Pharmacotherapy of psychiatric inpatients with mental and behavioral disorders caused by sedatives or hypnotics (F13): Results from an observational pharmacovigilance program between 2000 and 2017.

BACKGROUND

The treatment of choice for substance use disorder (SUD) caused by sedatives, hypnotics, and anxiolytics (SHA) is to slowly taper the dose of the implicated substance to the point of abstinence, thereby minimizing withdrawal symptoms. Concomitant pharmacotherapy may be indicated to manage excessive withdrawal or rebound symptoms. This study investigated the use of psychotropic drugs for the treatment of SHA-dependent SUD patients in Germany.

METHODS

Data were obtained from the German Drug Safety Program in Psychiatry ("Arzneimittelsicherheit in der Psychiatrie"; AMSP) from 2000 to 2017. SHA SUD was classified using the 10th Edition of the International Classification of Disease (ICD-10).

RESULTS

The present study included 1,015 patients with a primary diagnosis of mental and behavioral disorders due to use of sedatives or hypnotics (F13.1-F13.9). The most common comorbid psychiatric diagnoses were additional SUDs (F1, n = 279), especially alcohol use disorder (F10; n = 124), and mood disorders (F3; n = 201). A total of 95.6% of patients received one or more psychotropic drugs, most commonly antidepressant drugs (63.1% of patients), tranquillizing drugs (55.5%), and antipsychotic drugs (46.7%). The most common combination was an antidepressant drug and a tranquillizing drug (33.0%). Overall, psychotropic drugs with sedating properties (e.g., mirtazapine, quetiapine, doxepin, and trimipramine) were preferred. An increase in use over the 17-year observation period was observed for tranquillizing drugs and, most pronounced, for antipsychotic drugs.

CONCLUSION

We found high rates of non-SHA drugs among patients treated for SHA-SUD. The prevalent use of psychotropic drugs with strong sedating properties indicates a symptom-oriented treatment approach, which is often "off-label" but may be clinically necessary. Main limitation is the cross-sectional design of the AMSP databank. Therefore, we cannot provide any follow up data on the patient collective especially regarding outcome.