The Love-Hate Relationship with Benzodiazepines

Benzodiazepines: a class of medications that evokes that a visceral reaction.

CONFERENCE REPORTER

“Benzodiazepines. Is there any class of medications probably other than opiates that evokes that same visceral reaction? I don't think so,” said Jeffrey R. Strawn, MD, in his session “The When, Why, and How of Using Benzodiazepines” at the 2021 NEI Congress.

Strawn playfully asked the audience, “How many of your viewers are like me you have that love hate relationship with the benzodiazepines?” About 90% of the in-person audience raised their hands.

Strawn began with discussing the varied advantages and disadvantages of benzodiazepines use. Advantages include rapid onset, reasonable tolerability, useful for breakthrough symptoms, and may be useful for acute and chronic anxiety. Disadvantages include initial sedation, memory impairment, falls, possible increased risk of fracture, and possibility of abuse dependence and withdrawal.

According to Strawn, recent research shows approximately 7.4% of patients seen in psychiatric care are receiving benzodiazepines.1 Unfortunately, 5.2 million adults misuse benzodiazepines. Of those, 0.5 million adults had benzodiazepines use disorder and 0.3 million had benzodiazepines dependence.2 Factors that increase risk for benzodiazepines misuse, use disorders, and harms include younger age, male gender, socioeconomically disadvantage, substance use disorders, and divorced or separated or never married.

Overall, Strawn said, “Benzodiazepines have a role in treating anxiety disorders, but they require monitoring and consideration of risks/benefits.”

Tolerance data are mixed, although benzodiazepines should be used carefully in patients with a history of substance use. They could be potentially beneficial when patients have breakthrough symptoms, when rapid onset is needed (panic attacks), or when the patient is experiencing acute expected anxiety (phobias). However, patients who are older, children, and those concurrently using opioids, have a history of substance use disorder, are at risk of falling, or operate heavy machinery should be carefully monitored, as they have a lower likelihood of benefit.

References

1. Agarwal SD, Landon BE. Patterns in outpatient benzodiazepine prescribing in the United States. JAMA Netw Open. 2019;2(1):e187399.

2. Blanco C, Han B, Jones CM, et al. Prevalence and correlates of benzodiazepine use, misuse, and use disorders among adults in the United States. J Clin Psychiatry. 2018;79(6):18m12174.