Benzodiazepines for PTSD: A Systematic Review and Meta-Analysis
Benzodiazepines for PTSD: A Systematic Review and Meta-Analysis
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DOI：
10.1097/pra.0000000000000091
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发表时间：
2015-07-01
影响因子：
1.9
通讯作者：
Welton, Randon S.
中科院分区：
文献类型：
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作者：
Guina, Jeffrey;Rossetter, Sarah R.;Welton, Randon S.
目的：尽管苯二氮类药物(BZD)常用于创伤后应激障碍(PTSD)的治疗，但尚未有系统综述或荟萃分析专门研究这种治疗方法。本研究的目的是分析和总结有关BZDS治疗PTSD疗效的证据。方法：综述方案按照系统评价和荟萃分析首选报告项目(PRISMA)声明推荐的原则进行，并在PROSPERO国际系统评价前瞻性登记(http://www.crd.york.ac.uk/PROSPERO，注册号CRD42014009318)中注册。两位作者独立地使用多个电子数据库对所有相关文章进行了搜索，并独立地从使用BZD的患者的创伤后应激障碍结果的研究中提取信息。确定了18项临床试验和观察性研究，共有5236名参与者。结果：BZD对创伤后应激障碍的治疗和预防无效，与其使用相关的风险往往大于潜在的短期益处。除了对普通人群的不良影响外，BZD还与PTSD患者的特定问题有关：总体严重程度更差，在最近的创伤后使用BZD显著增加了患PTSD的风险，心理治疗结果更差，攻击性、抑郁和药物使用。基于对BZDS、PTSD和相关动物模型的研究，对这些结果提出了可能的生物心理社会学解释。结论：这项系统性综述的结果表明，BZDS应该被认为是PTSD或最近创伤患者的相对禁忌症。创伤后应激障碍的循证治疗应优先于BZD。
Objective: Although benzodiazepines (BZDs) are commonly used in the treatment of post-traumatic stress disorder (PTSD), no systematic review or meta-analysis has specifically examined this treatment. The goal of this study was to analyze and summarize evidence concerning the efficacy of BZDs in treating PTSD.Methods: The review protocol was undertaken according to the principles recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and is registered with the PROSPERO international prospective register of systematic reviews (http://www.crd.york.ac.uk/PROSPERO, registration number CRD42014009318). Two authors independently conducted a search of all relevant articles using multiple electronic databases and independently abstracted information from studies measuring PTSD outcomes in patients using BZDs. Eighteen clinical trials and observational studies were identified, with a total of 5236 participants. Outcomes were assessed using qualitative and quantitative syntheses, including meta-analysis.Results: BZDs are ineffective for PTSD treatment and prevention, and risks associated with their use tend to outweigh potential short-term benefits. In addition to adverse effects in general populations, BZDs are associated with specific problems in patients with PTSD: worse overall severity, significantly increased risk of developing PTSD with use after recent trauma, worse psychotherapy outcomes, aggression, depression, and substance use. Potential biopsychosocial explanations for these results are proposed based on studies that have investigated BZDs, PTSD, and relevant animal models.Conclusions: The results of this systematic review suggest that BZDs should be considered relatively contraindicated for patients with PTSD or recent trauma. Evidence-based treatments for PTSD should be favored over BZDs.