Use of benzodiazepines in psychiatry

Benzodiazepines are generally well tolerated (compared to barbiturates or antidepressants, their side-effects are milder). They may be used safely, their toxicity is low. Benzodiazepine overdosage may be lethal only if the drug is taken simultaneously with other drugs or alcohol. They act primarily through inhibiting the GABA system, their anxiolytic and sedative effects are of primary importance from the psychiatric aspect. Their classification is based on the difference in their receptor affinity (potency) and kinetics. Derivatives of low, medium and high potency are known. The introduction of high potency benzodiazepines in psychiatry has increased the therapeutic means. The major field of indication of benzodiazepine therapy is DSM-III anxiety disorders and insomnias but they may be successfully used in the treatment of manic conditions, schizophrenia, delirium tremens, clinical conditions accompanied by anxiety-depression, acute restlessness, neuroleptic-induced acute distonias, and akathisias. Even if therapeutic doses are used, tolerance to benzodiazepines may develop after some weeks of therapy. The general withdrawal symptoms are not severe, but the rebound symptoms often hinder the discontinuance of the drug or the reduction of doses. When prescribing benzodiazepines the risk of long-term therapy and the prevention of the development of drug addiction have to be considered.