The Future of Anxiolytic Drug Therapy

Abstract

Benzodiazepines are generally considered safer than previously used sedatives and hypnotics (e.g. opiates and barbiturates). In the past decade, however, they have generated considerable controversy. Although much of the ongoing debate about benzodiazepines tends to centre on issues related to their dependency and abuse potential, problems also may occur with their therapeutic use.

Despite a lack of study evidence demonstrating that benzodiazepines have continuing therapeutic efficacy beyond 6 months for anxiety and 4 weeks for insomnia, an unknown number of patients have taken benzodiazepines for extended periods, in some cases for up to 25 years or more. Other than increased risk of withdrawal reactions, little is known about the effects of protracted benzodiazepine use on health and cognitive function. A number of investigators, however, have reported considerable ill health, both mental and physical, in long-term users.

Short-term therapeutic use of benzodiazepines is often considered relatively risk-free. Problems, however, also may occur with brief administration of some benzodiazepines, particularly alprazolam and triazolam.

Although no new class of drugs has emerged as a clear replacement of benzodiazepines, several compounds are under investigation. In the meantime, physicians must use benzodiazepines judiciously and become adept at selecting from a range of available pharmacologic and non-pharmacologic alternatives.