The diagnosis and management of benzodiazepine dependence

@article{Ashton2005TheDA,
  title={The diagnosis and management of benzodiazepine dependence},
  author={Heather Ashton},
  journal={Current Opinion in Psychiatry},
  year={2005},
  volume={18},
  pages={249–255}
}
  • 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… 
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341 Citations
Highly Influential Citations
21
Background Citations
137
Methods Citations
17
Results Citations
3

341 Citations

Benzodiazepine Withdrawal in the Elderly: A Practical Approach
TLDR
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
TLDR
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.
TLDR
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
TLDR
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.
TLDR
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
TLDR
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
TLDR
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
TLDR
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.
Benzodiazepine Misuse and Addiction. Risk Factors and Adverse Behavioral Aspects
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References

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