Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
9.7 Major clinical issues with eating disorders and benzodiazepine use
Table of contents
- Acknowledgments
- Abbreviations
- Preface
- Introduction
- Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
1. Levels of evidence- 2. Management of people with comorbidity of mental disorders and substance use
- 3. The common drug groups
- 4. Tobacco
- 5. Depression and substance use
- 6. Anxiety disorders and substance use
- 7. Psychosis (schizophrenia and bipolar disorder) and substance use
- 8. Personality disorders and substance use
9. Eating disorders and substance use- 9.1 Eating disorders
- 9.2 Comorbidity with eating disorders
- 9.3 Major clinical issues with eating disorders and cannabis/ hallucinogen use
- 9.4 Major clinical issues with eating disorders and alcohol use
- 9.5 Major clinical issues with eating disorders and opioid use
- 9.6 Major clinical issues with eating disorders and stimulant (including methamphetamine) use
- 9.7 Major clinical issues with eating disorders and benzodiazepine use
- 9.8 Major clinical issues with eating disorders and inhalant/ solvent use
- 10. Somatoform disorders and substance use
- 11. Gambling and substance use
- 12. Brain injury, mental disorders and substance use
- 13. Bibliography
- 14. Appendices
- People with eating disorders do not commonly use benzodiazepines.
- Benzodiazepine use should be discouraged.
- If dependence has developed, then graduated withdrawal through slow reduction of dosage should be commenced.
- If long-term benzodiazepine use is indicated, then this should be monitored closely.
9.7.1 Effects of benzodiazepines on eating disorders
- People with eating disorders do not commonly use benzodiazepines(349).
- Benzodiazepines have been shown to increase the palatability of food and often result in the increased consumption of food(376).
9.7.2 Interactions between benzodiazepines nd therapeutic agents for eating disorders
- There is an increased risk of sedation and overdose with the combination of benzodiazepines and sedative antidepressants such as tricyclics and mirtazepinex.
- Benzodiazepines and antidepressants are both metabolised by CYP 450 enzymes which may result in the inhibition or induction of either drug group. Therefore, individuals should be monitored closely to ensure they are experiencing the appropriate therapeutic effectx.
- Fluvoxamine will inhibit the metabolism of alprazolam, midazolam, triazolam and diazepam causing increased sedation and potential toxicityx.
- Citalopram and sertraline are the least likely SSRIs to have cytochrome mediated drug interactionsx.
9.7.3 Management approaches to comorbid eating disorders and benzodiazepine use
- Benzodiazepine use should be discouraged.
- If large quantities of benzodiazepines (e.g. 40mg diazepam daily equivalent or more) are being consumed, then inpatient withdrawal to lower levels should be considered to avoid and manage seizure risk(194).
- If dependence has developed, then graduated withdrawal through slow reduction of dosage should be commenced****(194-196), possibly after transferring the patient onto a long acting benzodiazepine.
- If long-term benzodiazepine use is indicated, then:
- This should be subject to a contract with the patient.
- Authorities should be advised, including registration with the relevant local government health authority.
- The seeking of additional benzodiazepines from other prescribers should be monitored (e.g. using the Authority to release personal PBS claims information to a third party form).
- Daily or weekly dispensing of benzodiazepines should be considered and may assist with controlling use.
- Standard management of the eating disorder should commence if the patient is willing and engaged.
