Fast Five Quiz: Benzodiazepines

Mary L. Windle, PharmD

Disclosures

February 02, 2021

Benzodiazepines are often used with antidepressants as adjunct treatment. They are especially useful in the management of acute situational anxiety disorder and adjustment disorder where the duration of pharmacotherapy is anticipated to be 6 weeks or less and for the rapid control of panic attacks. Benzodiazepine use has not proved to be effective in the treatment of PTSD or OCD.

If long-term use of benzodiazepines seems necessary, obtaining a confirmatory opinion from a second clinician may be helpful because chronic benzodiazepine use may be associated with tolerance, withdrawal, and treatment-emergent anxiety. The risk of addiction with benzodiazepines should be carefully considered before use in anxiety disorders. Benzodiazepine use should be avoided in patients with a prior history of alcohol or other drug abuse. Evidence of unauthorized dose escalation or obtaining benzodiazepine prescriptions from multiple sources should be closely monitored.

Benzodiazepines act quickly but carry the liability of physiologic and psychologic dependence. They can be used as an initial adjunct while SSRIs are titrated to an effective dose, and they can then be tapered over 4-12 weeks while the SSRI is continued. This approach can improve short-term tolerability, although it may increase the risk of sedation and requires warnings not to operate motor vehicles after taking benzodiazepines or if feeling sedated. If possible, long-term prescription of benzodiazepines for chronic anxiety disorders should be avoided.

Alprazolam has been widely used for panic disorder, but it is currently discouraged because of its higher dependence potential. Clonazepam has become a favored replacement because it has a longer half-life and empirically elicits fewer withdrawal symptoms upon discontinuation.

Read more about the treatment of anxiety disorders.

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