Suicidal Ideation and Suicide Completion in Benzodiazepine Users: A Systematic Review of Current Evidence.

Benzodiazepines (BZDs) are widely used anxiolytics for treating various psychiatric conditions and for procedures requiring conscious sedation. Despite their therapeutic benefits, there is concern about their paradoxical effects, particularly the potential increase in suicidal ideation and suicide completion. This systematic review examines the extent to which benzodiazepines contribute to, cause, or exacerbate suicidal ideation and suicide completion. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we conducted a systematic review of literature from databases including PubMed, PubMed Central (PMC), and PubPsych. Search terms related to benzodiazepines and suicide were used, yielding 7,961 articles. After removing duplicates and applying inclusion and exclusion criteria, 587 articles were screened, leading to a final selection of six articles. These studies underwent rigorous quality assessment using various tools. The review highlighted several key findings. Moderate benzodiazepine use with concomitant psychotherapy or antidepressants was associated with reduced suicide risk. Concurrent use of opioids and benzodiazepines significantly elevated the risk of suicide attempts and intentional self-harm. Benzodiazepine use was linked to increased suicide risk in vulnerable groups, including those with pre-existing mental health conditions. Benzodiazepines should be prescribed with caution, ideally for short-term use until antidepressant effects manifest. Close monitoring for addiction, withdrawal, and suicidal ideation is essential. Prescribers must be aware of the increased risks when benzodiazepines are used in conjunction with opioids or in patients with heightened vulnerability to suicide. Effective weaning programs and risk assessment tools are crucial to mitigate these risks and ensure patient safety.