Title : Benzodiazepine and SSRI co-prescription vs. Monotherapy: A bibliometric review of effects on adherence and anxiety relief
Abstract:
Selective serotonin reuptake inhibitors (SSRIs) are first-line treatments but have delayed onset and may initially worsen symptoms; benzodiazepines are sometimes co-prescribed to provide immediate relief. Despite this, research on co-prescription is fragmented across study types and outcomes, making it difficult to determine how the field is structured and what areas are emphasized or underexplored. This study analyzes trends in the literature on benzodiazepine-SSRI co-prescription, examining the distribution of study types and research emphasis.
A bibliometric review of the top 100 most cited studies was performed using the Web of Science Core Collection, with a PRISMA-guided selection process. Records published through 2026 were identified using keywords “SSRI,” “benzodiazepine,” and “anxiety”, and ranked by citation count. Metadata, including authorship, publication year, journals, and citation count, were extracted and curated in Excel. Studies were categorized by study type, outcome focus, and study design. Data were analyzed using RStudio, with relative frequencies and distributions visualized in bar charts.
The literature is predominantly composed of clinical studies (77%), with comparatively limited mechanistic research. Outcome focus is largely directed toward long-term treatment trajectories (58.8%), while adherence and discontinuation remain underrepresented (8.8%), despite being central to the clinical rationale for co-prescription. This imbalance suggests that although co-prescription is intended as a short-term “bridge” strategy, the literature more frequently emphasizes long-term outcomes, a mismatch between clinical rationale and research focus. Additionally, predominance of observational study designs indicates a reliance on real-world data, which may limit causal interpretation of treatment effectiveness.
Overall, the literature on benzodiazepine-SSRI co-prescription is predominantly clinical and emphasizes long-term outcomes, while adherence remains underrepresented despite being a central rationale for co-prescription, a mismatch between the intended short-term use of co-prescription and the outcomes most frequently examined in the literature. These findings are limited by the use of a single database and variability in study designs and treatment protocols across studies. Future research should prioritize standardized longitudinal and mechanistic investigations to better align research focus with clinical practice.
