Benzodiazepine use among depressed patients treated in mental health settings.

OBJECTIVE Most depression treatment guidelines emphasize treatment with antidepressant medication and recommend that benzodiazepine use be minimized, particularly among elderly patients. However, little is known about patterns of benzodiazepine use in specialty mental health settings. The authors examined benzodiazepine use among a large sample of depressed patients treated in U.S. Department of Veterans Affairs (VA) mental health settings. METHOD The VA National Registry for Depression was used to identify patients treated for depression in specialty mental health settings in 129 VA facilities during the first 3 months of fiscal year 2001 (October 1 to December 31, 2000) (N=128,029). The VA pharmacy database was used to identify outpatients who filled a prescription for benzodiazepines. The authors report on the prevalence and patterns of outpatient benzodiazepine use during the study year (fiscal year 2001) and evaluate patient demographic and clinical factors associated with use. RESULTS During the study year, 36% of the depressed patients filled a benzodiazepine prescription and 89% filled an antidepressant prescription. Most users (78%) received > or = 90 days' supply of benzodiazepines, and 61% received > or = 180 days' supply. Older patients, whites, Hispanics, and patients with comorbid anxiety disorders were more likely to use benzodiazepines. Older patients were also more likely to receive > or = 90 days' supply of benzodiazepines, compared with younger patients, but were treated with lower doses. Benzodiazepine use varied significantly with region of the country and facility. CONCLUSIONS Depressed patients treated in mental health settings commonly receive long-term treatment with benzodiazepines in combination with antidepressants, a pattern of use that is inconsistent with guideline recommendations. Elderly patients are particularly likely to receive benzodiazepines. Further research on the effectiveness of this widespread practice is needed.