Long-Term Benzodiazepine Treatment: Is It Ever Justified?
Long-term benzodiazepine treatment is still used for various indications. It is now accepted that benzodiazepines can cause dependence even in normal therapeutic doses in long-term use. Is long-term use therefore ever justified? This review marshals the evidence for and against the elrectiveness of benzodiazepines in long-term use and their side-effects, especially psychological deficits. The topic of dependence is then addressed. It is concluded that although short-term use is justified in view of the etrectiveness and safety of the benzodiazepines, long-term benzodiazepine use is much more problematic. In the absence of comprehensive long-term efficacy and safety data, constant vigilance is necessary to prevent unplanned long-term use.
KEY woRDs-Benzodiazepines, dependence, long-term use
In psychiatry, benzodiazepines are still used in the long-term therapy of chronic anxiety disorder, panic disorder, insomnia and some epileptic conditions. It is now clearly evident that benzodiazepines (BZ) can cause dependence as shown by a withdrawal syndrome on cessation of treatment (Rickels, 1987;Lader, 1989). Warnings have been issued against long-term BZ treatment (Committee on Review of Medicines, 1980; Committee on Safety of Medicines, 1988). But is such use ever justified?
Two main situations can arise. The first is where patients have used BZ for longer periods than 4 weeks for relief of severe symptomatic distress but they, and sometimes their doctors, find the withdrawal symptoms so distressing and protracted that they resume medication indefinitely. The second is where patients, and their doctors, deny any substantial risk of dependence and continue to use the drugs for long-term management. They conclude that long-term BZ use is not dangerous, because the psychological and social functioning of patients with BZ dependence is apparently normal. In these circumstances, BZ misuse seems frequent. In this review we summarize some of the publications concerning these alternative scenarios, concentrating on recent papers.