By Dr Charlotte Archer, Research Fellow in Primary Care Mental Health, Centre for Academic Mental Health and Centre for Academic Primary Care, University of Bristol
Why did we do the research?
Benzodiazepines like Valium can be used to help manage the symptoms of anxiety. Research has found that the number of new prescriptions of benzodiazepines for patients with anxiety decreased between 2003 and 2018. It is likely that this is because there are some concerns in the medical community about prescribing benzodiazepines, such as dependency. However, although numbers have declined overall, rates of prescribing actually increased in young adults (those aged 18-34) from 2008 onwards.
Further, the clinical guidelines for the management of anxiety state benzodiazepines should only be used on a short-terms basis, around two to four weeks. Despite this, in 2017, just under half of the prescriptions for benzodiazepines were issued for longer than four weeks.
Although other studies have explored why GPs prescribe benzodiazepines, particularly in older adults, we know little about when and why they may choose to prescribe them for anxiety in younger adults. Understanding more about this might help us identify possible reasons for the increase seen in prescribing in this age group.
We conducted in-depth interviews with 17 GPs to explore their views on prescribing benzodiazepines for anxiety disorders in young adults. GPs were recruited via GP practices in Bristol and the surrounding area. This research has been recently published in the British Journal of General Practice.
What we found
We found that GPs said they were cautious in prescribing benzodiazepines for young adults and were reluctant to prescribe them on a longer-term basis. However, they reported that there were lengthy waiting lists to access talking therapies and limited treatment options for patients in severe distress. This meant that, sometimes, benzodiazepines had an important role in the management of anxiety in young adults.
GPs described how they would use short-term prescriptions to reduce the risk of dependency, although they also suggested that sometimes medium- or longer-term prescriptions could be appropriate. In reflecting on these views, some GPs questioned whether there was a need for practitioners to revisit how benzodiazepines are being used for the management of anxiety, particularly when prescriptions were often started in secondary care.
GPs also talked about patient-driven factors when they prescribed benzodiazepines. They reported that many young adults that presented to them wanted a benzodiazepine prescription. GPs suggested this might be because they wanted their symptoms to be resolved more quickly than previous generations and did not want to wait for access to talking therapies or for an antidepressant to start working.
Some GPs also shared that it could feel uncomfortable to refuse to prescribe a benzodiazepine, and that there had been a recent increase in the number of young adults presenting to them who were already dependant on benzodiazepines, having acquired them outside of primary care.
What does this mean for patients and GPs?
Although GPs are cautious in prescribing benzodiazepines and are reluctant to prescribe them for longer than two to four weeks, the number of new prescriptions in young adults is increasing. This study suggests there are several contributing factors for this. These include difficulties in accessing talking therapies because of long waiting times, the quick effect of these benzodiazepines in difficult situations, and pressure to prescribe from patients. However, the potential for creating long-term dependency in young adults is worrying. Therefore, it is important that when GPs initiate a benzodiazepine prescription, they continue to monitor the risks and benefits for ongoing use and prescribe the smallest dose and shortest duration for clinical benefit.
Given the recent increases in prescribing, and the reflections from GPs on the use of these drugs in secondary care, it may be timely to reconsider when and how benzodiazepines should be used in primary care for the management of people with anxiety, particularly young adults. Future research could also aim to understand the views of young adults, which would be to key to informing any changes in guidelines.
Finally, findings may also indicate a current unmet need for the support and management of young adults with anxiety in UK primary care and there may be a need to adapt existing services to better support this age group.
Paper: Prescribing benzodiazepines in young adults with anxiety: a qualitative study of GP perspectives. Charlotte Archer, Nicola Wiles, David Kessler, Carolyn A Chew-Graham and Katrina Turner. Published in British Journal of General Practice. November 2024.
Acknowledgements
The authors gratefully acknowledge the GPs who participated in this study, the support of the general practices, the Clinical Research Network West of England, and Bristol, North Somerset and South Gloucestershire Integrated Care Board (ICB). This study was also supported by the NIHR Bristol Biomedical Research Centre.