[Current status of treatment with benzodiazepines]

Benzodiazepines are the psychotropics most frequently prescribed despite an impressive reduction in use in the last 10 years. Their main pharmacodynamic effects (anxiolytic, sedative, anticonvulsive, muscle-relaxing, amnestic) are the basis for various therapeutic applications and indications. The most important differences among the variety of benzodiazepines are pharmacokinetic ones (elimination half-life, formation of pharmacologically active metabolites). Established indications are anxiety and sleep disorders, seizures, epilepsy, premedication and sedation in emergency medicine. In recent years it has also been proven to be effective in the treatment of panic disorder and catatonia. Among the side effects seen most frequently are impairments of cognitive and psychomotor function as well as rebound phenomena. Discussions have recently focused on the incidence of abuse and dependence as well as case reports on severe amnesia. Alternative medications like neuroleptics in low dosage and antidepressants seem to be predominantly unfavorable due to the fact that they are tolerated less well and sometimes have severe side effects. A clear-cut indication and time-limited prescription can reduce the number of benzodiazepine long-term users, and a comprehensive treatment concept must be the basis of rational prescription of benzodiazepines. The positive benefit-risk ratio as well as research perspectives [identification of receptor subtypes, development of highly selective ligands and partial (inverse) agonists] are reasons for assuming that the era of the benzodiazepines has not come to an end.