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Discontinuation of benzodiazepines among older insomniac adults treated with cognitive-behavioural therapy combined with gradual tapering: a randomized trial.

Abstract

BACKGROUND

Long-term use of hypnotics is not recommended because of risks of dependency and adverse effects on health. The usual clinical management of benzodiazepine dependency is gradual tapering, but when used alone this method is not highly effective in achieving long-term discontinuation. We compared the efficacy of tapering plus cognitive-behavioural therapy for insomnia with tapering alone in reducing the use of hypnotics by older adults with insomnia.

METHODS

People with chronic insomnia who had been taking a benzodiazepine every night for more than 3 months were recruited through media advertisements or were referred by their family doctors. They were randomly assigned to undergo either cognitive-behavioural therapy plus gradual tapering of the drug (combined treatment) or gradual tapering only. The cognitive-behavioural therapy was provided by a psychologist in 8 weekly small-group sessions. The tapering was supervised by a physician, who met weekly with each participant over an 8-week period. The main outcome measure was benzodiazepine discontinuation, confirmed by blood screening performed at each of 3 measurement points (immediately after completion of treatment and at 3- and 12-month follow-ups).

RESULTS

Of the 344 potential participants, 65 (mean age 67.4 years) met the inclusion criteria and entered the study. The 2 study groups (35 subjects in the combined treatment group and 30 in the tapering group) were similar in terms of demographic characteristics, duration of insomnia and hypnotic dosage. Immediately after completion of treatment, a greater proportion of patients in the combined treatment group had withdrawn from benzodiazepine use completely (77% [26/34] v. 38% [11/29]; odds ratio [OR] 5.3, 95% confidence interval [CI] 1.8-16.2; OR after adjustment for initial benzodiazepine daily dose 7.9, 95% CI 2.4-30.9). At the 12-month follow-up, the favourable outcome persisted (70% [23/33] v. 24% [7/29]; OR 7.2, 95% CI 2.4-23.7; adjusted OR 7.6, 95% CI 2.5-26.6); similar results were obtained at 3 months.

INTERPRETATION

A combination of cognitive-behavioural therapy and benzodiazepine tapering was superior to tapering alone in the management of patients with insomnia and chronic benzodiazepine use. The beneficial effects were sustained for up to 1 year. Applying this multidisciplinary approach in the community could help reduce benzodiazepine use by older people.

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  • Authors+Show Affiliations

    ,

    Department of Family Medicine, Laval University, Sainte-Foy, Que. lucie.baillargeon@crchul.ulaval.ca

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    Source

    MeSH

    Aged
    Anti-Anxiety Agents
    Behavior Therapy
    Benzodiazepines
    Confidence Intervals
    Female
    Humans
    Male
    Sleep Initiation and Maintenance Disorders
    Treatment Outcome

    Pub Type(s)

    Clinical Trial
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    14609970

    Citation

    Baillargeon, Lucie, et al. "Discontinuation of Benzodiazepines Among Older Insomniac Adults Treated With Cognitive-behavioural Therapy Combined With Gradual Tapering: a Randomized Trial." CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, vol. 169, no. 10, 2003, pp. 1015-20.
    Baillargeon L, Landreville P, Verreault R, et al. Discontinuation of benzodiazepines among older insomniac adults treated with cognitive-behavioural therapy combined with gradual tapering: a randomized trial. CMAJ. 2003;169(10):1015-20.
    Baillargeon, L., Landreville, P., Verreault, R., Beauchemin, J. P., Grégoire, J. P., & Morin, C. M. (2003). Discontinuation of benzodiazepines among older insomniac adults treated with cognitive-behavioural therapy combined with gradual tapering: a randomized trial. CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, 169(10), pp. 1015-20.
    Baillargeon L, et al. Discontinuation of Benzodiazepines Among Older Insomniac Adults Treated With Cognitive-behavioural Therapy Combined With Gradual Tapering: a Randomized Trial. CMAJ. 2003 Nov 11;169(10):1015-20. PubMed PMID: 14609970.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Discontinuation of benzodiazepines among older insomniac adults treated with cognitive-behavioural therapy combined with gradual tapering: a randomized trial. AU - Baillargeon,Lucie, AU - Landreville,Philippe, AU - Verreault,René, AU - Beauchemin,Jean-Pierre, AU - Grégoire,Jean-Pierre, AU - Morin,Charles M, PY - 2003/11/12/pubmed PY - 2003/12/12/medline PY - 2003/11/12/entrez SP - 1015 EP - 20 JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne JO - CMAJ VL - 169 IS - 10 N2 - BACKGROUND: Long-term use of hypnotics is not recommended because of risks of dependency and adverse effects on health. The usual clinical management of benzodiazepine dependency is gradual tapering, but when used alone this method is not highly effective in achieving long-term discontinuation. We compared the efficacy of tapering plus cognitive-behavioural therapy for insomnia with tapering alone in reducing the use of hypnotics by older adults with insomnia. METHODS: People with chronic insomnia who had been taking a benzodiazepine every night for more than 3 months were recruited through media advertisements or were referred by their family doctors. They were randomly assigned to undergo either cognitive-behavioural therapy plus gradual tapering of the drug (combined treatment) or gradual tapering only. The cognitive-behavioural therapy was provided by a psychologist in 8 weekly small-group sessions. The tapering was supervised by a physician, who met weekly with each participant over an 8-week period. The main outcome measure was benzodiazepine discontinuation, confirmed by blood screening performed at each of 3 measurement points (immediately after completion of treatment and at 3- and 12-month follow-ups). RESULTS: Of the 344 potential participants, 65 (mean age 67.4 years) met the inclusion criteria and entered the study. The 2 study groups (35 subjects in the combined treatment group and 30 in the tapering group) were similar in terms of demographic characteristics, duration of insomnia and hypnotic dosage. Immediately after completion of treatment, a greater proportion of patients in the combined treatment group had withdrawn from benzodiazepine use completely (77% [26/34] v. 38% [11/29]; odds ratio [OR] 5.3, 95% confidence interval [CI] 1.8-16.2; OR after adjustment for initial benzodiazepine daily dose 7.9, 95% CI 2.4-30.9). At the 12-month follow-up, the favourable outcome persisted (70% [23/33] v. 24% [7/29]; OR 7.2, 95% CI 2.4-23.7; adjusted OR 7.6, 95% CI 2.5-26.6); similar results were obtained at 3 months. INTERPRETATION: A combination of cognitive-behavioural therapy and benzodiazepine tapering was superior to tapering alone in the management of patients with insomnia and chronic benzodiazepine use. The beneficial effects were sustained for up to 1 year. Applying this multidisciplinary approach in the community could help reduce benzodiazepine use by older people. SN - 0820-3946 UR - https://www.unboundmedicine.com/medline/citation/14609970/Discontinuation_of_benzodiazepines_among_older_insomniac_adults_treated_with_cognitive_behavioural_therapy_combined_with_gradual_tapering:_a_randomized_trial_ L2 - http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=14609970 DB - PRIME DP - Unbound Medicine ER -