The diagnosis and management of benzodiazepine dependence

  title={The diagnosis and management of benzodiazepine dependence},
  author={Heather Ashton},
  journal={Current Opinion in Psychiatry},
  • H. Ashton
  • Published 1 May 2005
  • Medicine, Psychology
  • Current Opinion in Psychiatry
Purpose of review Despite repeated recommendations to limit benzodiazepines to short-term use (2–4 weeks), doctors worldwide are still prescribing them for months or years. This over-prescribing has resulted in large populations of long-term users who have become dependent on benzodiazepines and has also led to leakage of benzodiazepines into the illicit drug market. This review outlines the risks of long-term benzodiazepine use, gives guidelines on the management of benzodiazepine withdrawal… 

Benzodiazepine Withdrawal in the Elderly: A Practical Approach

In the elderly, benzodiazepine withdrawal under medical supervision coupled with psychotherapy has been shown to work and a flexible tapering schedule is suggested at a reduction rate that is acceptable for that individual.

Benzodiazepine dependence: focus on withdrawal syndrome.

Withdrawing Benzodiazepines in Primary Care

The clearest strategy was to taper the medication; abrupt cessation can only be justified if a very serious adverse effect supervenes during treatment, and no clear evidence suggests the optimum rate of tapering, and schedules vary from 4 weeks to several years.

The problems of long-term treatment with benzodiazepines and related substances.

Benzodiazepines are generally highly effective when first given, but they should generally be given only for strict indications and for a limited time, and if these drugs still need to be given beyond the short term, timely referral to a specialist is indicated and possibly also contact with the addiction aid system.

Withdrawing Benzodiazepines in Patients With Anxiety Disorders

It is concluded that little evidence exists outside the usual principles of drug withdrawal but there are some promising leads.

The long-term prescription of benzodiazepines, psychotropic agents, to the elderly at a university hospital in Japan.

The appropriate prescription of benzodiazepines in the elderly should be included in the educational programs at teaching hospitals, and rational prescribing needs to be monitored carefully.

Benzodiazepine dependence and its treatment with low dose flumazenil

Preliminary in vitro water bath and in vivo biocompatibility data in sheep show that such an implant is feasible and so is likely to be used in clinical trials in the near future, and could be capable of managing both acute and longer term benzodiazepine withdrawal sequelae.

Challenges of the pharmacological management of benzodiazepine withdrawal, dependence, and discontinuation

It is a challenge that requires further investigation through randomized clinical trials to maximize efficacy and to minimize additional risks and side effects, and the use of medications for the discontinuation of BZDs seems appropriate.

Use of benzodiazepines and z-drugs not compliant with guidelines and associated factors: a population-based study

Findings provide a solid basis for establishing a public health policy to reduce benzodiazepine use not compliant with guidelines and should be further explored in patients most at risk in the present study, e.g., patients treated by a psychiatrist.

Pharmacological interventions for benzodiazepine discontinuation in chronic benzodiazepine users.

A review of randomised controlled trials comparing pharmacological treatment versus placebo or no intervention or versus another pharmacological intervention in adults who had been treated with Benzodiazepines for at least two months and/or fulfilled criteria for benzodiazepine dependence to assess the benefits and harms of pharmacological interventions to facilitate discontinuation of chronic benzodiazine use.



Safety of benzodiazepines in the geriatric population

Significant adverse effects that may be associated with benzodiazepine use in the elderly include falls, cognitive impairment, sedation, and impairment of driving skills, all of which are particularly related to the long half-life of Benzodiazepines.

Benzodiazepine dependence. A review of the evidence.

The withdrawal syndrome is characterised by withdrawal symptoms on stopping treatment; these include perceptual disturbances, epileptic seizures, weight loss, insomnia and autonomic symptoms, and may be associated with altered sensitivity of benzodiazepine receptors.

Benzodiazepine self-administration in humans and laboratory animals – implications for problems of long-term use and abuse

A current review of various problems that have been identified with the long-term use and the recreational abuse of benzodiazepines, including memory impairment, risk of accidents, falls and hip fractures in the elderly, a withdrawal syndrome, brain damage, overuse inThe elderly, over use by chronic pain patients, overused by alcoholics and recreational abuse among alcoholic and polydrug abusers are provided.

Theory and practice in managing benzodiazepine dependence and misuse

Physical dependence on BZs appears to develop in a minority of users, with injectors possibly least likely to show withdrawal symptoms, and psychological approaches need not be highly specialized, and sometimes minimal interventions are successful.

Chronic benzodiazepine use in general practice patients with depression: an evaluation of controlled treatment and taper-off: report on behalf of the Dutch Chronic Benzodiazepine Working Group.

  • F. ZitmanJ. Couvée
  • Medicine, Psychology
    The British journal of psychiatry : the journal of mental science
  • 2001
Transfer to diazepam followed by gradual withdrawal is an effective way of discontinuing chronic benzodiazepine use and the addition of SSRI treatment is of limited value.

The role of captodiamine in the withdrawal from long-term benzodiazepine treatment

Captodiamine represents an interesting strategy for achieving benzodiazepine substitution with a low risk of dependence or impairment of cognitive function and may be an advantage for the overall safety of the anxiolytic treatment, for example with regard to road safety.

Benzodiazepine prescription practices and substance abuse in persons with severe mental illness.

Contrary to published guidelines, rates of benzodiazepine use are higher among Medicaid beneficiaries with severe mental illness and co-occurring SUD than among persons with severemental illness alone.


The results stress the need to take a more elaborate, person-centered view of dependence, and suggest six indicators of dependence.

Benzodiazepine Dependence

Benzodiazepine dependence is a frequent complication of regular prescriptions for 4 weeks or longer, occurring in almost one-third of patients, and is characterised by a withdrawal syndrome on stopping treatment.

Long-term benzodiazepine users in family practice: differences from short-term users in mental health, coping behaviour and psychological characteristics.

Having a DSM-IV disorder and psychiatric co-morbidity, being older, less educated, lonely and using more avoidance coping behaviour was associated with long- term use of benzodiazepines compared with short-term use.