FACTORS ASSOCIATED WITH LONGITUDINAL DECREASE IN DOSES OF BENZODIAZEPINE HYPNOTICS IN PATIENTS WITH DEPRESSIVE DISORDERS

Abstract Background The development of orexin receptor antagonists (ORAs) has become an alternative choice of pharmacotherapy for patients with sleep disorders. A previous prescription database (JP4DR) survey of patients who visited the Department of Psychiatry, The Jikei University Hospital in 2018 and 2020 showed a significant decrease in the diazepam equivalent dose of benzodiazepine (BZ) hypnotics in patients with psychiatric disorders. However, the factors associated with the decrease in patients with depressive disorders remain unclear. The study was approved by the Ethics Committee of the Jikei University School of Medicine. Aims and Objectives In the present study, we investigated the factors associated with the decrease in the dose of BZ hypnotics in patients with depressive disorders. Method We selected patients from the prescription database who visited the outpatient section of Department of Psychiatry, Jikei University Hospital from December 1 to 31, 2018 and from December 1 to 31, 2021. These patients were diagnosed with ICD-10 codes F32 (depressive episode) and F33 (recurrent depressive disorder). We compare doses of diazepam equivalents of BZ hypnotics, imipramine equivalent doses of antidepressants, and the doses of ORAs in 2018 and 2021. A multiple regression analysis was performed to examine the association of longitudinal changes in diazepam equivalent doses of BZ hypnotics between 2018 and 2021 with changes in the equivalent dose of imipramine, the dose of suvorexant, and the dose of lemborexant. The significance level was set at 5%. Results 877 patients with psychiatric disorders had visit the Department of Psychiatry, Jikei University Hospital on both December 1-31, 2018 and 2021. Of those, 246 patients with F32 (depressive episode) and F33 (recurrent depressive disorder) were included in the analysis. The diazepam equivalent doses of BZ hypnotics decreased significantly between 2018 and 2021 (p = 0.01). Multiple regression analysis showed that a decrease in imipramine equivalents of antidepressants was associated with a decrease in BZ hypnotics (p<0.01). Discussion and Conclusion The decrease in the diazepam equivalent dose of BZ hypnotics was significantly associated with the decrease in the imipramine equivalent dose of antidepressants. It is suggested that improvement in depressive symptoms and comorbid insomnia led to the decrease in antidepressant medication.