February 2015

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Many Older People Take Anti-Anxiety Meds Despite Risks

Despite known risks, older people often take benzodiazepines, a class of drugs that helps treat anxiety and sleep problems. New research raises questions about why benzodiazepines are prescribed so often when safer alternatives may be available.

Benzodiazepines include the medications alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan). Although effective for short-term use, they can have serious risks. Benzodiazepines can impair thinking, movement, and driving skills in older people and increase the risk of falls. Long-term use can lead to dependence, and stopping the drug may lead to withdrawal symptoms.

NIH-funded researchers studied benzodiazepine use over a 1-year period. They found that about 1 in 20 U.S. adults, ages 18 to 80, received a benzodiazepine prescription. This fraction rose with age, from about 3% among those 18 to 35, to 9% in those 65 to 80. Long-term use (over 4 months) also rose with age.

Women were about twice as likely as men to take benzodiazepines. Among women 65 to 80 years old, 1 in 10 was prescribed this class of drug, with almost a third of those receiving long-term prescriptions.

Most prescriptions for benzodiazepines were written by non-psychiatrists. “These medications can pose real risks, and there are often safer alternatives available,” says study co-author Dr. Michael Schoenbaum of NIH. Practice guidelines recommend psychotherapy approaches and antidepressants as the initial treatment for anxiety. For sleep problems, guidelines recommend behavioral changes as the first approach.

“Our findings strongly suggest that we need strategies to reduce benzodiazepine use, particularly for older women,” Schoenbaum says.