Module 4: Therapeutics
Benzodiazepines are indicated in the short-term or long-term treatment of Generalized Anxiety Disorder either during a crisis or during times of increased anxiety or concomitantly with an anti-depressant until the effects of an anti-depressant are optimized. A publication by the Canadian Agency for Drugs and Technologies in Health Short and Long-Term Use of Benzodiazepines in Patients with Generalized Anxiety Disorder: A Review of Guidelines provides an excellent overview.
Benzodiazepines have also been used in the short-term treatment of sleep disturbance, but recent clinical practice guideline recommendations from Quaseem, Kansagara, Forciea, Cookie, and Denberg (2016) state that there is insufficient evidence to support the efficacy of these agents for chronic insomnia.
Quaseem et al. (2016) concluded there was insufficient evidence to support long-term use of hypnotics for non-pharmacologic measure-resistant chronic insomnia when balancing the benefits and harms of medication use. Z-drug hypnotics may have short term benefits for the treatment of insomnia, but this effect must be balanced with consideration of adverse effects (Huedo-Medina, Kirsch, Middlemass, Klonizakis, & Siriwardena, 2012).
Caution should be taken with use of these agents in the elderly, children, adolescents, and pregnant or breastfeeding women.
- Eagles, L. (2008). Guidance for Prescribing and Withdrawal of Benzodiazepines & Hypnotics in General Practice. NHS Grampian. Retrieved from http://www.benzo.org.uk/amisc/bzgrampian.pdf
- Farinde, A. (2014). Benzodiazepine Equivalency Table. Retrieved from http://emedicine.medscape.com/article/2172250-overview
- Non-benzodiazepine hypnotics. (2007). Retrieved from http://www.benzo.org.uk/bzequiv.htm
- CADTH (2014). Short- and Long-Term Use of Benzodiazepines in Patients with Generalized Anxiety Disorder: A Review of Guidelines. Rapid Response Report: Summary with Critical Appraisal. Retrieved from: https://www.cadth.ca/short-and-long-term-use-benzodiazepines-patients-generalized-anxiety-disorder-review-guidelines
- Huedo-Medina, T. B., Kirsch, I., Middlemass, J., Klonizakis, M., & Siriwardena, A. N. (2012). Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. BMJ, 345, e8343. doi:https://doi.org/10.1136/bmj.e8343
- Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., & Denberg, T. (2016). Clinical Guidelines. Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Annals of Intern Medicine, 165(22), 125–133. doi:10.7326/M15-2175