Benzodiazepine use is useful

Benzodiazepines are the medications used to treat many of the frequent symptoms seen in medical practice and especially in psychiatry, including anxiety, depression, insomnia, epilepsy and other psychophysiological disorders. Benzodiazepines derive their name from their molecular structure. These molecules share a common effect on receptors that have been denominated benzodiazepine receptors, which modulate GABA activity. During 1980s, there was a decrease in benzodiazepine use because of their dependence and abuse potential. However, recent studies suggest that benzodiazepines are not drugs of abuse for all patients. Patients, who have a preexisting history of substance abuse or co-morbid personality disorders, are prone to addiction. Benzodiazepines are divided into three groups according to the duration of action: 1) short-acting (triazolam, midazolam); 2) intermediate-acting (alprazolam, lorazepam); 3) long-acting (diazepam, clorazepate, clonazepam). They have a rapid anxiolytic sedative effect and are most commonly prescribed for immediate treatment of insomnia, acute anxiety and agitation or anxiety associated with any psychiatric disorder. Alprazolam and clonazepam, both high potency benzodiazepines, are commonly used medications for panic disorder. However, the selective serotonin reuptake inhibitors are also used for treatment of panic disorder. Benzodiazepines have the advantage of rapid effect and of not causing significant sexual dysfunction and weight gain. Clonazepam has been suggested to be effective treatment for social phobia. In addition, several other benzodiazepines (e.g., diazepam) have been prescribed as adjunctive medications for treatment of social phobia. Clonazepam and lorazepam are useful in the management of manic episodes and as an adjuvant to maintenance therapy in lieu of antipsychotics. Additionally, benzodiazepines are prescribed to provide sedation when changing antipsychotic medications. In this presentation, the pharmacological properties, psychiatric use and side effects of the benzodiazepines will be reviewed based on the existing controlled studies and general principles. Additionally, minimizing the risk of withdrawal syndrome will be emphasized.