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The newer antidepressants: co-prescription of benzodiazepines, neuroleptics and hypnotics

There has been a recent report1 of an increased rate of benzodiazepine co-prescription with newer antidepressants. This may be to assist sleep as the newer antidepressants are not generally sedating. The rise is associated with an overall increase in benzodiazepine prescriptions, reversing the trend for reduced use over the last decade. In general, there is no place for the co-prescription of benzodiazepines, neuroleptics or hypnotics with the new antidepressants. Anxiety and insomnia are common symptoms of depression which are relieved by all effective antidepressants regardless of whether the antidepressant is regarded as sedative or not. Patients on sedative agents are likely to be adversely affected when driving motor vehicles, using machinery, or in complex decision making. They impair behavioural therapies and can impair therapeutic response, while neuroleptics can induce both acute and chronic extra pyramidal adverse events.

Co-prescription adds to acute and overdose toxicity.
Most patients will have had weeks or months of symptoms before presentation and will generally appreciate monotherapy rather than a potentially confusing array of medication, if they understand their symptoms will resolve in a few weeks as their depression resolves. Very occasionally, a patient will be so distressed that immediate relief with the co-prescribed medication is compassionate and appropriate therapy. However, the prescriber must be cautious if such use is continued beyond 2-4 weeks as the patient recovers.

References

  1. Parkes AJ. Starting SSRI antidepressant therapy: its effect on tricyclic antidepressant and benzodiazepine prescribing [letter]. Med J Aust 1996;164:509.