Benzodiazepines

Benzodiazepines were widely prescribed in the 1960s and 1970s as anxiolytics and hypnotics. For a while, they were perceived as 'wonder drugs' against neurosis, with no side-effects or addiction potential, in contrast to their predecessors, the barbiturates. In the 1980s, however, because of concern about their inappropriate use for people with social and interpersonal problems rather than true psychiatric disorder, and because of the emerging risk of dependence, prescription of benzodiazepines was discouraged, psychological techniques of anxiety management being recommended as an alternative. Current CSM advice is that

1. Benzodiazepines are indicated for the short-term relief (2-4 weeks only) of anxiety that is severe, disabling, or subjecting the individual to unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic, or psychotic illness.

2. The use of benzodiazepines to treat short-term 'mild' anxiety is inappropriate and unsuitable.

3. Benzodiazepines should be used to treat insomnia only when it is severe, disabling, or subjecting the individual to extreme distress.

Box 23.6 Benzodiazepines in Common Use

Generic name

Alprazolam

Chlordiazepoxide

Diazepam

Flurazepam

Nitrazepam

Lorazepam

Temazepam

It is important to realize that the CSM's sensible and cautious advice does not constitute a ban on benzodiazepines. The pendulum has, however, swung perhaps a little too far, and, at present, benzodiazepines as effective remedies for short-term anxiety are probably underused. Excessive prescription should certainly be avoided, but some authorities consider that these drugs remain a reasonable long-term treatment for a small minority of chronically anxious patients. Intensive effort to wean all long-term users off benzodiazepines is not automatically justified.

Further concern about benzodiazepines stems from their popularity with drug misusers. Intravenous injection of the gel from temazepam capsules became prevalent and caused gangrene of the limbs; these capsules have therefore been withdrawn.

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