaluates the effect of early administration of benzodiazepines on the course of PTSD and PTSD symptoms . METHOD Thirteen trauma survivors ( the benzodiazepine group ) were treated within 6.7 + /- 5.8 days after the trauma ( range , 2 - 18 ) with either clonazepam ( N = 10 , 2.7 + /- 0.8 mg/day ) or alprazolam ( N = 3 , 2.5 mg/day ) . Thirteen other trauma survivors , pair-matched with subjects in the active treatment group for gender and symptom severity in the first week after the trauma , constitute the control group . Both groups were reevaluated 1 and 6 months after the trauma for PTSD symptoms ( Horowitz Impact of Event Scale ; Mississippi Rating Scale for Combat-Related PTSD-civilian trauma version ) , PTSD status ( Clinician Administered PTSD Scale ) , state anxiety , depression , and resting heart rate . RESULTS Subjects in the benzodiazepine group did not differ from controls in 1-month and 6-month PTSD and anxiety scores . Repeated measures ANOVA showed no group or group-by-time effect on psychometric measures . A trend toward group-by-time interaction in resting heart rate was noted ( progressive decrease in the benzodiazepine group ) . Nine benzodiazepine subjects and 3 controls met PTSD diagnostic criteria 6 months after the trauma . CONCLUSION Contrary to expectations , the early administration of benzodiazepines to trauma survivors with high levels of initial distress did not have a salient beneficial effect on the course of their illness , while reducing physiologic expression of arousal PURPOSE Misuse and overuse of benzodiazepines ( BZD ) are common . Several studies have shown that benzodiazepines are frequently used in hospitalized patients , but fewer studies have been conducted to investigate whether BZD use increases during the hospital stay or whether patients have already taken BZD before admission . OBJECTIVE To assess the prevalence of  benzodiazepine use in hospitalized patients and to determine characteristics associated with this use . METHODS Prospect i ve study over a 4-month period based on all admissions to a department of internal medicine . The main outcome was the prevalence of benzodiazepine use at admission , during hospital stay and at discharge . RESULTS Of 444 patients admitted , 147 ( 33 % ) used at least one benzodiazepine which was in 75 % of the cases , short-elimination half-life BZD used as hypnotic . Of 105 ( 23.6 % ) patients using BZD at admission , 23 ( 5.2 % ) stopped BZD during hospital stay or when leaving hospital . The in-hospital prevalence of BZD use was 30 % ( 133 patients ) . In 28 ( 6.3 % ) patients without BZD at baseline , BZD was introduced during the hospital stay then stopped at discharge in 18 ( 4 % ) patients . The prevalence of BZD use at discharge was 23.9 % ( 106 patients ) . In multivariate analyses ,  BZD use was significantly associated with number of drugs taken during hospitalization ( OR : 1.13 ; 95 % CI : 1.03 - 1.24 ) , and current neuropsychiatric diseases ( OR : 2.12 ; 95 % CI : 0.86 - 5.23 ) , but not with gender , age or length of stay . CONCLUSION Prevalence of BZD use appeared to be fairly high among hospitalized patients . There were very few new BZD users during hospital stay , most of whom were stopped at discharge . Most treatments were started before hospital , and continued during and after hospital stay without clear reevaluation Veterans with posttraumatic stress disorder ( PTSD ) and substance abuse may abuse benzodiazepines and develop violent dyscontrol when using them . A total of 370 veterans were compared by substance abuse diagnosis ( 50 % ) , benzodiazepine use ( 36 % ) , and their interaction on 1-year outcomes after inpatient discharge . Substance abusers were less likely to be prescribed benzodiazepines ( 26 % vs. 45 % ) . No outcome showed a differential worsening by substance abuse or benzodiazepines , although some baseline differences were noted . Outpatient health care utilization was lower in benzodiazepine users ( 47 vs. 33 visits ) . Among PTSD patients with comorbid substance abuse , benzodiazepine treatment was not associated with adverse effects on outcome , but it may reduce health care utilization The objectives of this prospect i ve study were to calculate incidence rates for fall-related hospitalization , to compare the effect of risk factors among  benzodiazepine ( BZD ) users and unexposed controls , and to examine variations in risks according to length of time following a BZD prescription . Data were derived from Saskatchewan Health linked data bases , leading to information on 468 hospitalizations for injury due to falls among a study population of 321422 .  Incidence rates per 10000 within 28 days of the prescription fill date were 26.2 , 12.1 and 9.0 for BZD sedative users , BZD tranquillizer users and for unexposed controls , respectively . Incidence rates increased with age , and were higher for women than for men . Results from multivariate logistic regression models also showed a greater risk of falling for BZD users but the odds ratio was higher for men than for women . A history of treatment for alcohol abuse was a very strong risk factor for falls among both men ( odds ratio , 10.7 ) and women ( odds ratio , 4.3 ) . The highest risk of serious injury due to falls was within 15 days of filling the prescription , with an odds ratio of 3.6 for BZD sedatives and 2.6 for BZD tranquillizers . Risk decreased with further increase of time after the BZD fill date . For the individual BZD , flurazepam and triazolam showed the highest increase in risk with odds ratios of 3.4 and 2.7 , respectively , while oxazepam , lorazepam and diazepam showed odds ratios of 2.2 , 2.0 and 1.8 ( all odds ratios mentioned are statistically significant at p < 0.05 ) BACKGROUND evidence about possibilities to help older persons to withdraw the long-term use of benzodiazepines ( BZD ) is scarce . Effective and practicable methods are needed . OBJECTIVE the study aim ed to assess the persistence of one-time counselling by a geriatrician to reduce psychotropic drugs , especially BZD and related drugs ( RD ) . DESIGN a prospect i ve r and omised controlled trial with a 12-month follow-up was conducted . SUBJECTS five hundred ninety-one community-dwelling people aged 65 or older participated in the study . METHODS instructions to withdraw , reduce or change psychotropic drugs were given to the intervention group . A 1-h lecture about these drugs and their adverse effects was given later on . No changes in the drug therapy were suggested for the controls . RESULTS the number of regular users of BZD and RD decreased by 35 % ( 12/34 ) ( odds ratios ( OR ) = 0.61 , 95 % confidence interval ( 95 % CI ) 0.44 - 0.86 ) in the intervention group while it increased by 4 % ( 2/46 ) ( OR = 1.05 , 95 % CI 0.81 - 1.36 ) in the controls ( P = 0.012 ) . No significant changes in the users of other types of psychotropics were found . CONCLUSION one-time counselling of psychotropics and other fall-risk-increasing drugs by a geriatrician followed with a 1-h lecture about adverse effects of these drugs had positive effects in decreasing the number of regular users of BZD and RD , and these effects persisted for the total 12-month intervention period Long-term use of benzodiazepines ( BZDs ) has been linked with an array of negative health consequences and increased medical costs and social burden . In this study , we sought to investigate the factors accounting for differential risks in the process from incident BZD use to long-term use and discontinuation in the general population . On the basis of a r and om sample of 187,413 people enrolled in Taiwan 's National Health Insurance program on January 1 , 2000 , data of 2000 - 2002 healthcare and pharmacological services utilization were retrieved .  Long-term use ( LTU ) was defined by having received BZD prescriptions for 180 or more days within any given calendar year . Multivariate logistic regression analyses were carried out to assess the strength of associations while adjusting for the effects of individual sociodemographics , service providers , and pharmacological agents simultaneously . Results indicated that males , elderly , and those with physical or mental disorders were more likely to become long-term users of BZDs .  Having received BZD prescriptions in multiple pharmacological agents , short-acting or mixed-type agents , and hypnotic indication were associated with a roughly 2- to 5-fold increased risk of BZD LTU soon after prescription initiation . With respect to discontinuation , the effects of pharmacological characteristics seem more salient as compared to those of individual and service-provider factors . Future strategies targeting individual factors and modifying service-provider prescription behaviors may be considered to reduce possible negative consequences of BZD LTU Despite its acute efficacy for the treatment of panic disorder , benzodiazepines ( BZs ) are associated with a withdrawal syndrome that closely mimics anxiety sensations , leading to difficulty with treatment discontinuation and often disorder relapse . An exposure-based cognitive-behavioral treatment for BZ discontinuation , Panic Control Treatment for BZ Discontinuation ( CBT ) targets the fear of these sensations and has demonstrated efficacy in preventing disorder relapse and facilitating successful BZ discontinuation among patients with panic disorder . In this r and omized controlled trial , CBT was compared to taper alone and a taper plus a relaxation condition to control for the effect of therapist contact and support among 47 patients with panic disorder seeking taper from BZs . Based on the primary outcome of successful discontinuation of BZ use , results indicate that adjunctive CBT provided additive benefits above both taper alone and taper plus relaxation , with consistently medium and large effect sizes over time that reached significance at the six month follow-up evaluation . The efficacy of CBT relative to either of the other taper conditions reflected very large and significant effect sizes at that time . These findings suggest that CBT provides specific efficacy for the successful discontinuation from BZs , even when controlling for therapist contact and relaxation training Background Hypnosedatives are commonly prescribed for anxiety and sleep problems . Changes in pharmacokinetics and pharmacodynamics of benzodiazepines ( BZDs ) during ageing may increase their potential to cause adverse outcomes . Objective This study aim ed to investigate the use of BZDs in acute care setting s and explore their association with falls . Methods A prospect i ve cohort study was undertaken of patients aged over 70 years consecutively admitted to 11 acute care hospitals in Australia . Data were collected using the interRAI Acute Care assessment tool . Falls were recorded prospect ively ( in hospital ) and retrospectively ( in the 90 days prior to admission ) . Results Of 1,412 patients , 146 ( 10.3 % ) were taking BZDs at admission and 155 ( 11.3 % ) at discharge .  Incidence rates of in-hospital fallers for users and non-users of BZDs were not statistically different [ incidence rate ratio 1.03 , 95 % confidence interval ( CI ) 0.58–1.82 ] . There was also no significant association between benzodiazepine use at admission and history of falls in the previous 90 days compared with non-users . However , patients on diazepam were significantly more likely to have a history of falls than all other benzodiazepine users ( 70.8 vs. 36.1 % ; p = 0.002 ) , particularly when compared with oxazepam users ( 70.8 vs. 25.0 % ; p < 0.001 ) . Adjusting for confounders , use of diazepam at admission was positively associated with a history of falls compared with all other benzodiazepine users ( odds ratio 3.0 ; 95 % CI 1.1–8.5 ; p = 0.036 ) . Conclusions Different BZDs may vary in their propensity to predispose to falls , with diazepam having the strongest association . The selection of particular BZDs for older patients should be carefully evaluated OBJECTIVE Evidence from pre clinical and clinical studies suggests a role for alterations in the benzodiazepine/GABAA receptor complex in stress and anxiety .  Flumazenil is a relatively pure benzodiazepine/GABAA antagonist with limited intrinsic activity . In panic disorder patients , but not healthy controls , flumazenil has been demonstrated to provoke panic attacks . METHOD Vietnam combat veterans with PTSD ( n = 14 ) received 90-second intravenous infusions of flumazenil 2 mg or placebo in a double-blind , crossover study design . PTSD symptomology was assessed using the PTSD Symptom Scale , and anxiety symptoms were measured with visual analogue rating scales . RESULTS There was no significant difference in PTSD and anxiety symptoms between administration of flumazenil and placebo . CONCLUSION Flumazenil administration does not produce an increase in anxiety and PTSD symptoms in patients with PTSD . This suggests that PTSD and panic disorder are dissimilar in terms of benzodiazepine/GABAA system function Objective : Therapeutic approaches for benzodiazepine ( BZD ) dependence in patients in methadone maintenance treatment ( MMT ) have met with limited success . Clonazepam detoxification ( CDTX ) and clonazepam maintenance treatment ( CMT ) were compared in an open , clinical naturalistic study on such patients . Methods :  Benzodiazepine dependent patients substituted their BZD of abuse for clonazepam and were then either detoxified ( CDTX ) or a maintenance dose was reached and maintained ( CMT ) . Patients were considered as failing the trial if they either abused BZDs ( CDTX group ) or abused BZDs over the maintenance dose ( CMT group ) . Treatment outcome was evaluated based upon self and staff reports over 1 year after beginning treatment . Axis I and II psychiatric diagnosis was assessed and methadone dosage and history of abuse was recorded . Results : In the CDTX group , 9/33 ( 27.3 % ) , were BZD-free after 2 months . In the CMT group , 26/33 ( 78.8 % ) refrained from abusing additional BZDs over the maintenance dose after 2 months . The same success rate remained over the entire year . Survival analysis showed CMT to be more successful than the CDTX . Axis I psychiatric comorbidity was found to be positively related to treatment success in the CMT group while axis II antisocial personality disorder was found to be negatively related to treatment success in that group . It had no impact in the CDTX group . Conclusions : Maintenance strategy with clonazepam is a useful BZD treatment modality for BZD-dependent MMT patients with a long-term history of abuse and previous attempts at detoxification . Psychiatric comorbidity may have an important role in choosing the adequate treatment modality and influencing treatment outcome Background : Benzodiazepine ( BZD ) dependence among seniors is an understudied problem . Objective : Identify the factors associated with BZD dependence . Method : Face-to-face computer-assisted interviews were conducted in the homes of 2,785 persons aged 65 years or older , r and omly selected . Results : Nine- and -a-half percent of BZD users met DSM-IV-TR criteria for BZD dependence . Factors associated with BZD dependence are being a woman , and having cognitive impairment , panic disorders , suicidal ideations , and a degree of embarrassment in obtaining help for emotional problem . Discussion : Nurses should be better positioned to identify those elderly users of BZDs who are more likely to be dependent and to address the problem through BZD withdrawal program In this report , which is an up date of a guideline published in 2002 ( B and elow et al. 2002 , World J Biol Psychiatry 3:171 ) , recommendations for the pharmacological treatment of anxiety disorder , obsessive-compulsive disorder ( OCD ) and post-traumatic stress disorder ( PTSD ) are presented . Since the publication of the first version of this guideline , a substantial number of new r and omized controlled studies of anxiolytics have been published . In particular , more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs . The recommendations , developed by the World Federation of Societies of Biological Psychiatry ( WFSBP ) Task Force for the Pharmacological Treatment of Anxiety , Obsessive-Compulsive and Post-traumatic Stress Disorders , a consensus panel of 30 international experts , are now based on 510 published r and omized , placebo- or comparator-controlled clinical studies ( RCTs ) and 130 open studies and case reports . First-line treatments for these disorders are selective serotonin reuptake inhibitors ( SSRIs ) , serotonin-noradrenaline reuptake inhibitors ( SNRIs ) and the calcium channel modulator pregabalin . Tricyclic antidepressants ( TCAs ) are equally effective for some disorders , but many are less well tolerated than the SSRIs/SNRIs . In treatment-resistant cases , benzodiazepines may be used when the patient does not have a history of substance abuse disorders . Potential treatment options for patients unresponsive to st and ard treatments are described in this overview . Although these guidelines focus on medications , non-pharmacological were also considered . Cognitive behavioural therapy ( CBT ) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders , OCD , and PTSD to support them being recommended either alone or in combination with the above medicines Posttraumatic stress disorder ( PTSD ) is a prevalent condition that has been shown to be responsive to pharmacotherapy . Few head-to-head comparisons of medications used in the treatment of PTSD have been published . This 12-week , r and omized , double-blind study compares the effectiveness , safety , and tolerability of nefazodone and sertraline for the treatment of PTSD . Thirty-seven male and female out patients meeting DSM-IV criteria for PTSD were r and omly assigned to receive nefazodone ( maximum dose 600 mg/day ; average dose 463 mg/day ) or sertraline ( maximum dose 200/day ; average dose 153 mg/day ) . The primary outcome measures were the 17-item total severity score of the Clinician Administered PTSD Scale , Part 2 ( CAPS-2 ) and the Clinical Global Impression Improvement Scale ( CGI-I ) . Other assessment s included the Davidson Trauma Scale ( DTS ) , the Top-8 PTSD Rating Scale , Sheehan Disability Scale ( SDS ) , Montgomery-Asberg Depression Rating Scale ( MADRS ) , Hamilton Anxiety Scale ( HAM-A ) , and Pittsburgh Sleep Quality Index ( PSQI ) .  Twenty-six subjects had at least one post-r and omization CAPS-2 assessment and were therefore included in the data analysis . There were no statistically significant differences between treatment groups on any of the outcome measures . There was a significant effect for time in both groups , indicating an improvement in PTSD symptoms , depression , sleep , and quality of life over time . CAPS-2 scores for all of the PTSD symptom clusters decreased significantly over time . This study did not find significant differences in the effectiveness of nefazodone and sertraline for the treatment of PTSD . Larger trials are warranted Abstract . Objective : We have previously demonstrated that temporary substitution with a low-dose hypnosedative drug may lead to successful withdrawal from chronic benzodiazepine ( BZD ) use in the majority of patients admitted to a geriatric ward . In the present study , a withdrawal programme was evaluated in which the habitual treatment with BZDs was replaced by either 1 mg lormetazepam or placebo , defining withdrawal success rate , sleep quality and withdrawal symptoms as main outcomes . Methods : The target population was geriatric in patients who had been taking BZDs for at least 3 months . Subjects suffering from mental disorders were excluded .  Lormetazepam or placebo were r and omly assigned and given in a double-blind fashion . After 1 week , the replacement therapy was discontinued . Subjective estimations of sleep quality and withdrawal symptoms were registered at predefined intervals , four times in a period of 30 days , using st and ard question naires ( the Pittsburgh Sleep Quality Index and the Benzodiazepine Withdrawal Symptom Question naire , respectively ) . Results : The success rate was significantly higher in the lormetazepam substitution group ( 80 % vs 50 % in the placebo group , P<0.05 ) . Both the subjective quality of sleep and withdrawal symptoms were significantly better in the lormetazepam substitution group . Important withdrawal effects were observed in the control group in two patients with a history of chronic alcohol abuse . Conclusions : Initial replacement therapy with a low-dose BZD is preferred over placebo , since the latter alternative is associated with worse sleep quality and a lower success rate .  Placebo must only be used under medical scrutiny , given the potential for unmasking delirious symptoms , especially in patients with concomitant alcoholism BACKGROUND Based on an earlier pilot study , as well as a theoretical consideration of its mechanism of action , we undertook a placebo-controlled , double-blind trial of mirtazapine in posttraumatic stress disorder . METHODS Twenty-nine patients were r and omized to receive  drug  up to 45 mg/day or placebo double-blind on a 2:1 ratio for 8 weeks , with data being available for analysis in 26 . Primary outcome measures comprised the Short Posttraumatic Stress Disorder Rating Interview ( SPRINT ) Global Improvement item and total score . Secondary measures comprised the Davidson Trauma Scale , Structured Interview for Posttraumatic Stress Disorder and Hospital Anxiety Depression Scale . Adverse events were also measured . RESULTS On the Short Posttraumatic Stress Disorder Rating Interview Global Improvement measure , rates of response were 64.7 % and 20.0 % for mirtazapine and placebo . Treatment effects in favor of mirtazapine were noted on the Short Posttraumatic Stress Disorder Rating Interview global , Structured Interview for Posttraumatic Stress Disorder , and Hospital Anxiety Depression Scale anxiety subscale scores . The drug was well tolerated . CONCLUSIONS Mirtazapine was more effective than placebo on some measures in posttraumatic stress disorder and general anxiety symptoms
RESULTS BZDs are ineffective for PTSD treatment and prevention , and risks associated with their use tend to outweigh potential short-term benefits .
In addition to adverse effects in general population s , BZDs are associated with specific problems in patients with PTSD : worse overall severity , significantly increased risk of developing PTSD with use after recent trauma , worse psychotherapy outcomes , aggression , depression , and substance use .
The results of this systematic review suggest that BZDs should be considered relatively contraindicated for patients with PTSD or recent trauma .
OBJECTIVE Although benzodiazepines ( BZDs ) are commonly used in the treatment of posttraumatic stress disorder ( PTSD ) , no systematic review or meta- analysis has specifically examined this treatment .
The goal of this study was to analyze and summarize evidence concerning the efficacy of BZDs in treating PTSD .