Therapie der Benzodiazepinabhängigkeit

Langzeitverordnungen von Benzodiazepinen entfallen vor allem auf ältere und weibliche Patienten. Entzugsbehandlungen sollten schrittweise über einen mehrwöchigen Zeitraum erfolgen. Begleitende Schlaf- und depresssive Störungen im Benzodiazepinentzug kann man am ehesten mit sedierenden Antidepressiva behandeln. Die spärliche Studienlage deutet auf eine gewisse Effizienz von Psychoedukation, motivationalen Strategien und kognitiver Verhaltenstherapie.

Kernaussagen

• Benzodiazepine sind klinisch sehr sichere Substanzen mit hoher therapeutischer Breite.

• Trotz sinkender Verschreibungszahlen ist die Zahl der Patienten mit Benzodiazepinabhängigkeit immer noch sehr hoch.

• Langzeitverschreibungen sind gerade bei älteren Patienten sehr häufig.

• Risikogruppen für Benzodiazepinabhängigkeit sind Frauen, Ältere, Menschen mit psychischen Störungen, Schlafstörungen, chronischen Schmerzen, Angst oder mit Suchterkrankungen.

• Medikamentenabhängige vom Typ Benzodiazepine werden vom klassischen Suchthilfesystem kaum gesehen und selten in Suchtfachkliniken behandelt.

• Typische Entzugssymptome sind Angst, Unruhe, Schlafstörungen und Perzeptionsstörungen. Bei zu raschem Absetzen besteht die Gefahr von epileptischen Anfällen, Delir oder Entzugspsychosen.

• Der Entzug soll in jedem Falle schrittweise über mehrere Wochen erfolgen.

• Im Benzodiazepinentzug kann z. B. kognitive Verhaltenstherapie eingesetzt werden; Antidepressiva werden symptomatisch zur Behandlung depressiver Störungen, aber auch Schlafstörungen eingesetzt.

Schlüsselwörter

Benzodiazepine - Abhängigkeit - Entzug - Therapie

Publication History

Publication Date:
11 September 2018 (online)

• Literatur

• 1 Soyka M. Medikamentenabhängigkeit. Stuttgart: Schattauer; 2015
• 2 Soyka M, Queri S, Kufner H. et al. [Where are the 1.9 million patients dependent on legal drugs hiding?]. Nervenarzt 2005; 76: 72-77
• 3 Janhsen K, Roser P, Hoffmann K. The problems of long-term treatment with benzodiazepines and related substances. Dtsch Arztebl Int 2015; 112: 1-7
• 4 Petitjean S, Ladewig D, Meier CR. et al. Benzodiazepine prescribing to the Swiss adult population: results from a national survey of community pharmacies. Int Clin Psychopharmacol 2007; 22: 292-298
• 5 Olfson M, King M, Schoenbaum M. Benzodiazepine use in the United States. JAMA Psychiatry 2015; 72: 136-142
• 6 Buth S, Holzbach R, Rosenkranz M. et al. Der Gebrauch von Medikamenten mit Abhängigkeitspotenzial in Deutschland. Eine prospektive Analyse kassenärztlicher Verschreibungen der Jahre 2006 bis 2010. Bundesgesundheitsbl 2017; 60: 865-872
• 7 Pabst A, Kraus L, Gomes de Matos E. et al. Substanzkonsum und substanzbezogene Störungen in Deutschland im Jahr 2012. Sucht 2013; 59: 321-331
• 8 Huang B, Dawson DA, Stinson FS. et al. Prevalence, correlates, and comorbidity of nonmedical prescription drug use and drug use disorders in the United States: Results of the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2006; 67: 1062-1073
• 9 Kurko TA, Saastamoinen LK, Tahkapaa S. et al. Long-term use of benzodiazepines: Definitions, prevalence, and usage patterns – a systematic review of register-based studies. Eur Psychiatry 2015; 30: 1037-1047
• 10 Neutel CI. The epidemiology of long-term benzodiazepine use. Int Rev Psychiatry 2005; 17: 189-197
• 11 Okumura Y, Shimizu S, Matsumoto T. Prevalence, prescribed quantities, and trajectory of multiple prescriber episodes for benzodiazepines: A 2-year cohort study. Drug Alcohol Depend 2016; 158: 118-125
• 12 Davies J, Rae TC, Montagu L. Long-term benzodiazepine and Z-drugs use in the UK: a survey of general practice. Br J Gen Pract 2017; 67: e609-e613
• 13 Amato L, Minozzi S, Vecchi S. et al. Benzodiazepines for alcohol withdrawal. Cochrane Database Syst Rev 2010; (03) CD005063
• 14 Baldwin DS, Aitchison K, Bateson A. et al. Benzodiazepines: risks and benefits. A reconsideration. J Psychopharmacol 2013; 27: 967-971
• 15 Benkert O, Hippius H. Kompendium der Psychiatrischen Pharmakotherapie. 9. Aufl.. Berlin, Heidelberg: Springer; 2013
• 16 Buffett-Jerrott SE, Stewart SH. Cognitive and sedative effects of benzodiazepine use. Curr Pharm Des 2002; 8: 45-58
• 17 Mura T, Proust-Lima C, Akbaraly T. et al. Chronic use of benzodiazepines and latent cognitive decline in the elderly: results from the Three-city study. Eur Neuropsychopharmacol 2013; 23: 212-223
• 18 Pariente A, de Gage SB, Moore N. et al. The benzodiazepine-dementia disorders link: Current state of knowledge. CNS Drugs 2016; 30: 1-7
• 19 Jones JD, Mogali S, Comer SD. Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Depend 2012; 125: 8-18
• 20 Lintzeris N, Nielsen S. Benzodiazepines, methadone, and buprenorphine: interactions and clinical management. Am J Addict 2010; 19: 59-72
• 21 Bachhuber MA, Hennessy S, Cunningham CO. et al. Increasing benzodiazepine prescriptions and overdose mortality in the United States, 1996–2013. Am J Public Health 2016; 106: 686-688
• 22 Gustavsen I, Bramness JG, Skurtveit S. et al. Road traffic accident risk related to prescriptions of the hypnotics zopiclone, zolpidem, flunitrazepam and nitrazepam. Sleep Med 2008; 9: 818-822
• 23 Smink BE, Egberts AC, Lusthof KJ. et al. The relationship between benzodiazepine use and traffic accidents: A systematic literature review. CNS Drugs 2010; 24: 639-653
• 24 Hollister LE, Motzenbecker FP, Degan RO. Withdrawal reactions from chlordiazepoxide (“Librium”). Psychopharmacologia 1961; 2: 63-68
• 25 Tan KR, Brown M, Labouebe G. et al. Neural bases for addictive properties of benzodiazepines. Nature 2010; 463: 769-774
• 26 Lüscher C, Ungless MA. The mechanistic classification of addictive drugs. PLoS Med 2006; 3: e437
• 27 World Health Organization. The ICD-10 Classification of Mental and Behavioral Disorders. Clinical Descriptions and Disgnostic Guidelines. Geneva: World Health Organization; 1992
• 28 Ashton H. Benzodiazepine Abuse. In: Caan W, de Belleroche J. eds. Drink, Drugs, and Dependence from Science to clinical Practice. London, New York: Routledge; 2002: 197-212
• 29 Lader M, Kyriacou A. Withdrawing benzodiazepines in patients with anxiety disorders. Curr Psychiatry Rep 2016; 18: 8
• 30 Lader M, Tylee A, Donoghue J. Withdrawing benzodiazepines in primary care. CNS Drugs 2009; 23: 19-34
• 31 Lader M. Benzodiazepines revisited–will we ever learn?. Addiction 2011; 106: 2086-2109
• 32 Darker CD, Sweeney BP, Barry JM. et al. Psychosocial interventions for benzodiazepine harmful use, abuse or dependence. Cochrane Database Syst Rev 2015; (05) CD009652
• 33 Denis C, Fatseas M, Lavie E. et al. Pharmacological interventions for benzodiazepine mono-dependence management in outpatient settings. Cochrane Database Syst Rev 2006; (03) CD005194
• 34 Mugunthan K, McGuire T, Glasziou P. Minimal interventions to decrease long-term use of benzodiazepines in primary care: a systematic review and meta-analysis. Br J Gen Pract 2011; 61: e573-e578
• 35 Parr JM, Kavanagh DJ, Cahill L. et al. Effectiveness of current treatment approaches for benzodiazepine discontinuation: a meta-analysis. Addiction 2009; 104: 13-24
• 36 Sirdifield C, Chipchase SY, Owen S. et al. A systematic review and meta-synthesis of patientsʼ experiences and perceptions of seeking and using benzodiazepines and Z-drugs: Towards safer prescribing. Patient 2017; 10: 1-15
• 37 Lingford-Hughes AR, Welch S, Peters L. et al. BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP. J Psychopharmacol 2012; 26: 899-952
• 38 Soyka M, Steinberg R, Vollmer M. [Withdrawal phenomena in stepwise withdrawal of benzodiazepines]. Nervenarzt 1988; 59: 744-748
• 39 Soyka M, Batra A. Benzodiazepin-Abhängigkeit. In: Vorderholzer U, Hohagen F. Hrsg. Therapie psychischer Erkrankungen State of the Art. München: Urban und Fischer; 2014: 55
• 40 Soyka M. Treatment of benzodiazepine dependence. N Engl J Med 2017; 376: 1147-1157
• 41 Nielsen S, Dietze P, Lee N. et al. Concurrent buprenorphine and benzodiazepines use and self-reported opioid toxicity in opioid substitution treatment. Addiction 2007; 102: 616-622
• 42 Baandrup L, Fagerlund B, Jennum P. et al. Prolonged-release melatonin versus placebo for benzodiazepine discontinuation in patients with schizophrenia: a randomized clinical trial – the SMART trial protocol. BMC Psychiatry 2011; 11: 160
• 43 Baandrup L, Glenthoj BY, Jennum PJ. Objective and subjective sleep quality: Melatonin versus placebo add-on treatment in patients with schizophrenia or bipolar disorder withdrawing from long-term benzodiazepine use. Psychiatry Res 2016; 240: 163-169
• 44 Mariani JJ, Malcolm RJ, Mamczur AK. et al. Pilot trial of gabapentin for the treatment of benzodiazepine abuse or dependence in methadone maintenance patients. Am J Drug Alcohol Abuse 2016; 42: 333-340
• 45 Berglund M, Thelander S, Jonsson E. Treating alcohol and drug abuse: An evidence based review. Weinheim: Wiley-VCH Verlag; 2003
• 46 Dutra L, Stathopoulou G, Basden SL. et al. A meta-analytic review of psychosocial interventions for substance use disorders. Am J Psychiatry 2008; 165: 179-187
• 47 Ten Wolde GB, Dijkstra A, van Empelen P. et al. Long-term effectiveness of computer-generated tailored patient education on benzodiazepines: a randomized controlled trial. Addiction 2008; 103: 662-670
• 48 Oude Voshaar RC, Gorgels WJ, Mol AJ. et al. Long-term outcome of two forms of randomised benzodiazepine discontinuation. Br J Psychiatry 2006; 188: 188-189
• 49 Voshaar RC, Gorgels WJ, Mol AJ. et al. Tapering off long-term benzodiazepine use with or without group cognitive-behavioural therapy: three-condition, randomised controlled trial. Br J Psychiatry 2003; 182: 498-504
• 50 Otto C, Crackau B, Lohrmann I. et al. Brief intervention in general hospital for problematic prescription drug use: 12-month outcome. Drug Alcohol Depend 2009; 105: 221-226
• 51 de Gier NA, Gorgels WJ, Lucassen PL. et al. Discontinuation of long-term benzodiazepine use: 10-year follow-up. Fam Pract 2011; 28: 253-259
• 52 OʼBrien PL, Karnell LH, Gokhale M. et al. Prescribing of benzodiazepines and opioids to individuals with substance use disorders. Drug Alcohol Depend 2017; 178: 223-230
• 53 U.S. Food & Drug Administration. FDA Drug Safety Communication: FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning. U.S. Food and Drug Administration; 2016. Im Internet: Accessed March 05, 2018 at: http://www.fda.gov/Drugs/DrugSafety/ucm518473.htm
• 54 Taburin S, Faccini M, Casari R. et al. Low risk of seizures with slow flumazenil infusion and routine anticonvulsant prophylaxis for high-dose benzodiazepine dependence. J Psychopharmacol 2017; 31: 1369-1373
• 55 Faccini M, Leone R, Opri S. et al. Slow subcutaneous infusion of flumazenil for the treatment of long-term, high-dose benzodiazepine users: a review of 214 cases. J Psychopharmacol 2016; 30: 1047-1053
• 56 Liebrenz M, Boesch L, Stohler R. et al. Agonist substitution – a treatment alternative for high-dose benzodiazepine-dependent patients?. Addiction 2010; 105: 1870-1874
• 57 Nissen C, Frase L, Hajak G. et al. [Hypnotics-state of the science]. Nervenarzt 2014; 85: 67-76
• 58 Morin CM, Culbert JP, Schwartz SM. Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy. Am J Psychiatry 1994; 151: 1172-1180
• 59 Morgan K, Dixon S, Mathers N. et al. Psychological treatment for insomnia in the regulation of long-term hypnotic drug use. Health Technol Assess 2004; 8: iii-iv 1–68