Benzodiazepines for depression? A review of the literature

Abstract

The English language literature on the use of benzodiazepines in depressive disorders was reviewed. We selected double-blind random assignment studies in which benzodiazepines were compared with reference drugs and/or placebo. Comparative studies with classical (non-triazolo) benzodiazepines in major depression show that these agents do not alleviate the core symptoms of depression, although they do have an effect on sleep and anxiety. Classical benzodiazepines show some efficacy in minor depression, but this conclusion could be related to efficacy in patients suffering from anxiety disorders rather than depression. Triazolo-benzodiazepines, mainly alprazolam, have been found to be effective in mild to moderate depression, although they turned out to be inferior to tricyclic antidepressants (TCAs) in patients with endogenous or melancholic depression. Furthermore it is questionable whether triazolo-benzodiazepines cause amelioration of the core symptoms of depression. With regard to combination therapy benzodiazepines may contribute to antidepressant response in the first weeks, because of a faster onset of effect than TCAs and/or because of effects on different symptoms. Beyond the first weeks of treatment combination therapy does not seem superior to monotherapy with TCAs.