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Article Dans Une Revue Progress in Neuro-Psychopharmacology and Biological Psychiatry Année : 2023

Long-term benzodiazepine prescription in treatment-resistant depression: A national FACE-TRD prospective study

1 CEReSS - Centre d'études et de recherche sur les services de santé et la qualité de vie
2 Hôpitaux Sud - Hôpital Sainte-Marguerite [CHU - APHM]
3 Fondation FondaMental [Créteil]
4 EA7479 SPURBO - Soins Primaires, Santé Publique, Registre des cancers de Bretagne Occidentale
5 PSNREC - Neuropsychiatrie : recherche épidémiologique et clinique
6 ToNIC - Toulouse NeuroImaging Center
7 Inserm CIC 1431 - Centre d'Investigation Clinique de Besançon
8 Laboratoires de neurosciences intégratives et cliniques (EA 481)
9 NutriNeuro - Nutrition et Neurobiologie intégrée
10 IP - Institut Pascal
11 CHU Clermont-Ferrand
12 U955 Inserm - UPEC - IMRB - "Neuropsychiatrie translationnelle" [Créteil]
13 UGA - Université Grenoble Alpes
14 CRNL - Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center
15 Centre Hospitalier le Vinatier [Bron]
16 Service de Psychiatrie [CHRU Lille]
17 CN2R - Centre National de Ressources et de Résilience [Lille]
18 Hôpital Lariboisière-Fernand-Widal [APHP]
19 UPCité - Université Paris Cité
20 OPTeN (UMR_S 1144 / U1144) - Optimisation thérapeutique en Neuropsychopharmacologie
21 iBraiN - Imaging, Brain & Neuropsychiatry
22 CIC - Centre d’Investigation Clinique [Tours] CIC 1415
23 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
24 Centre hospitalier Charles Perrens [Bordeaux]
25 FRESNEL - Institut FRESNEL
26 ECM - École Centrale de Marseille
27 IMOTHEP - Imagerie MOléculaire pour applications THéranostiques personnalisées

Résumé

Background: Benzodiazepine long-term use (BLTU) is a public health challenge. We lack data on the consequences of LBTU on the trajectory of treatment-resistant depression (TRD). Objective: To determine the prevalence of BLTU in a nationwide non-selected population of patients with TRD, to determine the rate of patients succeeding at withdrawing benzodiazepines at one year and to determine if persistent BLTU is associated with poorer mental health outcomes. Method: The FACE-TRD cohort is a national cohort of TRD patients recruited in 13 resistant depression expert centers between 2014 and 2021 and followed-up at one year. A standardized one-day long comprehensive battery was carried out, including trained-clinician and patient-reported outcomes, and patients were reevaluated at one year. Results: At baseline, 45.2% of the patients were classified in the BLTU group. In multivariate analysis, compared to patients without BLTU, patients with BLTU were more frequently classified in the "low physical activity" group (adjusted odds ratio (aOR) = 1.885, p = 0.036), and had higher primary healthcare consumption (B = 0.158, p = 0.031) independently of age, sex and antipsychotic consumption. We found no significant difference for personality traits, suicidal ideation, impulsivity, childhood trauma exposure, earlier age at first major depressive episode, anxiety and sleep disorders (all p > 0.05). Despite recommendations for withdrawal, <5% of BLTU patients withdraw benzodiazepines during the one-year follow-up. Persistent BLTU at one-year was associated with higher depression severity (B = 0.189, p = 0.029), higher clinical global severity (B = 0.210, p = 0.016), higher state-anxiety (B = 0.266, p = 0.003), impaired sleep quality (B = 0.249, p = 0.008), increased peripheral inflammation (B = 0.241, p = 0.027), lower functioning level (B = -0.240, p = 0.006), decreased processing speed (B = -0.195, p = 0.020) and verbal episodic memory (B = -0.178, p = 0.048), higher absenteeism and productivity loss (B = 0.595, p = 0.016) and lower subjective global health status (B = -0.198, p = 0.028). Conclusion: Benzodiazepines are over-prescribed in TRD (in almost a half of the patients). Despite recommendations for withdrawal and psychiatric follow-up, <5% of patients successfully stopped taking benzodiazepines at one-year. Maintaining BLTU may contribute to the worsening of clinical and cognitive symptoms and of daily functioning in TRD patients. Progressive and planed withdrawal of benzodiazepines seems therefore strongly recommended in TRD patients with BLTU. Pharmacological and non-pharmacological alternatives should be promoted when possible.
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Dates et versions

inserm-04119754 , version 1 (06-06-2023)

Identifiants

Citer

Guillaume Fond, Mélanie Faugere, Laurent Boyer, Pauline Peri, Florian Stephan, et al.. Long-term benzodiazepine prescription in treatment-resistant depression: A national FACE-TRD prospective study. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2023, 126, pp.110779. ⟨10.1016/j.pnpbp.2023.110779⟩. ⟨inserm-04119754⟩
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