Keywords: anxiety, benzodiazepines, depression, insomnia, mental health, prescription drug overuse

Background:

Benzodiazepines are the most prescribed drugs for treating anxiety and insomnia in the world. Their continuous usage for more than three months is strongly discouraged because of the possible development of addiction, cognitive disorders, and confusion. Real-life data shows serious overuse in many countries.

Research questions:

Do family medicine physicians prescribe benzodiazepines beyond three months and for which clinical indications?

Method:

This is a cross-sectional study that will be conducted in at least eight family medicine practices across Croatia. Patients who have used one or more of the listed benzodiazepines and Z drugs – diazepam, alprazolam, nitrazepam, oxazepam, lorazepam, bromazepam, zolpidem, zopiclone – in the last five years (1.1.2019 – 31.12.2024) will be identified and included in the research using the search engine of the information system. The diagnosis for which the listed drugs were prescribed, the prescribed dose, the number of re-prescriptions of the drug (duration of therapy) for the same indication, and other comorbidities that the patient has recorded in the available medical documentation in the same period will be recorded. Other data will include the age and gender of the subjects, the date of the first recorded prescription of the sleeping drug, who prescribed the drug (family doctor or doctor of another specialty), whether the patient takes antidepressants, comorbidities, and whether the therapy has changed over time. We used a purposive sampling method, and the estimated sample size for adequate statistical analysis is at least 400 subjects.

Results:

Conclusions:

The results from this study will determine the indications, rates, duration, and current prescribing patterns of benzodiazepines in family medicine. By checking how big the problem of benzodiazepine overuse is, we could improve adherence to evidence-based clinical guidelines and management of patients with mental health conditions.

Points for discussion:

Why are benzodiazepines prescribed more than antidepressants in treating anxious disorders?

Are the guidelines for treating mental diseases just a dead letter?

What are the potential sociological consequences of benzodiazepine overuse?