Abstract
Stress is an increasing problem that can result in various psychiatric and somatoform symptoms. Among others, benzodiazepines and valerian preparations are used to treat stress symptoms. The aim of this study was to investigate whether the prescription of a fixed herbal extract combination of valerian, lemon balm, passionflower, and butterbur (Ze 185) changes the prescription pattern of benzodiazepines in hospitalized psychiatric patients. In a retrospective case‐control study, anonymized medical record data from 3,252 psychiatric in‐house patients were analysed over a 3.5‐year period. Cases (n = 1,548) with a prescription of Ze 185 and controls (n = 1,704) were matched by age, gender, hospitalization interval, and main International Classification of Diseases, Version 10 F‐diagnoses. The primary objective was to investigate the effect of Ze 185 on the prescription pattern of benzodiazepines. Secondary objectives investigated the prescriptions of concomitant drugs and effectiveness of the hospital stay. Distribution of drug classes was analysed using the WHO's anatomic‐therapeutic‐chemical code. Data showed that both treatment modalities had a comparable clinical effectiveness but with significantly less prescriptions of benzodiazepines in the Ze 185 group (p = .006). This is of clinical importance because suitable alternatives to benzodiazepines are desirable. To obtain more support for this hypothesis, a dedicated randomized, controlled clinical trial monitoring drug safety is required.
Highlights
1,548 cases were treated with Ze 185, and 1,704 matched controls received regular medical treatment without Ze 185
The broad indication of Ze 185 covers the treatment of stress-related complaints, such as nervousness, nervous tension, agitation, and anxiousness
Patients with these symptoms are often treated with benzodiazepines
Summary
In modern societies, stress is an increasing problem that can result in various somatoform symptoms such as sleep disorders. Long-term use of benzodiazepines can pose important adverse effects, which should be considered. These adverse effects include drug dependence, abuse, hangover effects, cognitive and memory impairment, drowsiness, ataxia, motor incoordination, and falls (Gerlach, Maust, Leong, Mavandadi, & Oslin, 2018; Johnson & Streltzer, 2013; Woods, Katz, & Winger, 1992). Chronic use of benzodiazepines can lead to tolerance to the pharmacological effects and withdrawal symptoms after discontinuation of the drug. They act as sedatives and have myorelaxant and anxiolytic effects. Recreational use is a relevant complication (Lalive, Rudolph, Luscher, & Tan, 2011)
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