Benzodiazepines in the treatment of anxiety

The efficacy of the benzodiazepines in the symptomatic treatment of nonpsychotic anxiety has been well established. Eight benzodiazepines are presently available in the U.S. as anxiolytics. Research conducted over many years has shown that such nonpsychotic anxious patients respond best to anxiolytics if they suffer from high levels of emotional and somatic symptoms of anxiety and from low levels of depression and interpersonal problems. Despite the widespread use of benzodiazepines, it has been difficult to demonstrate tolerance or physical dependence to these drugs when used in therapeutic doses. In addition, data clearly indicate a pattern of conservative benzodiazepine use and possible an under- rather than overuse. Thus, the argument is made that cost-benefit ratios should be considered when discussing the use of benzodiazepines for the treatment of anxiety.