Benzodiazepines could increase suicide risk in COPD and PTSD patients
A study from the VA Puget Sound Healthcare System has found a link between the use of benzodiazepines and suicide in patients with COPD or PTSD…
Researchers have found that long-term use of benzodiazepine medications in patients with posttraumatic stress disorder (PTSD) or chronic obstructive pulmonary disease (COPD) could lead to an increased risk of suicide.
Dr Lucas M. Donovan and his team studied 44,555 veterans who received medical care between 2010-2012. Of these individuals, 23.6 percent received benzodiazepines long term (90 days or longer).
Benzodiazepines are anxiety-reducing, hypnotic, anticonvulsant and sedative drugs that are usually prescribed for COPD and PTSD. Symptoms including shortness of breath, anxiety, insomnia can be alleviated with the drug. The use of benzodiazepines is controversial because of the adverse side effects associated with the drug, which includes an increased risk of COPD exacerbations and self-injury.
“The use of benzodiazepines among patients with high-risk comorbidities is a frequent dilemma for patients and clinicians,” said Dr Donovan, a pulmonary, critical care and sleep physician and health services researcher at the VA Puget Sound Healthcare System. “Understanding the risks of benzodiazepines is difficult because the symptoms that prompt their use, including anxiety and shortness of breath, are themselves linked with poor outcomes.”
The researchers matched patients in their analysis by taking over 44 patient characteristics into account, to try to identify the risks of the drugs. These characteristics included medical and psychiatric history, medication use and health care utilisation.
They found that long-term use of benzodiazepines in COPD patients who also had PTSD more than doubled their risk of suicide. These patients also had higher rates of psychiatric admissions.
However, the researchers did not find that long-term use of benzodiazepines in this patient group increased their risk of death from all causes or respiratory events, as previous studies have suggested.
The researchers did find that short-term use (less than 90 days) of benzodiazepines was associated with increased mortality, which supports previous findings. Dr Donovan said this finding should be interpreted with some caution given the researchers did not use the same matching techniques employed in the primary analyses.
The authors said study limitations include the possibility of not being able to fully determine the severity of lung obstruction or PTSD from medical record data.
“Although long-term benzodiazepine use among patients with COPD and PTSD is not linked with overall mortality, the association with suicide is concerning,” said Dr Donovan, who is also an acting instructor at the University of Washington. “More research will be needed to better understand this link with suicide, but in the meantime we would advise that clinicians reconsider prescribing benzodiazepines to patients who already are at high risk for self-harm.”
The study was published in the journal Annals of the American Thoracic Society.