[Plea for benzodiazepines or is there a future for benzodiazepines in psychiatry?]

Thirty years ago chlordiazepoxide was used in psychiatry for the first time. Benzodiazepines, a therapeutic class with a large spectrum of activities, are now used regularly by 5 to 15% of adults. In France 15% of prescriptions include at least 1 benzodiazepine and 5 compounds of this class appear among the 30 most frequently prescribed of state reimbursed medications. In a developing country like Tunisia sales of psychotropic drugs increased by 84% between 1984 and 1987, benzodiazepines representing half of the prescriptions. Criticisms were voiced as early as in the years 1970. Ralph Nader himself led a campaign against those drugs used in suicidal attempts, provoking car accidents and industrial injuries, memory deficits and dependence. Later, several side effects were pin-pointed: amnesia, which has been used with criminal intent in a few dramatic cases; in fact it should be differentiated from the cognitive troubles resulting from anxiety itself; tolerance: for instance in drug addicts using high doses; it concerns only some effects of the drug; dependence: which remains rare when contrasted with the large consumption of benzodiazepines; withdrawal reaction should be differentiated from teh relapse of anxiety once the drug has been discontinued. In the public opinion one is supposed to bear any pain--and never complain--when it is psychic and not somatic. Benzodiazepines that alleviate psychic pain were considered with spite and then grudge, to use the terminology of erotomania. Actually, benzodiazepine treatment should be a part of a larger therapeutic program taking into account the characteristics of each individual patient.(ABSTRACT TRUNCATED AT 250 WORDS)