Skip to main content Accessibility help

Concurrent benzodiazepine use in older adults treated with antidepressants in Asia

  • Xiao-Mei Zhong (a1) (a2), Fei Wang (a2), Qinge Zhang (a3), Gabor S. Ungvari (a4) (a5), Chee H. Ng (a6), Helen F. K. Chiu (a7), Tian-Mei Si (a8), Kang Sim (a9), Ajit Avasthi (a10), Sandeep Grover (a10), Mian-Yoon Chong (a11), Kok-Yoon Chee (a12), Shigenobu Kanba (a13), Min-Soo Lee (a14), Shu-Yu Yang (a15), Pichet Udomratn (a16), Roy A. Kallivayalil (a17), Andi J. Tanra (a18), Margarita M. Maramis (a19), Winston W. Shen (a20), Norman Sartorius (a21), Rathi Mahendran (a22), Chay-Hoon Tan (a23), Naotaka Shinfuku (a24) and Yu-Tao Xiang (a2)...



Little is known about the combined use of benzodiazepines and antidepressants in older psychiatric patients. This study examined the prescription pattern of concurrent benzodiazepines in older adults treated with antidepressants in Asia, and explored its demographic and clinical correlates.


The data of 955 older adults with any type of psychiatric disorders were extracted from the database of the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) project. Demographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. Both univariate and multiple logistic regression analyses were performed.


The proportion of benzodiazepine and antidepressant combination in this cohort was 44.3%. Multiple logistic regression analysis revealed that higher doses of antidepressants, younger age (<65 years), inpatients, public hospital, major comorbid medical conditions, antidepressant types, and country/territory were significantly associated with more frequent co-prescription of benzodiazepines and antidepressants.


Nearly, half of the older adults treated with antidepressants in Asia are prescribed concurrent benzodiazepines. Given the potentially adverse effects of benzodiazepines, the rationale of benzodiazepines and antidepressants co-prescription needs to be revisited.


Corresponding author

Correspondence should be addressed to: Dr Yu-Tao Xiang, Faculty of Health Sciences, University of Macau, Avenida da Universidade, Taipa, Macau SAR, 3/F, Building E12, China. Phone: +853-8822-4223; Fax: +853-2288-2314. Email:


Hide All

These authors contributed equally to this work.



Hide All
Aarts, N., Noordam, R., Hofman, A., Tiemeier, H., Stricker, B. H. and Visser, L. E. (2014). Utilization patterns of antidepressants between 1991 and 2011 in a population-based cohort of middle-aged and elderly. European Psychiatry, 29, 365370.
Biderman, A., Cwikel, J., Fried, A. V. and Galinsky, D. (2002). Depression and falls among community dwelling elderly people: a search for common risk factors. Journal of Epidemiology and Community Health, 56, 631636.
Binder, R. L., Kazamatsuri, H., Nishimura, T. and McNiel, D. E. (1987). Tardive dyskinesia and neuroleptic-induced parkinsonism in Japan. American Journal of Psychiatry, 144, 14941496.
Bushnell, G. A., Stürmer, T., Gaynes, B. N., Pate, V. and Miller, M. (2017). Simultaneous Antidepressant and Benzodiazepine new use and subsequent long-term Benzodiazepine use in adults with depression, United States, 2001–2014. JAMA Psychiatry, 74, 747755.
Chong, M. Y. et al. (2001). Community study of depression in old age in Taiwan: prevalence, life events and socio-demographic correlates. British Journal of Psychiatry, 178, 2935.
Dai, J. et al. (2013). The prevalence of insomnia and its socio-demographic and clinical correlates in older adults in rural China: a pilot study. Aging Ment Health, 17, 761765.
Dassori, A. M., Copeland, L. A., Zeber, J. E. and Miller, A. L. (2011). Factors in second-generation antipsychotic switching patterns in a national sample of older veterans with schizophrenia. Psychiatric services, 62, 4753.
Fulone, I., Silva, M. T. and Lopes, L. C. (2016). Factors associated with the combined use of antidepressants and Benzodiazepines in major depression: a case-control study. Basic & clinical pharmacology & toxicology, 119, 273277.
Johnson, E. O., Roth, T. and Breslau, N. (2006). The association of insomnia with anxiety disorders and depression: exploration of the direction of risk. Journal of Psychiatric Research, 40, 700708.
Kruse, W. H. H. (1990). Problems and Pitfalls in the Use of Benzodiazepines in the Elderly. Drug Safety, 5, 328344.
Kua, E. H. (1992). A community study of mental disorders in elderly Singaporean Chinese using the GMS-AGECAT package. Australian and New Zealand Journal of Psychiatry, 26, 502506.
Leggett, A., Kavanagh, J., Zivin, K., Chiang, C., Kim, H. M. and Kales, H. C. (2015). The association between Benzodiazepine use and depression outcomes in older veterans. Journal of geriatric psychiatry and neurology, 28, 281287.
Manthey, L. et al. (2011). Correlates of (inappropriate) benzodiazepine use: the Netherlands study of depression and anxiety (NESDA). British Journal of Clinical Pharmacology, 71, 263272.
Masand, P. S. (2000). Side effects of antipsychotics in the elderly. Journal of Clinical Psychiatry, 61 (Suppl. 8), S43S49.
Meyers, B. S. and Jeste, D. V. (2010). Geriatric psychopharmacology: evolution of a discipline. Journal of Clinical Psychiatry, 71, 14161424.
Millan, M. J. (2014). On ‘polypharmacy’ and multi-target agents, complementary strategies for improving the treatment of depression: a comparative appraisal. International Journal of Neuropsychopharmacology, 17, 10091037.
Neckelmann, D., Mykletun, A. and Dahl, A. A. (2007). Chronic insomnia as a risk factor for developing anxiety and depression. Sleep, 30, 873880.
Parabiaghi, A. et al. (2011). Antidepressants utilization among elderly in Lombardy from 2000 to 2007: dispensing trends and appropriateness. European Journal of Clinical Pharmacology, 67, 10771083.
Rajaratnam, K. et al. (2016). Factors associated with antidepressant dosing in Asia: findings from the research on Asian psychotropic prescription study. Journal of Clinical Psychopharmacology, 36, 716719.
Shinfuku, N. and Tan, C. H. (2008). Pharmacotherapy for schizophrenic inpatients in East Asia–changes and challenges. International Review of Psychiatry, 20, 460468.
Smith, A. J. and Tett, S. E. (2009). How do different age groups use benzodiazepines and antidepressants? Analysis of an Australian administrative database, 2003–6. Drugs and Aging, 26, 113122.
Soudry, A., Dufouil, C., Ritchie, K., Dartigues, J. F., Tzourio, C. and Alpérovitch, A. (2008). Factors associated with changes in antidepressant use in a community-dwelling elderly cohort: the three-city study. European Journal of Clinical Pharmacology, 64, 5159.
Uchida, H. et al. (2009). Benzodiazepine and antidepressant use in elderly patients with anxiety disorders: a survey of 796 outpatients in Japan. Journal of Anxiety Disorders, 23, 477481.
Ungvari, G. S., Chow, L. Y., Chiu, H. F., Ng, F. S. and Leung, T. (1997). Modifying psychotropic drug prescription patterns: a follow-up survey. Psychiatry and clinical neurosciences, 51, 309314.
van Dijk, K. N., de Vries, C. S., ter Huurne, K., van den Berg, P. B., Brouwers, J. R. and de Jong-van den Berg, L. T. (2002). Concomitant prescribing of benzodiazepines during antidepressant therapy in the elderly. Journal of Clinical Epidemiology, 55, 10491053.
Volz, A., Khorsand, V., Gillies, D. and Leucht, S. (2007). Benzodiazepines for schizophrenia. Cochrane Database Systematic Review, CD006391.
White, C. L., Bateman, A., Fisher, W. H. and Geller, J. L. (1995). Factors associated with admission to public and private hospitals from a psychiatric emergency screening site. Psychiatric services, 46, 467472.
WHO (2001). Information Needs for Research, Policy and Action on Ageing and Older Adults: A Report of the Follow-up Meeting to the 2000 Harare MDS Workshop. Geneva: World Health Organization.
WHO Collaborating Centre for Drug Statistic Methodology (2002). Guidelines for ATC Index with DDDs. Oslo: WHO.
Xiang, Y. T. et al. (2012). Adjunctive mood stabilizer and Benzodiazepine use in older Asian Patients with Schizophrenia, 2001–2009. Pharmacopsychiatry, 45, 217222.
Xiang, Y. T. et al. (2013). Adjunctive antidepressant prescriptions for hospitalized patients with schizophrenia in Asia (2001-2009). Asia and Pacific Psychiatry, 5, E81E87.
Xiang, Y. T. et al. (2014a). Common use of high doses of antipsychotic medications in older Asian patients with schizophrenia (2001–2009). International Journal of Geriatric Psychiatry, 29, 359366.
Xiang, Y. T. et al. (2014b). Insomnia in older adults with chronic obstructive pulmonary disease (COPD) in Hong Kong: a case-control study. COPD, 11, 319324.
Xiang, Y. T., Weng, Y. Z., Leung, C. M., Tang, W. K. and Ungvari, G. S. (2007). Clinical and social determinants of antipsychotic polypharmacy for Chinese patients with schizophrenia. Pharmacopsychiatry, 40, 4752.
Zhang, W. H., Qiu, Z. F. and Zhang, L. J. (2004). Several ethical problems on the closed ward of psychiatric department (in Chinese). Chinese Journal of Medical Ethics, 17, 12.


Related content

Powered by UNSILO

Concurrent benzodiazepine use in older adults treated with antidepressants in Asia

  • Xiao-Mei Zhong (a1) (a2), Fei Wang (a2), Qinge Zhang (a3), Gabor S. Ungvari (a4) (a5), Chee H. Ng (a6), Helen F. K. Chiu (a7), Tian-Mei Si (a8), Kang Sim (a9), Ajit Avasthi (a10), Sandeep Grover (a10), Mian-Yoon Chong (a11), Kok-Yoon Chee (a12), Shigenobu Kanba (a13), Min-Soo Lee (a14), Shu-Yu Yang (a15), Pichet Udomratn (a16), Roy A. Kallivayalil (a17), Andi J. Tanra (a18), Margarita M. Maramis (a19), Winston W. Shen (a20), Norman Sartorius (a21), Rathi Mahendran (a22), Chay-Hoon Tan (a23), Naotaka Shinfuku (a24) and Yu-Tao Xiang (a2)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.