Benzodiazepines revisited.

zodiazepines’ and to develop some guidelines for the appropriate use of BZPs in clinical practice. The conclusion (too long to be cited in its entirety) contains a lot of interesting information. At that time, there were no data ‘to suggest that long-term therapeutic use of benzodiazepines by patients commonly leads to dose escalation or to recreational abuse’ [ 1 , p. 55] (in all fairness, this was before the introduction of short half-life BZPs). The text stated that, at those times, a certain small percentage of patients used therapeutic doses of BZPs for self-medication of symptoms. The conclusion also discussed the development of physiological dependence, discontinuance symptoms and the relationship of the timing and severity of these to the half-life of the drug and the side effects of BZPs. The authors concluded that automobile driving is neither predictably nor consistently impaired by repeated therapeutic BZP doses. The report also noted that BZPs do not strongly reinforce their own use and are not widely abused drugs and that when abuse does occur, it is almost always among individuals who are also actively abusing alcohol, opiates or other sedative hypnotics [ 1 , p. 58]. The Task Force, after much cautious discussion and deliberation, came out in favor of careful prescribing of BZPs. The experts suggested that the benefits of BZPs clearly outweigh their hazards ‘(1) in patients with demonstrable persistent anxiety or dysphoric disorder or anxiety as a component of medical illness that cannot be otherwise treated and (2) in patients with chronic panic Since the arrival of chlordiazepoxide in 1959 and diazepam in 1960, benzodiazepines (BZPs) have been hesitantly lauded and frequently enthusiastically vilified by many. Nevertheless, new BZPs have been synthesized and by now, there are almost forty of them available around the world. This number alone is certainly a testimony to their wide use, usefulness and efficacy. Their anxiolytic properties are unquestionable. BZPs have been used in numerous clinical conditions and diagnoses – from all anxiety disorders (as defined by whatever diagnostic system) to sleep disorders, alcohol withdrawal and the augmentation of antidepressants and antipsychotics as well as for mania, muscle relaxation, seizures and in many other approved and nonapproved indications. Interestingly, psychiatrists have been, at least in my experience, hesitant to use BZPs. This hesitancy has been reinforced by the emphasis on possible dependence, toxicity and abuse. Yet these issues have been overstated and overemphasized. In 1990, the American Psychiatric Association published a small monograph compiled by the American Psychiatric Association Task Force on Benzodiazepine Dependency, led by Carl Salzman [1] . The report focused specifically on the development of physiological dependence, especially at therapeutic doses, on acute and chronic toxicity and on the possible recreational use of BZPs as well as looking at the patterns of prescription and clinical use and on enabling psychiatrists to ‘weight the relative benefits versus the risk of using benReceived: June 7, 2013 Accepted: June 10, 2013 Published online: September 20, 2013