Simultaneous Benzodiazepine and SSRI Initiation in Young People With Anxiety Disorders

J Clin Psychiatry. 2021 Oct 19;82(6):20m13863. doi: 10.4088/JCP.20m13863.


Objective: There are potential risks and benefits of combining benzodiazepine (BZD) and selective serotonin reuptake inhibitor (SSRI) therapy at anxiety disorder treatment onset. We investigated how often adolescents and young adults with anxiety disorders simultaneously initiate BZD treatment with SSRI treatment and examined whether SSRI treatment duration varies by simultaneous BZD initiation.

Methods: In a United States commercial claims database (January 2008-December 2016), we identified adolescents (10-17 years) and young adults (18-24 years) with ICD-9-CM/ICD-10-CM anxiety disorder diagnoses initiating SSRI treatment, without past-year SSRI and BZD treatment. We defined simultaneous initiation as filling a new BZD prescription on the date of SSRI initiation. We estimated time to SSRI treatment discontinuation and used stabilized inverse probability of treatment weighting for adjusted estimates.

Results: The study included 94,399 adolescents and 130,971 young adults initiating SSRI treatment with an anxiety disorder. Four percent of adolescents and 17% of young adults simultaneously initiated BZD treatment, varying by age, anxiety disorder, comorbidities, health care utilization, and provider type. Simultaneous BZD initiation among SSRI initiators declined from 2008 to 2016. SSRI treatment duration was similar in initiators of simultaneous therapy vs SSRI monotherapy: ≥ 6 months in adolescents (55% vs 56%, respectively) and in young adults (39% vs 40%). Nine percent of simultaneous initiators continued BZDs for ≥ 6 months.

Conclusions: Simultaneous initiation of BZD and SSRI treatment is relatively common in young adults with anxiety disorders and was not associated with longer SSRI persistence. Given risks of BZD treatment, potential benefits and risks of adding a BZD at SSRI treatment initiation must be carefully weighed.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Age Factors
  • Anxiety Disorders* / drug therapy
  • Anxiety Disorders* / epidemiology
  • Anxiety Disorders* / psychology
  • Benzodiazepines* / administration & dosage
  • Benzodiazepines* / adverse effects
  • Child
  • Comorbidity
  • Drug Therapy, Combination* / adverse effects
  • Drug Therapy, Combination* / methods
  • Drug-Related Side Effects and Adverse Reactions / prevention & control
  • Duration of Therapy*
  • Female
  • Humans
  • Male
  • Patient Acceptance of Health Care
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Selective Serotonin Reuptake Inhibitors* / administration & dosage
  • Selective Serotonin Reuptake Inhibitors* / adverse effects
  • United States / epidemiology
  • Young Adult


  • Serotonin Uptake Inhibitors
  • Benzodiazepines