Prior benzodiazepine exposure and benzodiazepine treatment outcome

Background: We examined discontinuation symptoms following brief benzodiaze pine therapy (8 weeks) and intermittent benzodiazepine therapy (2 weeks wit h at least 2 weeks without drug) and associations with prior benzodiazepine use. The hypothesis was that prior benzodiazepine use would predispose pat ients to more severe discontinuation symptoms. Method: Data were drawn from 3 double-blind, randomized, placebo-controlled , published treatment trials: alprazolam for patients with premenstrual syn drome (PMS) and diazepam and lorazepam for patients with generalized anxiet y disorder (GAD). The PMS group provided prospective daily symptom ratings, which allowed ongoing investigation of effects of prior treatment. In the GAD groups, taper outcome was examined after 8 weeks of benzodiazepine ther apy as a function of prior benzodiazepine use and as a function of time sin ce last prior benzodiazepine use. Symptom scores were analyzed using t stat istics in the PMS group and analysis of covariance with 8-week scores as th e covariate in the GAD groups. Results: The PMS subjects reported no increase in symptom scores and no sig nificant difference from placebo-treated subjects during taper and disconti nuation of alprazolam in the follicular phase of each treatment cycle. In t he GAD trials, the results of treatment discontinuation did not differ sign ificantly as a function of presence or absence of prior benzodiazepine use or as a function of time since last benzodiazepine use, Conclusion: These preliminary data fail to support the hypothesis that prio r benzodiazepine use predisposes patients to more severe discontinuation sy mptoms when treatment is brief and doses are low.