Most sedating benzo
All treatments were given for 6 weeks and withdrawn by week 10.By 6 weeks, the initial efficacy of diazepam had waned and by the end of the study period, patients treated with diazepam were actually worse off than those on placebo and the other treatments.It must be pointed out from the onset that perceptions of the risk/benefit ratio of the benzodiazepines vary substantially from country to country. Unfortunately, close evaluation of the available data shows even this efficacy to be surprisingly limited.One meta-analysis from Australia examined 81 studies mainly of benzodiazepines in anxiety, as compared to a placebo, and in some studies, to no treatment at all.(3) Useful therapeutic effects were apparent in the meta-analysis but half of this improvement was placebo-related, i.e. A large number of short-term trials (up to 28 nights) attest to the effectiveness of benzodiazepines in the treatment of insomnia.(4) Thus, they shorten time to sleep onset, usually prolong sleep time, and reduce the number of arousals in the night.This demonstrates the mis-match between subjective and objective measures.In fact, patients given a benzodiazepine overestimate their sleep duration by an average of 72 minutes as compared with the EEG recordings.(12) The benzodiazepine was then abruptly withdrawn, and patients slept poorly but underestimated their duration of sleep by about an hour.The benzodiazepines are a large group of drugs which are widely used in psychiatry, neurology and other branches of medicine.They were first introduced over 30 years ago, and have been extensively prescribed to treat anxiety, insomnia, muscle spasm, and epilepsy.
Although these two sets of data correlate at a notoriously low level, the rating of "a good night's sleep" usually reflects infrequent nocturnal arousals.
In another study from this group the long-term treatment of chronic anxiety with the benzodiazepine clorazepate was compared with the effects of the non-benzodiazepine, buspirone.(7) After double-blind placebo substitution, the clorazepate-treated patients showed increased anxiety levels and some developed typical withdrawal syndromes: no such phenomena were seen in the buspirone-treated group.
In a more complex study,(8) 210 psychiatric outpatients (71 GAD; 74 PD; 65 dysthymic disorder) were treated with either diazepam, dothiepin (a tricyclic antidepressant), placebo, cognitive/behaviour therapy, or a self-help procedure.
This review will first list the benefits and risks of these drugs and then outline their uses. Acute stress reactions and anxiety symptoms as part of other psychiatric disorders or physical disorders are very commonly encountered.
Finally, such usage will be set into treatment algorithms for anxiety and insomnia which also incorporate other forms of treatment. The benzodiazepines seem to be useful and powerful anxiolytic agents and are generally accepted as such, at least in short-term usage.They have also been used as induction agents in anaesthetic practice.Generally regarded as safe and effective drugs, their safety profile is becoming increasingly questioned.(1,2)The benzodiazepines were originally marketed as improvements on the barbiturates but it became evident that they were much safer in overdose, had fewer drug interactions and probably a low propensity for both dependence in licit medical use and illicit abuse "on the street".If you subscribe to any of our print newsletters and have never activated your online account, please activate your account below for online access.