The following are highlights from a research article:
Current use of benzodiazepines in anxiety disorders, Cloos, Jean-Marc; Ferreira, Valérie, Current Opinion in Psychiatry, Issue: Volume 22(1), January 2009, p 90–95
HERE ARE SEVERAL REASONS AGAINST PRESCRIBING THESE MEDICATIONS:
- The American Psychiatric Association (APA, 1998) guideline for the treatment of panic disorder and the National Institute for Health and Clinical Excellence (NICE, 2004, amended 2007) guideline on the management of anxiety actually recommend selective serotonin reuptake inhibitors (SSRIs) as the best choice for the treatment of these anxiety disorders, alongside cognitive–behavioural therapy (CBT) and self-help based on CBT principles.
- According to the NICE guidelines, benzodiazepines are associated with a less good outcome in the long term and should not be prescribed for the treatment of individuals with anxiety disorders, and they should not usually be used beyond 2–4 weeks.
- The APA guideline points out that, with benzodiazepines, consideration must be given to the fact that all of them will produce physical dependency in most patients and that this may make it difficult to discontinue treatment.
- Even though benzodiazepines mainly have a favourable side effect profile, patients may experience sedation, fatigue, ataxia, slurred speech, memory impairment and weakness.
- If benzodiazepines are used, even when anti-anxiety medication or Cognitive Behavioural Therapy (CBT) has probably started to work, the patient may still believe that the benzodiazepine is the effective agent and then have difficulty discontinuing it.
- benzodiazepines may relieve anxiety to such an extent that the patient loses motivation to follow all the steps of CBT.
- Even after relatively brief periods of benzodiazepines treatment – often only a few weeks – some patients experience withdrawal reactions upon discontinuation and may believe that they are experiencing an anxiety relapse; thus, they have great difficulty in discontinuing the use of the benzodiazepines.
- For all these reasons, benzodiazepines are currently recommended only in the initial stages of the treatment of anxiety disorders, until more definitive treatment is likely to work.
- In order to prevent addiction, the clinician should avoid unnecessarily high doses of benzodiazepines, ask the patient to take these medications only when needed, and favour psychotherapy or antidepressants or both.
- Clinicians should not prescribe benzodiazepines to patients with a history of substance abuse, owing to a higher prevalence of benzodiazepines abuse and a greater euphoric response to benzodiazepines in these patients, and be careful when prescribing them in the elderly.
- SSRIs are a first-line treatment in these disorders, alongside serotonin–norepinephrine reuptake inhibitors (SNRIs). The study points out that benzodiazepines are also effective treatments, especially because of the advantage of a rapid onset of action, but that their use is limited by their potential for abuse and lack of antidepressant properties.
- Clinicians should remain careful when prescribing benzodiazepines to potentially suicidal patients. It has been suggested that … benzodiazepines have disinhibitory effects in approximately 5% of the patients.
- There are studies that did not find any convincing evidence of the short-term effectiveness of benzodiazepines in General Anxiety Disorder.
- Equally interesting was a research report assessing the effects of diazepam and chlordiazepoxide in mice exposed to a three-dimensional maze, which showed that administration of these benzodiazepines did not reduce anxiety in the animals, but produced sedation only when given in a higher dosage; thus, demonstrating for the first time that it is likely that the primary effect of benzodiazepines is not anxiolytic.
- Long-term prescription may have some important secondary effects such as driving problems and falls.
- The sole use of benzodiazepines in anxiety disorders, without having tried the alternatives, is to be avoided and benzodiazepines are contraindicated for patients with a history of substance use disorder.