CMAJ • May 25, 2004; 170 (11). doi:10.1503/cmaj.1040166.
© 2004 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters
Correspondance

Discontinuation of benzodiazepines

Shabbir M.H. Alibhai

University Health Network, Toronto, Ont.

I commend Lucie Baillargeon and colleagues1 for conducting their important and challenging study on discontinuation of benzodiazepine therapy in elderly patients. However, I have concerns about the control group, as described in the report. The physicians of patients whose benzodiazepines were gradually withdrawn in the control group "were not permitted to give advice on nonpharmacological treatments of insomnia."1 Given the effectiveness of such interventions for chronic insomnia in older people,2,3it is not surprising that cognitive–behavioural therapy combined with drug tapering was found to be superior to benzodiazepine withdrawal alone. What this study does not establish is whether cognitive–behavioural therapy is better than standard care, which would include, at a minimum, advice on sleep hygiene.2

Shabbir M.H. Alibhai University Health Network Toronto, Ont.

Footnotes

Competing interests: None declared.


References

  1. Baillargeon L, Landreville P, Verreault R, Beauchemin JP, Grégoire JP, Morin CM. Discontinuation of benzodiazepines among older insomniac adults treated with cognitive–behavioural therapy combined with gradual tapering: a randomized trial. CMAJ 2003;169(10):1015-20.[Abstract/Free Full Text]
  2. McDowell JA, Mion LC, Lydon TJ, Inouye SK. A nonpharmacologic sleep protocol for hospitalized older patients. J Am Geriatr Soc 1998; 46:700-5. [Medline]
  3. Mendelson W. A 96-year-old woman with insomnia. JAMA 1997;277:990-6.[Abstract/Free Full Text]




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