Withdrawing Benzodiazepines in Patients With Anxiety Disorders
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The large class of CNS-depressant medications—the benzodiazepines—have been extensively used for over 50 years, anxiety disorders being one of the main indications. A substantial proportion (perhaps up to 20–30 %) of long-term users becomes physically dependent on them. Problems with their use became manifest, and dependence, withdrawal difficulties and abuse were documented by the 1980s. Many such users experience physical and psychological withdrawal symptoms on attempted cessation and may develop clinically troublesome syndromes even during slow tapering. Few studies have been conducted to establish the optimal withdrawal schedules. The usual management comprises slow withdrawal over weeks or months together with psychotherapy of various modalities. Pharmacological aids include antidepressants such as the SSRIs especially if depressive symptoms supervene. Other pharmacological agents such as the benzodiazepine antagonist, flumazenil, and the hormonal agent, melatonin, remain largely experimental. The purpose of this review is to analyse the evidence for the efficacy of the usual withdrawal regimes and the newer agents. It is concluded that little evidence exists outside the usual principles of drug withdrawal but there are some promising leads.
KeywordsBenzodiazepines Dependence Withdrawal Clinical risks Abuse Flumazenil Circadin
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Conflict of Interest
Malcolm Lader and Andri Kyriacou declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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