TECHNICAL TERMS MUST be strictly and consistently used in academic reports, as done in our recent report.1 Given the title of our paper, it was reasonable to exclude thienodiazepine-derivative drugs and report benzodipazepine-derivative anxiolytics alone. But this does not mean that we disagree with Dr Toda's proposal. We rather appreciate this opportunity to present additional data. Indeed, we surveyed the prescription rate of thienodiazepine-derivative anxiolytics. The mean rate was as low as 3.6%, and 63.4% of the total sample received benzodiazepine- or thienodiazepine-derivative anxiolytics without any statistical difference among age groups. Although the overall prescription rate of etizolam may still be high in Japan, it was not the case in the present sample: lorazepam, diazepam, and alprazolam comprised more than half of the total prescriptions. This difference may be due to the fact that prescription behaviours are likely to be subject to physician training as well as to direct and indirect influence of local standard of care.1–3

The statement ‘the massive use of anxiolytics is one of the characteristics of Japanese medicine’ by Dr Toda may give an incorrect impression. In fact, the prevalent use of benzodiazepines has also been reported outside Japan, and its frequent use without any rationale is apparently not a local issue.1,3,4 This is critically important especially for senior people, given the increased drug sensitivity in this population.5 Further investigations are warranted to pursue not only effective treatments for new patients, but also safe methods of discontinuing (at least tapering) those potentially toxic medications for already medicated patients,6 irrespective of country.


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