Although the title of April’s cover story (“Benzodiazepines: A versatile clinical tool,” Current Psychiatry, April 2012, p. 54-63; http://bit.ly/1zkanU3) seems to encourage the use of benzodiazepines, the authors state benzodiazepines are second-or third-line treatments for most conditions, particularly for chronic problems.
As an addiction medicine physician, I see well-intentioned doctors prescribing benzodiazepines to patients with chronic ailments. I would like to emphasize the addictive nature of benzodiazepines. “When used appropriately” is contradictory if benzodiazepines are used daily. Tolerance manifests as an exacerbation of the original symptoms, usually leading to a dosage increase. Every day, I see patients in a state of chronic withdrawal manifested in unpleasant ways because they took benzodiazepines “exactly as prescribed, 3 times per day for 4 years.”
Alprazolam is the bane of an addiction medicine practice because it crosses the blood-brain barrier immediately and is relatively short acting. This is a recipe for almost certain addiction, and there are better medications. I regularly transition patients from addictive substances, including benzodiazepines, and no matter what condition I am treating—panic attacks, obsessive-compulsive disorder, depression, generalized anxiety, social anxiety, posttraumatic stress disorder, or situational anxiety—I can almost always control the patient’s symptoms using non-addictive medications.
If benzodiazepines are used for almost anything other than a short-lived condition, we are doing a tremendous disservice to our patients and exhibiting the “just give them a pill and get to the next patient” mentality we are accused of.
Terrance Reeves, MD, ABAM
Medical Director
South Walton Medical Center
Miramar Beach, FL
The authors respond
We thank Dr. Reeves for his comments and reminders of the downside to routine and long-term prescribing of benzodiazepines. As an addiction specialist, he is well positioned to see patients who are struggling with syndromes related to benzodiazepine abuse. We stand by our review of the evidence-based studies of the appropriateness of judicious benzodiazepine use in various psychiatric syndromes. The section of our article labeled “Risks of benzodiazepine use” addresses Dr. Reeves’ concerns.
Jolene R. Bostwick, PharmD, BCPS, BCPP
Clinical Assistant Professor of Pharmacy
University of Michigan College of Pharmacy
Clinical Pharmacist
Michael I. Casher, MD
Clinical Assistant Professor
Department of Psychiatry
University of Michigan Medical School
Director of Inpatient Adult Psychiatry
Shinji Yasugi, MDFirst-Year Psychiatry ResidentUniversity of Michigan Health SystemAnn Arbor, MI