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Abstract
The significant increase in the use of psychotropic drugs, especially benzodiazepines and antidepressants, in primary health care (PHC) has raised concerns due to the risks associated with prolonged use, adverse effects, and dependence. This trend reflects both the growing demand for mental disorder management and gaps in diagnosis and psychosocial treatment, highlighting a multifactorial phenomenon that compromises the quality of care and patient safety. The present objective is to critically analyze the landscape of excessive use of benzodiazepines and antidepressants in PHC, identifying determining factors, clinical consequences, and strategies for the rational management of these drugs. This is an integrative review of the literature with a qualitative approach, aimed at analyzing the impact of psychopharmacology, particularly the prescription and use of benzodiazepines in primary care. The bibliographic search was conducted between August and September 2023, covering articles, official documents, and reviews published between 2004 and 2023, with a special focus on the last five years to reflect the current scenario. The databases consulted included PubMed, SciELO, LILACS, Google Scholar, and institutional websites such as those of the World Health Organization (WHO) and the Brazilian Ministry of Health. Studies show that the indiscriminate and prolonged use of benzodiazepines is associated with significant risks, such as chemical dependence, tolerance, cognitive impairment, falls, and accidents, especially in the elderly. Excessive consumption of antidepressants, although less associated with dependence, can cause significant adverse effects, including gastrointestinal symptoms, weight gain, and sleep disturbances. The high prescription of these drugs in PHC is related to factors such as a lack of resources for mental health, lack of specific training for professionals, pressure for quick responses, and patient expectations for pharmacological solutions. In addition, the absence of clear protocols for review and discontinuation contributes to the inappropriate prolongation of treatment. Multidisciplinary interventions involving psychosocial follow-up, health education, and deprescribing programs are essential to reverse this situation, promoting the rational and safe use of psychotropic drugs. It is concluded that the crisis of excessive use of benzodiazepines and antidepressants in PHC requires coordinated actions to improve the training of professionals, strengthen psychosocial support, and implement policies that encourage rational prescribing. The proper management of these drugs is crucial to minimize risks, improve clinical outcomes, and promote mental health in a comprehensive and sustainable manner.
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