Dr. Wolter rightly points out that, above all in the elderly, the pharmacological characteristics of the medication require special attention and that well-established processes in other patient populations may need to be modified. Given the high prevalence of benzodiazepine dependence among elderly patients, this is an important issue. Further studies are needed to establish the impact of the potential additional risks brought up by Dr. Reuther. Currently, the available data is insufficient. Billiotiti et al. (1) phrase their proposition as a question (quote: “Is there really a link between benzodiazepine use and the risk of dementia?“).
Prof. Bschor addresses a fundamental problem: the treatment of substance dependence with a substance. This discussion went on for years with regard to disulfiram. The addiction-specific tendency of those affected to externalize problems and needs and to prefer presumably simple “substance-related” solutions always involves the risk of a substance shift with all potential consequences. However, whether the statements made in the recommendations of the Drug Commission of the German Medical Association (2) can be directly applied to patients with benzodiazepine dependence, as suggested by Prof. Bschor, remains to be seen. Likewise, the guideline Unipolar Depression (3) ultimately addresses comorbidities only in relation to alcohol dependence. Although it is certainly correct that a valid evaluation of affective symptoms can only be performed after period of time where no substance is taken, it is likely that the time required in patients with benzodiazepine dependence is rather longer than that in alcohol dependence. It is rather obvious that further research is needed to reveal the specific links between benzodiazepine dependence and mood disorders.
Dr. med. Knut Hoffmann
Klinik für Psychiatrie, Psychotherapie und Präventivmedizin,
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Billiottti de Gage S, Pariente A, Begaud B: Is there really a link between benzodiazepine use and the risk of dementia? Expert Opin Draug Saf 2015; 18: 1–15 CrossRef|
|2.||AG Psychiatrie der AkdÄ: Empfehlungen zum Einsatz von Antidepressiva bei alkoholabhängigen Patienten. Arzneiverordnung in der Praxis (AVP) 38:27–29. www.akdae.de/Arzneimitteltherapie/AVP/Ausgaben/2003–2014/20112.pdf#page=3&view=fitB (last accessed on 7 February 2015).|
|3.||DGPPN, BÄK, KBV, AWMF, AkdÄ, BPtK, BApK, DAGS, HG, DEGAM, DGPM, DGPs, DGRW (eds.) für die Leitliniengruppe Unipolare Depression: S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression – Langfassung. 1th edition. Berlin, Düsseldorf: DGPPN, ÄZQ, AWMF 2009. www.dgppn.de, www.versorgungsleitlinien.de, www.awmf-leitlinien.de (last accessed on 16. April 2015).|
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