Benzodiazepines May Increase Suicide Risk in Some Patients

Long-term use of benzodiazepines may increase the risk of death by suicide in patients with both chronic obstructive pulmonary disease (COPD) and post-traumatic stress disorder (PTSD), according to a study published online in the Annals of the American Thoracic Society.

The use of the benzodiazepines is controversial in both groups because of their side effects, yet they are still commonly prescribed to ease anxiety and insomnia that accompany both conditions.

“The use of benzodiazepines among patients with high-risk comorbidities is a frequent dilemma for patients and clinicians,” said researcher Lucas M. Donovan, MD, a pulmonary, critical care and sleep physician and health services researcher at the VA Puget Sound Healthcare System in Seattle, Washington. “Understanding the risks of benzodiazepines is difficult because the symptoms that prompt their use, including anxiety and shortness of breath, are themselves linked with poor outcomes.”

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In a group of 44,555 US veterans with COPD and PTSD who received medical care between 2010 and 2012, researchers identified 23.6% who were prescribed benzodiazepines for 90 days or more. They then matched 19,552 of those patients with others for characteristics including medical and psychiatric history, medication use, and health care use.

Long-term use of benzodiazepines in patients with COPD who also had PTSD, they found, more than doubled the risk of suicide and raised the rate of psychiatric admissions.

While previous studies have suggested long-term use of benzodiazepines is linked with increased overall mortality in the population, this study did not find such an association. It did, however, find an increased mortality risk with short-term (fewer than 90 days) use, which does support previous findings.

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“Although long-term benzodiazepine use among patients with COPD and PTSD is not linked with overall mortality, the association with suicide is concerning," Dr. Donovan said. “More research will be needed to better understand this link with suicide, but in the meantime, we would advise that clinicians reconsider prescribing benzodiazepines to patients who already are at high risk for self-harm.”

—Jolynn Tumolo

References

Donovan LM, Malte CA, Spece LJ, et al. Risks of benzodiazepines in chronic obstructive pulmonary disease with comorbid posttraumatic stress disorder. Annals of the American Thoracic Society. 2018 October 12;[Epub ahead of print].

Benzodiazepines in patients with COPD and PTSD may increase suicide risk [press release]. New York, New York: American Thoracic Society; October 12, 2018.