Benzodiazepines revisited--will we ever learn?

Area of Science:

• Psychiatry and Pharmacology
• Neuroscience
• Clinical Medicine

Background:

• Benzodiazepines (BZDs) have been widely prescribed for anxiety and insomnia for 50 years.
• Their efficacy is contrasted by concerns regarding adverse effects, dependence, and abuse.
• The availability of alternative medications has reignited debate on BZD use.

Purpose of the Study:

• To re-examine the multifaceted aspects of benzodiazepine (BZD) use.
• To focus on the adverse effects, dependence, and abuse potential associated with BZDs.
• To review the ongoing controversies and clinical challenges surrounding long-term BZD prescription.

Main Methods:

• A comprehensive literature search was conducted across Medline, Embase, and Cochrane Collaboration databases.
• Keywords included 'benzodiazepine(s)' combined with terms like 'dependence' and 'abuse'.
• Reference lists of key papers were hand-searched to supplement database findings.

Main Results:

• Benzodiazepines (BZDs) remain controversial due to polarized opinions on efficacy versus adverse effects.
• Cognitive and psychomotor impairments are noted adverse effects, alongside significant dependence and abuse issues.
• Despite guidelines, high BZD usage persists, with limitations in therapy choice, dosage, and duration.

Conclusions:

• Practical problems with benzodiazepines (BZDs) have persisted for 50 years, often overlooked by practitioners and official bodies.
• The short-term risk-benefit ratio of BZDs is generally positive, but long-term use carries unestablished risks, primarily due to potential for indefinite use and dependence.
• Further research is needed on long-term brain changes and the role of flumazenil in BZD withdrawal.