[Consumption of benzodiazepines: good and bad uses]

In both general practice and psychiatry, the indication for benzodiazepines recognized by the French Technical Commissions--"all forms of anxiety"--remains very broad, and absolute contraindications are limited to severe respiratory insufficiency and, for certain drugs, myasthenia. Responsibility for deciding at what moment it becomes necessary to prescribe benzodiazepines therapy lies with the individual doctor--he is sole judge in his relationship with the patient: reactional anxiety, anxiety or distress accompanying somatic disease, insomnia. Benzodiazepines should not be prescribed to children, unless there are exceptional reasons for doing so. In psychiatry, higher doses are authorized for neurotic or psychotic anxiety, which are considered to be more serious forms. It is more or less accepted practice to prescribe benzodiazepines in combination therapy of various kinds with other psychotropic drugs. There are certain indications for which benzodiazepines in monotherapy are wrongly used, such as depressive states, and others where their use is contested, schizophrenic states, for example. Pharmacokinetic data are now beginning to provide a guide to dosage scheduling and to the choice of drug for the different indications. Maximum duration of benzodiazepine therapy should not exceed 4 months in certain cases. Risk of withdrawal syndrome appears to be slight for usual therapeutic doses. Finally, benzodiazepines are not the first choice of the drug addicts.