Hostname: page-component-76fb5796d-25wd4 Total loading time: 0 Render date: 2024-04-26T04:08:04.146Z Has data issue: false hasContentIssue false

The Place of Benzodiazepines in Psychiatric Practice

Published online by Cambridge University Press:  02 January 2018

Peter Tyrer*
Affiliation:
Mapperley Hospital, Nottingham
Siobhan Murphy
Affiliation:
Mapperley Hospital, Nottingham
*
Mapperley Hospital, Nottingham NG3 6AA

Extract

For the past 20 years, benzodiazepines have been the most commonly prescribed psychotropic drugs. It is now difficult to imagine the excitement produced by this new class of compounds. Existing anti-anxiety drugs, mainly the barbiturates, were known to be dangerous in overdosage, tend to cause addiction, and have many side-effects. Previous compounds, including opium, alcohol, chloral, and bromides, were similarly burdened. The benzodiazepine era began almost 30 years ago, in style. “Four hours after being given chlordiazepoxide on New Year's day 1958, one of 12 chronically anxious but therapeutically recalcitrant patients previously studied by Tobin and N. D. C. Lewis telephoned that for the first time in many years he was totally free from symptoms” (Hordern, 1968). The early studies were all enthusiastic and confirmed the therapeutic potential of the drug (Tobin et al, 1960; Jenner et al, 1961). In the ‘tranquilliser decade’ of the 1970s, prescriptions of benzodiazepines increased at a rate that was perceived as alarming, ‘the relentless march of the psychotropic drug juggernaut’ (Trethowan, 1975). This concern was related more to the inappropriate use of these drugs for treating personal problems than to the demonstration of dangers with these compounds. The dangers, however, appeared to be remarkably few; the drugs were safe in overdose, had greater efficacy than the barbiturates (Lader et al, 1974), and had virtually no unwanted effects, apart from sedation when given in excessive dosage. It was therefore hardly surprising that they proved so popular with clinicians. As Priest (1980) commented when benzodiazepine prescription was at its peak: “it is a tremendous boon to the medical profession to have active weapons in the fight against misery that are not only effective but are relatively safe when abused by despairing and desperate patients”.

Type
Annotation
Copyright
Copyright © Royal College of Psychiatrists, 1987 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM-III). Washington, DC: APA.Google Scholar
Aranko, K., Mattila, M. J. & Seppala, T. (1983) Development of tolerance and cross-tolerance to the psychomotor actions of lorazepam and diazepam in man. British Journal of Clinical Pharmacology, 15, 545552.CrossRefGoogle Scholar
Aranko, K., Mattila, M. J., Seppala, T., Nuutila, A. & Pellinen, J. (1985) Benzodiazepines, but not antidepressants or neuroleptics, induce dose-dependent development of tolerance to lorazepam in psychiatric patients. Acta Psychiatrica Scandinavica, 72, 436446.CrossRefGoogle ScholarPubMed
Bick, P. A. & Hannah, A. L. (1986) Intramuscular lorazepam to restrain violent patients. the lancet, i, 206.CrossRefGoogle Scholar
Busto, U., Sellers, E., Naranjo, C. A., Cappell, H., Sanchez-craig, M. & Sykora, K. (1986) Withdrawal reaction after longterm therapeutic use of benzodiazepines. New England Journal of Medicine, 315, 854859.CrossRefGoogle ScholarPubMed
Catalan, J. & Gath, D. (1985) Benzodiazepines in general practice: time for a decision. British Medical Journal, 290, 13741376.CrossRefGoogle ScholarPubMed
Drugs and Therapeutics Bulletin (1978) Therepeutic differences between benzodiazepines. Drugs and Therapeutics Bulletin, 16, 4648.CrossRefGoogle Scholar
Drugs and Therapeutics Bulletin (1985) Lorazepam-a benzodiazepine to choose or avoid? Drugs and Therapeutics Bulletin, 23, 6162.CrossRefGoogle Scholar
Drugs and Therapeutics Bulletin (1987) Limited list: effects in general practice. Drugs and Therapeutics Bulletin, 25, 2124.CrossRefGoogle Scholar
Fontaine, R., Chouinard, S. & Annable, L. (1984) Rebound anxiety in anxious patients after abrupt withdrawal of benzodiazepine treatment. American Journal of Psychiatry, 141, 848852.Google ScholarPubMed
Griffiths, R. R., Mcleod, D. R., Bigelow, G. E., Liebson, I. A., Roache, J. D. & Nowowieski, P. (1984) Comparison of diazepam and oxazepam. Preference, liking and extent of abuse. Journal of Pharmacology and Experimental Therapeutics, 229, 501508.Google ScholarPubMed
Griffiths, R. R., Mcleod, D. R., Bigelow, G. E., Liebson, I. A., Roache, J. D., Nowowieski, P., Lamb, R. J., Ator, N. A., Roache, J. D. & Brady, J. V. (1985) Relative abuse liability of triazolam: experimental assessment in animals and humans. Neuroscience and Biobehavioural Reviews, 9, 133151.CrossRefGoogle Scholar
Hanna, S. M. (1972) A case of oxazepam (Serenid-D) dependence. British Journal of Psychiatry, 120, 443445.CrossRefGoogle Scholar
Higgitt, A., Lader, M. & Fonagy, P. (1985) Clinical management of benzodiazepine dependence. British Medical Journal, 291, 688690.CrossRefGoogle ScholarPubMed
Hollister, L. E. Motzenbecker, F. P. & Degan, R. O. (1961) Withdrawal reaction from chlordiazepoxide (Librium). Psycho-pharmacologia, 2, 6368.CrossRefGoogle ScholarPubMed
Hordern, A. (1968) Psychopharmacology: some historical considerations. In Psychopharmacology: Dimensions and Perspectives (ed. C. R. B. Joyce), p. 121. London: Tavistock.Google Scholar
Jenner, F. A., Kerry, R. J. & Parkin, D. (1961) A controlled trial of methaminodiazepoxide (chlordiazepoxide, ‘Librium’) in the treatment of anxiety in neurotic patients. Journal of Mental Science, 107, 575582.CrossRefGoogle ScholarPubMed
Jobung, M. & Stein, G. (1986) Lorazepam in resistant mania. The Lancet, i, 510.Google Scholar
Johnstone, E. C., Cunningham Owens, D. G., Frith, C. D., Mcpherson, K., Dowie, C., Riley, G. & Gold, A. (1980) Neurotic illness and its response to anxiolytic and antidepressant treatment. Psychological Medicine, 10, 321328.CrossRefGoogle ScholarPubMed
Kaim, S. C., Klett, C. J. & Rothfeld, B. (1969) Treatment of the acute alcohol withdrawal state: a comparison of four drugs. American Journal of Psychiatry, 125, 16401646.CrossRefGoogle Scholar
Kahn, R. J., Mcnair, D. M., Lipman, R. S., Covi, L., Rickels, K., Downing, R., Fisher, S. & Frankenthaler, L. M. (1986) Imipramine and chlordiazepoxide in depressive and anxiety disorders: 2. Efficacy in anxious outpatients. Archives of General Psychiatry, 43, 7985.CrossRefGoogle Scholar
Kales, A., Scharf, M. B. & Kales, J. D. (1978) Rebound insomnia: a new clinical syndrome. Science, 201, 10391041.CrossRefGoogle ScholarPubMed
Kales, A., Scharf, M. B., Kales, J. D., Soldatos, C. R., Bixler, E. O. & Kales, J. D. (1983a) Rebound insomnia and rebound anxiety: a review. Pharmacology, 26, 121137.CrossRefGoogle ScholarPubMed
Kales, A., Scharf, M. B., Kales, J. D., Soldatos, C. R., Bixler, E. O. & Kales, J. D. (1983b) Early morning insomnia with rapidly eliminated benzodiazepines. Science, 220, 9597.CrossRefGoogle ScholarPubMed
Klein, D. F. (1964) Delineation of two-drug-responsive anxiety syndromes. Psychopharmacology, 5, 397408.CrossRefGoogle ScholarPubMed
Lader, M. H., Bond, A. J. & James, D. C. (1974) Clinical comparison of anxiolytic drug therapy. Psychological Medicine, 44, 381387.CrossRefGoogle Scholar
Lader, M. H., Bond, A. J., James, D. C., & Petursson, H. (1983) Long-term effects of benzodiazepines. Neuropharmacology, 22, 527533.CrossRefGoogle ScholarPubMed
Marinker, M. (1973) The doctor's role in prescribing. Journal of the Royal College of General Practitioners, 23, (suppl. 2), 2630.Google ScholarPubMed
Marks, J. (1978) The Benzodiazepines: Use, Overuse, Misuse, Abuse. Lancaster: MTP Press.CrossRefGoogle Scholar
Mcnair, D. M. & Kahn, R. J. (1981) Imipramine compared with a benzodiazepine for agoraphobia. In Anxiety: New Research in Changing Concepts (eds D. F. Klein & J. C. Rabkin), pp. 69 80. New York: Raven Press.Google Scholar
Mellinger, G. D., Balter, M. B., Manheimer, D. I., Cisin, I. H. & Parry, H. J. (1978) Psychic distress, life crisis and the use of psychotherapeutic medications. Archives of General Psychiatry, 35, 10451052.CrossRefGoogle ScholarPubMed
Murphy, S. M., Owen, R. T. & Tyrer, P. (1984) Withdrawal symptoms after six weeks treatment with diazepam. The Lancet, ii, 1389.CrossRefGoogle Scholar
Oswald, I. (1986) Drugs for poor sleepers? British Medical Journal, 292, 715.CrossRefGoogle ScholarPubMed
Owen, R. T. & Tyrer, P. (1983) Benzodiazepine dependence: a review of the evidence. Drugs, 25, 385398.CrossRefGoogle ScholarPubMed
Petursson, H. & Lader, M. H. (1981) Withdrawal from longterm benzodiazepine treatment. British Medical Journal, 283, 643645.CrossRefGoogle ScholarPubMed
Pevnick, J. S., Jasinski, D. R. & Haertzen, C. A. (1978) Abrupt withdrawal from therapeutically administered diazepam. Archives of General Psychiatry, 35, 995998.CrossRefGoogle ScholarPubMed
Power, K. G., Jerrom, D. W. A., Simpson, R. J. & Mitchell, M. (1985) Controlled study of withdrawal symptoms and rebound anxiety after six week course of diazepam for generalised anxiety. British Medical Journal, 290, 12461248.CrossRefGoogle ScholarPubMed
Priest, R. G. (1980) The Benzodiazepines: Today and Tomorrow, p. 3. Lancaster: MTP Press.Google Scholar
Roberts, K. & Vass, N. (1986) Schneiderian first-rank symptoms caused by benzodiazepine withdrawal. British Journal of Psychiatry, 148, 593594.CrossRefGoogle ScholarPubMed
Sanchez-Craig, N., Kay, G., Busto, U. & Cappell, H. (1986) Cognitive-behavioural treatment for benzodiazepine dependence. The Lancet, i, 388.CrossRefGoogle Scholar
Snaith, R. P. (1984) Benzodiazepines on trial. British Medical Journal, 288, 1379.CrossRefGoogle Scholar
Stephenson, F. A. (1987) Benzodiazepines in the brain. Trends in Neurosciences, 10, 185186.CrossRefGoogle Scholar
Thorley, A. P. (1982) Alcohol. In Drugs in Psychiatric Practice (ed. P. J. Tyrer), p. 361. London: Butterworths.Google Scholar
Tobin, J. M., Bird, I. F. & Boyle, D. E. (1960) Preliminary evaluation of Librium (Ro5–0690) in the treatment of anxiety reactions. Diseases of the Nervous System, 21, (suppl.), 1119.Google Scholar
Trethowan, W. (1975) Pills for personal problems. British Medical Journal, 3, 749751.CrossRefGoogle ScholarPubMed
Tyrer, P. (1974) The benzodiazepine bonanza. The Lancet, ii, 709710.CrossRefGoogle Scholar
Tyrer, P. (1980) Dependence on benzodiazepines. British Journal of Psychiatry, 137, 576577.CrossRefGoogle ScholarPubMed
Tyrer, P. (1982) Anti-anxiety drugs. In Drugs in Psychiatric Practice (ed. P. J. Tyrer). London: Butterworth.Google Scholar
Tyrer, P. (1983) The place of tranquillisers in the management of stress. Journal of Psychosomatic Research, 27, 385390.CrossRefGoogle ScholarPubMed
Tyrer, P. (1985) Clinical management of benzodiazepine dependence. British Medical Journal, 291, 1507.CrossRefGoogle ScholarPubMed
Tyrer, P. (1986) How to Stop Taking Tranquillisers. London: Sheldon Press.Google Scholar
Tyrer, P., Rutherford, D. & Huggett, T. (1981) Benzodiazepine withdrawal symptoms and propranolol. The Lancet, i, 520522.CrossRefGoogle Scholar
Tyrer, P., Rutherford, D., Huggett, T., Owen, R. & Dawling, S. (1983) Gradual withdrawal of diazepam after long-term therapy. The Lancet, i, 14021406.CrossRefGoogle Scholar
Tyrer, P., Rutherford, D., Huggett, T., Owen, R., Dawling, S., Murphy, S., Oates, G. & Kingdon, D. (1985) Psychological treatment for benzodiazepine dependence. The Lancet, i, 10421043.CrossRefGoogle Scholar
Winokur, A., Rickels, K., Greenblatt, D. J., Snyder, P. J. & Schatz, N. J. (1980) Withdrawal reaction from long-term low dosage administration of diazepam. Archives of General Psychiatry, 37, 101105.CrossRefGoogle ScholarPubMed
World Health Organization (1978) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases (ICD-9). Geneva: WHO.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.