Phobic disorders, benzodiazepines

Anxiety states Benzodiazepines with intermediate or long durations of action are favored in the drug treatment of most anxiety states. Alprazolam and clonazepam have greater efficacy than other benzodiazepines in panic and phobic disorders. The anxiolytic effects of buspirone occur without sedation or cognitive impairment but take a week or more to develop. Buspirone is commonly used for generalized anxiety disorders in patients with a past history of substance abuse. 

An Australian study compared medical utilization and costs in patients with panic disorder, those with social anxiety disorder, and a control group (Rees et al, 1998). Almost half of the panic disorder patients had seen a primary-care physician more than seven times over a 6-month period, compared with 7% of the social phobic patients and none of the control group. The mean costs were A 150, A 60 and A 20 respectively. The patients with panic disorder were treated with antidepressants (39%), benzodiazepines (15%), relaxants (12%), beta-blockers (7%) and other medication (7%). Twenty per cent received no medication. Patients with panic... 

Therapeutic indications for benzodiazepines include anxiety states associated with neurotic, phobic, and depressive disorders, or myocardial infarction (decrease in cardiac stimulation due to anxiety) insomnia preanesthetic (preoperative) medication epileptic seizures and hypertonia of skeletal musculature (spasticity, rigidity). 

Guidance on the clinical indications for benzodiazepine therapy is available from various sources (Task Force Report of the American Psychiatric Association 1990 Ballenger et al. 1998a Bandelow et al. 2002). Long-term therapy is most likely to present problems with discontinuation and is usually reserved for cases that have proved resistant to treatment with antidepressants alone. Patients may benefit from a 2-4 week course of a benzodiazepine whilst antidepressant therapy is initiated, as this counteracts the increased anxiety caused by some drugs (Goddard et al. 2001). A benzodiazepine maybe useful as a hypnotic in some cases of anxiety disorder, and can be used by phobic patients on an occasional basis before exposure to a feared situation. 

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