A Trend Towards Causal Therapy
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Buth et al. discussed an important topic, using a good research method and adequate case numbers (1). They drew attention to the fact that action is needed. In addition to the listed causes for long-term use of benzodiazepines and zolpidem and zopiclone, a dissertation by Bierhals (2) showed that primarily patients with dependent or depressive personality traits, manifest depression, or abnormal anger expression lean towards long-term use. It also reflected the important role of general practitioners, who are usually the first prescribers (77%) and ongoing prescribers (90%), but during the study period 2008 all too rarely discussed with their patients the indication (42%), the potential for dependency (45%), the duration of intake (2%), and cessation methods (21%). Benzodiazepine dependency was the higher the greater the degree of satisfaction with and confidence in the general practitioner. This illustrates the huge responsibility that lies with GPs and also the necessity to weigh up a patient’s personality structure against the indication before issuing a prescription.
In this context Buth et al. sent a positive signal with the decrease in prescriptions and the duration of intake of benzodiazepines and zolpidem and zopiclone, which they explained with increasing awareness of the risk potential among doctors. The concomitant increase in opiate prescriptions could be an indication of a trend towards causal rather than symptomatic therapy. In this setting it would be interesting to look at data on how during the same time period, prescribing behaviors have developed with regard to (a)typical neuroleptic drugs and tricyclic antidepressants or selective serotonin reuptake inhibitors, especially in older patients (3).
An additional group of effective substances of interest for using monitoring approaches is laxatives, for which a high rate of misuse can be assumed especially in older persons.
Dr. med Jana Hummel
Dr. med Bernadette Bierhals
Prof. Dr. Boris Breivogel
PD Dr. Alexander Diehl
Conflict of interest statement
The authors declare that no conflict of interest exists.
|1.||Buth S, Holzbach R, Martens MS, Neumann-Runde E, Meiners O, Verthein U: Problematic medication with benzodiazepines, „Z-drugs“, and opioid analgesics—an analysis of national health insurance prescription data from 2006–2016. Dtsch Arztebl Int 116: 607–14 VOLLTEXT|
|2.||Bierhals B: Identifikation, Charakterisierung und Intervention bei Patienten mit chronischem Benzodiazepingebrauch in der Hausarztpraxis. Inauguraldissertation zur Erlangung des Doktorgrades 2015 an der Ruprecht-Karls-Universität Heidelberg.|
|3.||Kopf D, Hummel J: Depression in frail geriatric patients: diagnostics and treatment. Z Gerontol Geriatr 2013; 46: 127–33 CrossRef MEDLINE|