Chronic use of Benzodiazepines (BZDs) can lead to tolerance
and dependence, as indicated by a BZD Withdrawal Syndrome
(BWS). In general, it is preferred a gradual than an abrupt tapering
of BZDs as a first step in the treatment of BZD Dependence (BD).
In addition, a great variety of agents have been used as adjuvant
medication for BD. Recently, research has focused in the use of
Anticonvulsant (AC) drugs. The aim of this article is to review the use
of AC in the management of BWS and BD.
MEDLINE and the Cochrane were searched, selecting studies
from 1980 until 2014, in which a pharmacological intervention with
classic and new AC was made for discontinuing long-term BZD use.
In regard to classic AC, there were identified 10 studies related
to carbamazepine and 4 studies related to valproate. On one hand,
whereas there is a great body of research involving carbamazepine
and there is a consensus about its efficacy for discontinuing
long-term BZD use, especially in terms of improving drug-free
outcomes, there have been brought inconclusive results in regard to
valproate. On the other hand, studies identified of the new AC are
as follows: 2 for gabapentin, 2 for oxcarbazepine, 2 for pregabalin,
1 for tigabine and 2 for topiramate. With the exception of pregabalin,
only small studies and cases report have been conducted for most
of the new AC. Pregabalin has demonstrated to be effective in the treatment of BD and BWS, exerting its beneficial action by reducing
the severity of withdrawal and anxiety symptoms.
To date, among AC agents, only carbamazepine and pregabalin
can be considered as augmentation alternatives for the treatment
of long-term BZD use. Further randomized, double-blind,
placebo-controlled studies are necessary to increase the knowledge
to support the use of AC for the treatment of BD and BWS.||es