Benzodiazepines Carlat Reports

Expert Q&A

Benzodiazepines: A Reevaluation of Their Benefits and Dangers

From The Carlat Psychiatry Report, Psychotic Depression

Topics: Anxiety | Anxiety Disorder | Benzodiazepines | Hypnotics

TCPR: Benzodiazepines were the most commonly prescribed drug—of all drugs—in the 1970s. Are they still that popular? Dr. Salzman: I think benzodiazepines are still widely used, both appropriately and inappropriately. The SSRIs were supposed to replace the benzos for long-term treatment of anxiety, but while the use of these antidepressants has in

Clinical Update

Deprescribing Anti-Anxiety Medications in Older Adults

From The Carlat Geriatric Psychiatry Report, Anxiety

Our inclination may be to “not rock the boat” when a patient is stable and not misusing prescribed medication. However, tapering anti-anxiety medications in older adults is often a good idea when considering the risks of falls, sedation, and accidents. Which meds to taper? The risks of anti-anxiety medications increase with age. Here are some of t

Expert Q&A

Benzodiazepines in Older Adults

From The Carlat Geriatric Psychiatry Report, Anxiety

CGPR: When do you start benzodiazepines in older adults? Dr. Aiken: The best evidence for benzodiazepines in the elderly is in panic disorder, followed by phobias, social anxiety disorder, and generalized anxiety disorder. Benzodiazepines are also the mainstay of treating catatonia, rapid eye movement sleep behavior disorder, and alcohol withdrawal. Ho

Expert Q&A

Assessing and Treating Catatonia

From The Carlat Hospital Psychiatry Report, Catatonia

CHPR: Welcome, Dr. Heckers. You recently published a review of the management of catatonia (Heckers S and Walther S, JAMA Psychiatry 2021;78(5):560–561). What is catatonia and how do you diagnose it? Dr. Heckers: Catatonia is a psychomotor syndrome. Some patients cannot move or respond normally. Patients often stare blankly, remain motionless for lon

Expert Q&A

Treating Agitation in Patients with Dementia

From The Carlat Hospital Psychiatry Report, Agitation

CHPR: Can you tell us about yourself and your background? Dr. Metzger: I’m the medical director of psychiatry at Hebrew SeniorLife and an assistant professor of psychiatry at Harvard Medical School. My work also includes training residents and geriatric medicine fellows who rotate through our facility. CHPR: You participated in the psychopharmacol

Expert Q&A

Anticholinergic Drugs and Risk of Cognitive Impairment and Dementia

From The Carlat Hospital Psychiatry Report, Agitation

CHPR: Can you tell us about your research? Dr. Gray: My research uses large databases to examine medication safety issues in older adults with the goal of optimizing healthy aging. My focus is on examining medications and risk for dementia, falls, and fractures—the types of outcomes that are not easily addressed in randomized controlled trials. CH

Clinical Update

Medications to Rapidly Treat Psychotic Agitation

From The Carlat Hospital Psychiatry Report, Agitation

Topics: | | | | | | | | | | | | | | | | | | Agitation Antipsychotics Aripiprazole Benzodiazepines Chlorpromazine De-escalation Diphenhydramine Droperidol Emergency Haloperidol Hydroxyzine olanzapine Pharmacotherapy Promethazine Psychosis Quetiapine Risperidone Violence Ziprasidone

If you work in an emergency department (ED) or psychiatric inpatient unit, you’ve encountered agitated and even violent patients. We can help many patients settle down by listening empathically, validating their emotions, and offering oral medications, but even with our best efforts, these interventions do not always work. Medications help reduce agit

In Brief

IM Olanzapine Plus Benzodiazepines: Safe or Unsafe?

From The Carlat Hospital Psychiatry Report, Agitation

Topics: Antipsychotics | Benzodiazepines | olanzapine | Psychotic Agitation | Side Effects

The Eli Lilly warning followed reports of 160 adverse events, including 29 fatalities, linked to IM olanzapine/IM benzodiazepine combinations from January 2004 to September 2005 (Marder SR et al, J Clin Psychiatry 2010;71(4):433–441). Looking closely at these cases, it is unclear that this medication combination actually caused the fatalities. Many of

Expert Q&A

Benzodiazepines: Old Medicines, New Concerns

From The Carlat Addiction Treatment Report, Emerging Risks for Old Medications

CATR: To begin, tell us about the research and clinical work you do. Dr. Morford: I am an assistant professor at the Yale School of Medicine in the Program of Addiction Medicine. I trained as a general internist, and I see patients primarily at a large opioid treatment program and in an inpatient setting on an addiction consult service. I’m involved

In-Brief

A Longer Acting Lorazepam

From The Carlat Psychiatry Report, Living With Mental Illness

Topics: Anxiety | Anxiety Disorder | Benzodiazepines | extended-release | Sleep

Lorazepam (Ativan) received a new coating this year as Loreev XR, which promises a 24-hour duration for this benzodiazepine that is otherwise divided in two or three daily doses. It joins alprazolam (Xanax) as the only benzos with extended-release (XR) formulations (clorazepate ventured into this territory as Tranxene SD in 2002, but that medication is

Clinical Update

Six Tips for Working With Older Adults

From The Carlat Psychiatry Report, Metabolism and Mental Health

Topics: Benzodiazepines | Depression | Geriatric Psychiatry | Medical Comorbidities

In the US, 1 in 7 adults are over the age of 65, and the growth in this population is far outpacing the growth in geriatric psychiatrists. As a result, general clinicians are increasingly called on to provide the majority of care for older adults. In this article I’ll share some tips for working with this population. Tip 1: Communication Many olde

Expert Q&A

How to Come Off a Psych Med Part 2: Antidepressants, Stimulants, and Benzos

From The Carlat Psychiatry Report, Stopping Psych Meds Part 2

Topics: Antidepressants | Benzodiazepines | Deprescribing | Withdrawal

TCPR: Before we talk about your experience with tapering medications, tell us about the population you work with.Dr. Gupta: In the past, I worked at the Connecticut Mental Health Center for Yale University. There I saw patients with pretty serious mental illness: mainly psychotic disorders, severe trauma, addictions, and serious psychosocial stressors

Clinical Update

Buspirone: Still Effective After All These Years?

From The Carlat Psychiatry Report, Stopping Psych Meds Part 1

When buspirone was released in 1986, it was advertised as providing “a different kind of calm.” Unfortunately, physicians and their patients weren’t ready to accept the kind of calm that required several weeks to take effect, when punchier, quicker benzos were the standard route to tranquility. Although buspirone is FDA approved for generalized an

Research Update

Rest Easy: Benzos, Z-Drugs, and Dementia

From The Carlat Psychiatry Report, Mind-Gut Connection

Review of: Osler M and Jorgensen MB, Am J Psych 2020;177(6):497–505 Study TYPE: Epidemiologic case-control Few psychotropics stir controversy like the benzodiazepines. While they work well for anxiety and insomnia, their risks of abuse and dependence have always nagged at us. More recently, some research has suggested that long-term use increase

Clinical Update

Is Ramelteon an Effective Hypnotic?

From The Carlat Psychiatry Report, Practical Psychotherapy

Ramelteon (Rozerem) stands out from other hypnotics in several ways: It is not a controlled substance and has no risk of addiction or withdrawal. It is relatively safe in the elderly. It has a low risk of falls and complex sleep behaviors. However, ramelteon’s use has been limited by its high cost and modest efficacy. Now that it’s gone ge

Article

Benzodiazepines: New Risks for an Old Drug

From The Carlat Psychiatry Report, Emergency Psychiatry

Topics: Benzodiazepines

In the May 2018 issue of TCPR, we wrote about using benzodiazepines for anxiety and other disorders, and we got some reader feedback that we did not provide a thorough enough review of medication risks. So, in a follow-up article this month, I will focus on two groups where benzos pose the greatest risks: opioid users and the elderly. Benzodiazepines

Article

Benzodiazepines in Children and Adolescents

From The Carlat Child Psychiatry Report, Anxiety in Children and Adolescents

Topics: Benzodiazepines | Child Psychiatry | Pharmacology

Michael, who’s 9, is brought in by his parents for his first psychiatric assessment. His parents report that lately, Michael has been worrying all the time. He asks to sleep in his parents’ bed. This past month, he also began having problems separating from his parents in the morning for school. Michael’s therapist suggested a medication assessmen

Article

Medication Treatment of Anxiety Disorders in Substance Abusers

From The Carlat Addiction Treatment Report, Benzodiazepines

Topics: Addiction | Anxiety Disorder | Benzodiazepines | Psychopharmacology Tips

Among substance abusers, anxiety seems to be more the rule than the exception. Studies show that up to 50% of patients with alcohol dependence or drug dependence have some type of anxiety disorder (Lai HM et al, Drug Alcohol Depend 2015;154:1–13). But anxiety comes in many flavors other than official DSM disorders. In any given substance-abusing

Expert Q&A

Benzodiazepines: Dependence, Tolerance, and Addiction

From The Carlat Addiction Treatment Report, Benzodiazepines

Topics: Addiction | Anxiety Disorder | Benzodiazepines | Psychopharmacology Tips