Benzodiazepines revisited—will we ever learn?
Version of Record online: 17 OCT 2011
© 2011 The Author, Addiction © 2011 Society for the Study of Addiction
Volume 106, Issue 12, pages 2086–2109, December 2011
How to Cite
Lader, M. (2011), Benzodiazepines revisited—will we ever learn?. Addiction, 106: 2086–2109. doi: 10.1111/j.1360-0443.2011.03563.x
- Issue online: 3 NOV 2011
- Version of Record online: 17 OCT 2011
- Accepted manuscript online: 29 JUN 2011 10:13AM EST
- Submitted 7 June 2011; initial review completed 22 June 2011; final version accepted 22 June 2011
- Abuse liability;
- adverse effects;
- extent of use
Aims To re-examine various aspects of the benzodiazepines (BZDs), widely prescribed for 50 years, mainly to treat anxiety and insomnia. It is a descriptive review based on the Okey Lecture delivered at the Institute of Psychiatry, King's College London, in November 2010.
Methods A search of the literature was carried out in the Medline, Embase and Cochrane Collaboration databases, using the codeword ‘benzodiazepine(s)’, alone and in conjunction with various terms such as ‘dependence’, ‘abuse’, etc. Further hand-searches were made based on the reference lists of key papers. As 60 000 references were found, this review is not exhaustive. It concentrates on the adverse effects, dependence and abuse.
Results Almost from their introduction the BZDs have been controversial, with polarized opinions, advocates pointing out their efficacy, tolerability and patient acceptability, opponents deprecating their adverse effects, dependence and abuse liability. More recently, the advent of alternative and usually safer medications has opened up the debate. The review noted a series of adverse effects that continued to cause concern, such as cognitive and psychomotor impairment. In addition, dependence and abuse remain as serious problems. Despite warnings and guidelines, usage of these drugs remains at a high level. The limitations in their use both as choice of therapy and with respect to conservative dosage and duration of use are highlighted. The distinction between low-dose ‘iatrogenic’ dependence and high-dose abuse/misuse is emphasized.
Conclusions The practical problems with the benzodiazepines have persisted for 50 years, but have been ignored by many practitioners and almost all official bodies. The risk–benefit ratio of the benzodiazepines remains positive in most patients in the short term (2–4 weeks) but is unestablished beyond that time, due mainly to the difficulty in preventing short-term use from extending indefinitely with the risk of dependence. Other research issues include the possibility of long-term brain changes and evaluating the role of the benzodiazepine antagonist, flumazenil, in aiding withdrawal.