Psychiatrist.comResolving the Paradox of Long-Term Benzodiazepine Treatment: Toward Evidence-Based Practice Guidelines

A Commentary on the Polarizing Aspect of Benzodiazepine Treatment

This commentary presents a comprehensive analysis of the paradoxical views on long-term benzodiazepine treatment. The authors, Edward Silberman, MD; Antonio E. Nardi, MD, PhD; Vladan Starcevic, MD, PhD; Richard Balon, MD; Fiammetta Cosci, MD; Giovanni A. Fava, MD; Carl Salzman, MD; Richard Shader, MD; and Nicoletta Sonino, MD, delve into the contrasting perspectives and propose a set of prescribing guidelines for clinicians.

Key Points

• The literature presents two starkly different pictures of long-term benzodiazepine treatment.
• One view stems from patients trying to withdraw from long-term use, emphasizing the difficulty for many of stopping and staying off these medications.
• The other view comes from investigations of benzodiazepine efficacy and tolerability, in which maintenance treatment is stable and unproblematic.
• The authors propose that benzodiazepines may be appropriate for both acute treatment and long-term maintenance for well-characterized DSM anxiety disorders.

According to a review in the British Journal of General Practice, long-term treatment with benzodiazepines should involve regular patient review, usually monthly, and regular attempts to reduce or stop treatment when conditions allow.

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