Letters to the Editor

What Role Do Benzodiazepines Have in Treating Patients with Anxiety?

 

Am Fam Physician. 2019 Nov 1;100(9):520.

To the Editor: As a psychiatrist embedded within a family practice setting, I have found that many of my primary care colleagues view benzodiazepines as a medication to be avoided completely or used only as a last resort. However, when used properly, benzodiazepines are an essential tool that can mitigate pain and suffering in patients who present with anxiety symptoms.

Benzodiazepines present risks of addiction and overdose, particularly among patients who concurrently use opioids.1 Since 1996, overdose deaths involving benzodiazepines have increased fivefold, and the proportion of adults receiving and filling benzodiazepine prescriptions has also considerably increased.2

The underuse of benzodiazepines in patients who have untreated anxiety also has risks. I recall treating a patient in his mid-40s who struggled with severe periods of anxiety as part of his depression. The anxiety-fueled periods of physical and emotional distress included bouts of angina, diarrhea, and insomnia. He had been prescribed various antidepressants; they were not fully effective, and some produced intolerable adverse effects, including more anxiety. By adding a low-dose benzodiazepine along with an antidepressant to his treatment, my patient reached full stability. The benzodiazepine was then tapered but available for periods of exacerbation, which prevented him from relapsing into depression.

This example illustrates the complexity of managing anxiety as a chief symptom. Benzodiazepines have been found to be the fastest and most effective approach to controlling anxiety symptoms.3,4 In my experience, prescribing benzodiazepines requires low dosages that do not escalate (e.g., 1 mg or less per day, or 10 mg for diazepam [Valium]). If a patient requires escalating doses, this indicates that other problems need to be assessed, such as addictive behavior, iatrogenic causes, caffeine intake, or other undiagnosed medical problems. After anxiety symptoms are controlled, patients can be more successfully transitioned to alternative therapies.

Physicians always need to balance the risks associated with our tools of healing against the benefits. When used together with the right balance of other interventions (e.g., psychotherapy), benzodiazepines remain an essential treatment for patients with anxiety.

Author disclosure: No relevant financial affiliations.

References

show all references

1. Sun EC, Dixit A, Humphreys K. Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis. BMJ. 2017;356:j760....

2. Bachhuber MA, Hennessy S, Cunningham CO. Increasing benzodiazepine prescriptions and overdose mortality in the United States, 1996–2013. Am J Public Health. 2016;106(4):686–688.

3. Locke AB, Kirst N, Shultz CG. Diagnosis and management of generalized anxiety disorder and panic disorder in adults. Am Fam Physician. 2015;91(9):617–624. Accessed October 4, 2019. https://www.aafp.org/afp/2015/0501/p617.html

4. Balon R. Benzodiazepines for anxious depression. Curr Psychiatry. 2018;17(8):9–12.

Send letters to afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. Include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.

 

 

Copyright © 2019 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article