by Elisa Cascade and Amir H. Kalali, MD

Ms. Cascade is Vice President, Quintiles Inc./iGuard, Falls Church, Virginia; and Dr. Kalali is Vice President, Global Therapeutic Group Leader CNS, Quintiles Inc., San Diego, California, and Professor of Psychiatry, University of California, San Diego.

Psychiatry (Edgemont) 2008;5(9):21–22

Abstract

We examined the role of benzodiazepines in the treatment of anxiety by both psychiatrists and primary care physicians. Over the past year, 112.8 million prescriptions were filled for a benzodiazepine: 55 percent were prescribed by a primary care physician, 16 percent by a psychiatrist, and the remaining 29 percent of prescriptions by another type of specialty physician. Benzodiazepine monotherapy is much more common in the treatment of anxiety by primary care physicians (42%) than psychiatrists (22%). Even when both benzodiazepine monotherapy and combination regimens are considered, total benzodiazepine use remains slightly greater in primary care than psychiatry (51% vs. 42%).

Key words

anxiety, benzodiazepine, antidepressant, monotherapy, combination therapy, psychiatrist, primary care physician

Introduction

Benzodiazepines remain an important option for treatment of anxiety. In this article, we examine the role of benzodiazepines in the treatment of anxiety by both psychiatrists and primary care physicians.

Methods

We obtained data from the following sources: 1) total benzodiazepine prescriptions from SDI Health’s (formerly Verispan) VONA, July 2007 to June 2008 and 2) July 2007 to June 2008 data from SDI Health’s Prescription Drug and Diagnosis Audit (PDDA) regarding products used to treat anxiety (ICD-9 diagnosis code 300). PDDA captures data on disease state and associated therapy from 3,100 office-based physicians representing 29 specialties across the United States.

Results

Over the past year, 112.8 million prescriptions were filled for a benzodiazepine. Slightly more than half of all benzodiazepine prescriptions (55%) were written by primary care physicians. Psychiatrists accounted for an additional 16 percent of prescriptions, and the remaining 29 percent of prescriptions were written by another type of specialty physician (Figure 1).

Figure 2 displays use of antidepressants and benzodiazepines in the treatment of anxiety by primary care physicians and psychiatrists. As seen in Figure 2, benzodiazepine monotherapy is much more common in the treatment of anxiety by primary care physicians (42%) than psychiatrists (22%). Even when both benzodiazepine monotherapy and combination regimens are considered, total benzodiazepine use remains slightly greater in primary care than psychiatry (51% vs. 42%).