Major Depression and Sedative-Hypnotic Use Disorder: a Review
Purpose of Review
Nonmedical use or addiction of sedative-hypnotics is commonly seen among patients with major depressive disorder (MDD). The aim of this article is to review the prevalence of, the relationship between, and the current treatment of MDD comorbid with sedative-hypnotic use disorder.
Approximately 3–5% of general population is prescribed sedative-hypnotic medications and prescribing of these agents is more common in women and the elderly. About 2.3% of the US population reported using hypnotics nonmedically, with 0.6% reporting using sedatives nonmedically. Among these nonmedical sedative-hypnotic users, 9.8% met criteria for sedative use disorders. MDD was found to be associated with higher odds of sedative-hypnotics both in adult and adolescent population; however, very few studies examined specifically the prevalence of sedative-hypnotic use disorders in MDD patients. The main motive to misuse or abuse these medications is self-medication of sleep and anxiety problems. In addition, the relationship between MDD and sedative-hypnotic use disorders seems bidirectional. While MDD is a risk factor for the development of sedative-hypnotic use disorder, long-term use of these medications could lead to occurrence of MDD. Thus, it is crucial to offer integrated program that could treat both MDD and sedative-hypnotic use disorder simultaneously.
Adequate treatment of MDD and earlier identification of sedative-hypnotic use problems are essential for the treatment of MDD with sedative-hypnotic use disorder. A more integrated treatment program that fulfills the need of patients with both mental and addiction problems should be developed and expanded.
KeywordsDual diagnosis Sedative-hypnotic use disorder Major depressive disorder
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no competing interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 6.Martins SS, Fenton MC, Keyes KM, Blanco C, Zhu H, Storr CL. Mood and anxiety disorders and their association with non-medical prescription opioid use and prescription opioid-use disorder: longitudinal evidence from the National Epidemiologic Study on Alcohol and Related Conditions. Psychol Med. 2012;42(6):1261–72.CrossRefPubMedGoogle Scholar
- 21.Chong Y, Fryer CD, Gu Q. Prescription sleep aid use among adults: United States, 2005-2010. NCHS Data Brief. 2013;127:1–8.Google Scholar
- 22.Ford ES, Wheaton AG, Cunningham TJ, Giles WH, Chapman DP, Croft JB. Trends in outpatient visits for insomnia, sleep apnea, and prescriptions for sleep medications among US adults: findings from the National Ambulatory Medical Care survey 1999-2010. Sleep. 2014;37(8):1283–93.CrossRefPubMedPubMedCentralGoogle Scholar
- 28.Brandt J, Leong C. Benzodiazepines and Z-drugs: an updated review of major adverse outcomes reported on in epidemiologic research: Drugs R D 2017;17(4):493–507. https://doi.org/10.1007/s40268-017-0207-7.
- 29.Herings RM, Stricker BH, de Boer A, Bakker A, Sturmans F. Benzodiazepines and the risk of falling leading to femur fractures. Dosage more important than elimination half-life. Arch Intern Med 1995;155(16):1801–1807.Google Scholar
- 33.• Olfson M, King M, Schoenbaum M. Benzodiazepine use in the United States. JAMA psychiatry. 2015;72(2):136–42. This study described the pattern of benzodiazepine prescription focusing on patient age and duration of use and found long-term benzodiazepine use was particularly pronounced in the elderly. CrossRefPubMedGoogle Scholar
- 35.Billioti de Gage S, Moride Y, Ducruet T, Kurth T, Verdoux H, Tournier M, et al. Benzodiazepine use and risk of Alzheimer’s disease: case-control study. BMJ. 2014;349.Google Scholar
- 36.Chen PL, Lee WJ, Sun WZ, Oyang YJ, Fuh JL. Risk of dementia in patients with insomnia and long-term use of hypnotics: a population-based retrospective cohort study. PLoS One. 2012;7(11):7.Google Scholar
- 44.•• Hughes A, Williams MR, Lipari RN, Bose J, Copello EAP, Kroutil LA. Prescription drug use and misuse in the United States: results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. 2016; This NSDUH report offers a general picture of the scope of prescription drug misuse or addiction problem in the USA. Higher odds of mental disorders and behavior problems are found to be associated with misuse of prescription sedative-hypnotics. Google Scholar
- 46.•• Young AM, Glover N, Havens JR. Nonmedical use of prescription medications among adolescents in the United States: a systematic review. J Adolesc Health. 2012;51(1):6–17. This study offers evidence that misuse or addiction of sedative-hypnotic medications is associated with mental or behavioral problems in adolescent population. CrossRefPubMedGoogle Scholar
- 58.Grant BF, Stinson FS, Dawson DA, Chou SP, Dufour MC, Compton W, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004;61(8):807–16.CrossRefPubMedGoogle Scholar
- 61.Center for Behavioral Health Statistics and Quality. Key substance use and mental health indicators in the United States: results from the 2015 National Survey on Drug Use and Health (HHS Publication No.SMA 16–4984, NSDUH Series H-51). 2016. Retrieved from http://www.samhsa.gov/data/.
- 70.Department of health (England). Drug misuse and dependence: UK guidelines on clinical management. London; 2007.Google Scholar