Costs and Benefits of Drug therapy

Insomnia and anxiety disorders are very different problems, each making normal, everyday life difficult, and drug therapy can usually help with both of these conditions.

However, a word of caution is now being given about such therapy as a meta-analysis of over 12 years’ Canadian data suggests that the costs of such treatment might outweigh the benefits. The issue is that these treatments seem to be associated with a significant increase in mortality rate from 10.5% to 15.7%.  This is still a low risk of dying, but it does represent an increase if using the medication of about 36% compared to not using medication when other variables are factored in.  The data came from more than 14.000 adults between the ages of 18 and 102, and extraneous or confounding variables such as smoking, alcohol use, general health and physical activity were controlled for.

Why is there such an increased risk of dying when using these drug therapies? It is known that sleeping pills and anti-anxiety drugs all slow reaction times, alertness and coordination, so increased falls may be a partial factor. These drugs could also depress the respiratory system enough to cause or trigger breathing problems during sleep. And as these medications also inhibit some CNS function,  judgement may be affected, which could increase suicidal behaviours. CBT has been shown to have good results in treating people with insomnia and anxiety disorders, and this psychotherapy does not carry an increased risk of dying, so the research suggests that perhaps this could be combined with cautious use of drugs after discussion between doctor and patient.

Belleville, G. Mortality Hazard Associated With Anxiolytic and Hypnotic Drug Use in the National Population Health Survey. Canadian Journal of Psychiatry, 2010; 55 (9)

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