Clinical application of paroxetine for tapering benzodiazepine use in non-major-depressive outpatients visiting an internal medicine clinic

Chronic benzodiazepine (BDZ) users often have difficulty with BDZ withdrawal. To examine clinical effects of selective serotonin reuptake inhibitor (SSRI) on tapering BDZ use in non-depressive patients, 97 outpatients with a history of BDZ use for at least 3 months were recruited at an internal medicine clinic of a university hospital. After the 4th edition of the Diagnostic and Statistical Manual (DSM-IV) clinical interviews for screening major depression, 66 outpatients (68%) without the DSM-IV major depression were randomly assigned to one of three groups: SSRI-assisted BDZ-reduction group (10-20 mg of paroxetine, n = 22), simple BDZ-reduction group (no paroxetine, n = 23), and reference group (no BDZ-reduction, n = 21). A standardized 8-week program involving gradual BDZ discontinuation was performed in the two BDZ-reduction groups. The Hamilton Rating Scales for Depression (HAM-D) and Anxiety (HAM-A) and the BDZ Withdrawal Symptom Questionnaire were assessed during the intervention period. Those with major depression were excluded from the BDZ-reduction intervention and treated with a different protocol of medication. In total, 10 (45.5%) in the SSRI-assisted BDZ-reduction group (n = 22) succeeded in becoming BDZ-free after completing the program, whereas only four (17.4%) in the simple BDZ-reduction group (n = 23) succeeded. The assistance of the SSRI significantly predicted the success of becoming BDZ-free (P = 0.023), controlling for the effects of age, gender, period of BDZ use, and baseline HAM-D and HAM-A scores. The score changes on the three questionnaires were comparable (all P > 0.05) among the three groups during the intervention period. The use of SSRI may have beneficial effects on BDZ withdrawal without the worsening of mood states in cases without major depression.