14 Benzodiazepine Medical Use: Anxiety
Table of Contents
14.8 Benzodiazepines for Anxiety by Specific Benzodiazepines. 5
14.9 Benzodiazepine Selection. 12
14.10 Benzodiazepines for Anxiety by Anxiety Type. 13
14.12 Comparative Outcomes: Other Medications. 19
14.13 Comparative Outcomes: Non-Pharmacologic. 20
14.14 Combination Outcomes: With Other Medications. 21
14.15 Combination Outcomes: Non-Pharmacologic + Benzodiazepines. 21
14.16 Benzodiazepines for Anxiety By Subpopulation. 22
Note:
Literature is hard to come by: Many articles old and do not have abstracts.
Not all anxiety disorders are included
PTSD, OCD is included due to prominent anxiety features, though technically classified separately
See also:
Benzodiazepine
Benzodiazepine Adverse Effects
Benzodiazepine Adverse Executive Functions
Benzodiazepine Adverse Aggression, Homicide, Suicide
14.1 Reviews |
Expert Opinion
Allen MH, Currier GW, Carpenter D, et al. The expert consensus guideline series. Treatment of behavioral emergencies 2005. J Psychiatr Pract. 2005;11 Suppl 1:5-108; quiz 110-2. Abstract
Ashton H. Guidelines for the rational use of benzodiazepines. When and what to use. Drugs.1994;48(1):25-40. Abstract
Barthelmé B, Poirot Y. Anxiety level and addiction to first-time prescriptions of anxiolytics: a psychometric study. Presse Med. 2008;37(11):1555-60. Abstract
Davidson JR. Pharmacotherapy of social anxiety disorder: what does the evidence tell us? J Clin Psychiatry. 2006;67 Suppl 12:20-6. Abstract
Hirshbein L. Looking back to the future of psychopharmacology. J Nerv Ment Dis. 2012;200(12):1109-12. Abstract
Locke AB, Kirst N, Shultz CG. Diagnosis and management of generalized anxiety disorder and panic disorder in adults. Am Fam Physician. 2015;91(9):617-24. Article
Pull CB, Damsa C. Pharmacotherapy of panic disorder. Neuropsychiatr Dis Treat. 2008;4(4):779-95. Article
Sheikh JI. Anxiety disorders and their treatment. Clin Geriatr Med. 1992;8(2):411-26. Abstract
Starcevic V. The reappraisal of benzodiazepines in the treatment of anxiety and related disorders. Expert Rev Neurother. 2014;14(11):1275-86. Abstract
Uhlenhuth EH, Balter MB, Ban TA, Yang K. International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: IV. Therapeutic dose dependence and abuse liability of benzodiazepines in the long-term treatment of anxiety disorders. J Clin Psychopharmacol. 1999;19(6 Suppl 2):23S-29S. Abstract
Sutherland SM, Davidson JR. Pharmacotherapy for post-traumatic stress disorder. Psychiatr Clin North Am. 1994;17(2):409-23. Abstract
Guidelines
Baldwin DS, Anderson IM, Nutt DJ, et al; British Association for Psychopharmacology. Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2005;19(6):567-596. Article
National Guideline Alliance 2013 Social Anxiety Disorder: Recognition, Assessment and Treatment
National Institute for Health and Clinical Excellence: Guidance. Generalized anxiety disorder and panic disorder (with or without agoraphobia) in adults: management in primary, secondary and community care. January 2011. Document
Nelson J, Chouinard G. Guidelines for the clinical use of benzodiazepines: pharmacokinetics, dependency, rebound and withdrawal. Canadian Society for Clinical Pharmacology. Can J Clin Pharmacol. 1999;6(2):69-83. Abstract
Pennsylvania 2016 Safe Prescribing of Benzodiazepines for Acute Anxiety and Insomnia
Meta – Analyses
Guina J, Rossetter SR, DeRHODES BJ, et al. Benzodiazepines for PTSD: a systematic review and meta-analysis. J Psychiatr Pract. 2015;21(4):281-303. Abstract
Reviews
Baldwin DS, Aitchison K, Bateson A, et al. Benzodiazepines: risks and benefits. a reconsideration. J Psychopharmacol. 2013;27(11):967-71. Abstract
Fava GA, Balon R, Rickels K. Benzodiazepines in anxiety disorders. JAMA Psychiatry. 2015;72(7):733-4. Link
Kaplan M, DuPont RL. Benzodiazepines and anxiety disorders: a review for the practicing physician. Curr Med Res Opin. 2005;21(6):941-50. Link
Perna G, Alciati A, Riva A, et al. Long-term pharmacological treatments of anxiety disorders: an updated systematic review. Curr Psychiatry Rep. 2016;18(3):23. Abstract
14.2 History |
Hirshbein L. Looking back to the future of psychopharmacology. J Nerv Ment Dis. 2012;200(12):1109-12. Abstract
14.3 Animal Studies |
Bouton ME, Kenney FA, Rosengard C. State-dependent fear extinction with two benzodiazepine tranquilizers. Behav Neurosci. 1990;104(1):44-55. Abstract
14.4 Ethics |
Abramson J. Overdosed America: the Broken Promise of American Medicine. Book Link
Angell M. The Truth About the Drug Companies: How they Deceive Us and what to do About It. Book Link
Bursztajn, HJ, Brodsky A. Ethical and legal dimensions of benzodiazepine prescription: a commentary. Psych Annals. 1998;28(3):121-8. Abstract
Goldacre B. Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients. Book Link
Gotzsche P. Deadly Medicines and Organized Crime: How big Pharma has Corrupted Healthcare. Book Link
Gotzsche P. Deadly Psychiatry and Organized Denial. Book Link
Healy D. Pharmageddon. Book Link
Lembke A. Drug Dealer, MD. Book Link
Olson G. Confessions of an Rx Drug Pusher. Book Link
Whitaker R. Anatomy of an Illness: Magic Bullets, Psychiatric Drugs, and the Astonishing pics of Mental Illness in America. Book Link
Whitaker R. Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Book Link
Whitaker R. Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform. Book Link
14.5 Epidemiology of Use |
Cascade E, Kalali AH. Use of benzodiazepines in the treatment of anxiety. Psychiatry (Edgmont). 2008;5(9):21-2. Article
Ernst CL, Bird SA, Goldberg JF, Ghaemi SN. The prescription of psychotropic medications for patients discharged from a psychiatric emergency service. J Clin Psychiatry. 2006;67(5):720-6. Abstract
Mark TL. For what diagnoses are psychotropic medications being prescribed?: a nationally representative survey of physicians. CNS Drugs. 2010;24(4):319-26. Abstrat
Mojtabai R, Olfson M. National trends in psychotropic medication polypharmacy in office-based psychiatry. Arch Gen Psychiatry. 2010;67(1):26-36. Abstract
Pincus HA, Tanielian TL, Marcus SC, et al. Prescribing trends in psychotropic medications: primary care, psychiatry, and other medical specialties. JAMA. 1998;279(7):526-31. Abstract
Stahl SM. Don’t ask, don’t tell, but benzodiazepines are still the leading treatments for anxiety disorder. J Clin Psychiatry. 2002;63(9):756-7. Article
Van Hulten R, Heerdink ER, Bakker A, Leufkens HG. Benzodiazepine pathways in the chronically ill. Pharmacoepidemiol Drug Saf. 1999;8(5):325-30. Abstract
Veronese A, Garatti M, Cipriani A, Barbui C. Benzodiazepine use in the real world of psychiatric practice: low-dose, long-term drug taking and low rates of treatment discontinuation. Eur J Clin Pharmacol. 2007;63(9):867-73. Abstract
Westra HA, Stewart SH. As-needed use of benzodiazepines in managing clinical anxiety: incidence and implications. Curr Pharm Des. 2002;8(1):59-74. Abstract
Zandstra SM, Van Rijswijk E, Rijnders CA, et al. Long-term benzodiazepine users in family practice: differences from short-term users in mental health, coping behavior and psychological characteristics. Fam Pract. 2004;21(3):266-9. Abstract
Zandstra SM, Furer JW, van de Lisdonk EH, et al. Different study criteria affect the prevalence of benzodiazepine use. Soc Psychiatry Psychiatr Epidemiol. 2002;37(3):139-44. Abstract
14.6 Economics of Use |
US
Lavin RA, Tao XG, Yuspeh L, Bernacki EJ. Impact of the combined use of benzodiazepines and opioids on workers’ compensation claim cost. J Occup Environ Med. 2014;56(9):973-8. Abstract
14.7 Overall Outcomes |
General Health
Zandstra SM, Furer JW, van de Lisdonk EH, et al. Differences in health status between long-term and short-term benzodiazepine users. Br J Gen Pract. 2002;52(483):805-8. Article
Mental Health
Pélissolo A, Maniere F, Boutges B, et al. Anxiety and depressive disorders in 4,425 long term benzodiazepine users in general practice. Encephale. 2007;33(1):32-8. Abstract
Quality of Life
van Hulten R, Teeuw B, Bakker A, Leufkens HG. Initial benzodiazepine use and improved health-related quality of life. Pharm World Sci. 2005;27(1):41-6. Abstract
van Hulten R, Teeuw KB, Bakker AB, et al. Characteristics of current benzodiazepine users as indicators of differences in physical and mental health. Pharm World Sci. 2000;22(3):96-101. Abstract
14.8 Benzodiazepines for Anxiety by Specific Benzodiazepines |
Alprazolam
Niravam Xanax Xanax XR
Prescribing Information: Xanax
Approved on 4 week study
Ballenger JC, Burrows GD, DuPont RL, et al. Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. I. Efficacy in short-term treatment. Arch Gen Psychiatry. 1988;45(5):413-22. Abstract
Başoğlu M, Marks IM, Swinson RP, et al. Pre-treatment predictors of treatment outcome in panic disorder and agoraphobia treated with alprazolam and exposure. J Affect Disord. 1994;30(2):123-32. Abstract
Başoğlu M, Marks IM, Kiliç C, et al. Alprazolam and exposure for panic disorder with agoraphobia. Attribution of improvement to medication predicts subsequent relapse. Br J Psychiatry. 1994;164(5):652-9. Abstract
Başoğlu M, Marks IM, Kiliç C, et al. Relationship of panic, anticipatory anxiety, agoraphobia and global improvement in panic disorder with agoraphobia treated with alprazolam and exposure. Br J Psychiatry. 1994;164(5):647-52. Abstract
Casacalenda N, Boulenger JP. Pharmacologic treatments effective in both generalized anxiety disorder and major depressive disorder: clinical and theoretical implications. Can J Psychiatry. 1998;43(7):722-30. Abstract
Chouinard G, Annable L, Fontaine R, Solyom L. Alprazolam in the treatment of generalized anxiety and panic disorders: a double-blind placebo-controlled study. Psychopharmacology (Berl). 1982;77(3):229-33. Abstract
Cohn JB, Wilcox CS. Low-sedation potential of buspirone compared with alprazolam and lorazepam in the treatment of anxious patients: a double-blind study. J Clin Psychiatry. 1986;47(8):409-12. Abstract
Cohn JB, Wilcox CS. Long-term comparison of alprazolam, lorazepam and placebo in patients with an anxiety disorder. Pharmacotherapy. 1984;4(2):93-8. Abstract
Dawson GW, Jue SG, Brogden RN. Alprazolam: a review of its pharmacodynamic properties and efficacy in the treatment of anxiety and depression. Drugs. 1984;27(2):132-47. Abstract
De La Gándara Martín JJ, Sanz Granado O, et al. Clinical use of sustained release of alprazolam: A naturalistic study. Actas Esp Psiquiatr. 1999;27(3):191-7. Abstract
Evans RL. Alprazolam (Xanax, the Upjohn Company). Drug Intell Clin Pharm. 1981;15(9):633-8. Abstract
Fawcett JA, Kravitz HM. Alprazolam: pharmacokinetics, clinical efficacy, and mechanism of action. Pharmacotherapy. 1982;2(5):243-54. Abstract
Glue P, Fang A, Gandelman K, Klee B. Pharmacokinetics of an extended release formulation of alprazolam (Xanax XR) in healthy normal adolescent and adult volunteers. Am J Ther. 2006;13(5):418-22. Abstract
Greenblatt DJ, Harmatz JS, Shader RI. Plasma alprazolam concentrations. Relation to efficacy and side effects in the treatment of panic disorder. Arch Gen Psychiatry. 1993;50(9):715-22. Abstract
Greiss KC, Fogari R. Double-blind clinical assessment of alprazolam, a new benzodiazepine derivative, in the treatment of moderate to severe anxiety. J Clin Pharmacol. 1980;20(11-12):693-9. Abstract
Klein E. The role of extended-release benzodiazepines in the treatment of anxiety: a risk-benefit evaluation with a focus on extended-release alprazolam. J Clin Psychiatry. 2002;63 Suppl 14:27-33. Article
Lesser IM, Lydiard RB, Antal E, et al. Alprazolam plasma concentrations and treatment response in panic disorder and agoraphobia. Am J Psychiatry. 1992;149(11):1556-62. Abstract
Lydiard RB, Lesser IM, Ballenger JC, et al. A fixed-dose study of alprazolam 2 mg, alprazolam 6 mg, and placebo in panic disorder. J Clin Psychopharmacol. 1992;12(2):96-103. Abstract
Marks IM, Swinson RP, Başoğlu M, et al. Alprazolam and exposure alone and combined in panic disorder with agoraphobia. A controlled study in London and Toronto. Br J Psychiatry. 1993;162:776-87. Abstract
Moroz G. High-potency benzodiazepines: recent clinical results. J Clin Psychiatry. 2004;65 Suppl 5:13-8. Abstract
Munjack DJ, Crocker B, Cabe D, et al. Alprazolam, propranolol, and placebo in the treatment of panic disorder and agoraphobia with panic attacks. J Clin Psychopharmacol. 1989;9(1):22-7. Abstract
Nagy LM, Krystal JH, Woods SW, Charney DS. Clinical and medication outcome after short-term alprazolam and behavioral group treatment in panic disorder. 2.5 year naturalistic follow-up study. Arch Gen Psychiatry. 1989;46(11):993-9. Abstract
Pecknold J, Luthe L, Munjack D, Alexander P. A double-blind, placebo-controlled, multicenter study with alprazolam and extended-release alprazolam in the treatment of panic disorder. J Clin Psychopharmacol. 1994;14(5):314-21. Abstract
Pecknold JC, Swinson RP, Kuch K, Lewis CP. Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. III. Discontinuation effects. Arch Gen Psychiatry. 1988;45(5):429-36. Abstract
Pyke RE, Kraus M. Alprazolam in the treatment of panic attack patients with and without major depression. J Clin Psychiatry. 1988 ;49(2):66-8. Abstract
Rickels K. Alprazolam extended-release in panic disorder. Expert Opin Pharmacother. 2004;5(7):1599-611. Abstract
Rimón R, Kultalahti ER, Kalli A, et al. Alprazolam and oxazepam in the treatment of anxious out-patients with depressive symptoms: a double-blind multicenter study. Pharmacopsychiatry. 1991;24(3):81-4. Abstract
Sheehan DV, Sheehan KH, Raj BA. The speed of onset of action of alprazolam-XR compared to alprazolam-CT in panic disorder. Psychopharmacol Bull. 2007;40(2):63-81. Abstract
Swinson RP, Pecknold JC, Kuch K. Psychopharmacological treatment of panic disorder and related states: a placebo controlled study of alprazolam. Prog Neuropsychopharmacol Biol Psychiatry. 1987;11(2-3):105-13. Abstract
Väisänen E, Jalkanen E. A double-blind study of alprazolam and oxazepam in the treatment of anxiety. Acta Psychiatr Scand. 1987;75(5):536-41. Abstract
Verster JC, Volkerts ER. Clinical pharmacology, clinical efficacy, and behavioral toxicity of alprazolam: a review of the literature. CNS Drug Rev. 2004;10(1):45-76. Abstract
Chlorazepate
Tranxene Tranxene SD Tranxene-T-Tab
Prescribing Information: Chlorazepate
Burrows GD, Dumovic P, Smith JA, et al. A controlled comparative trial of clorazepate (Tranxene) and diazepam (Valium) for anxiety. Med J Aust. 1977;2(16):525-8. Abstract
Cohn JB, Bowden CL, Fisher JG, Rodos JJ. Double-blind comparison of buspirone and clorazepate in anxious outpatients. Am J Med. 1986;80(3B):10-6. Abstract
De Wit S, Cremers L, Hirsch D, et al. Efficacy and safety of trazodone versus clorazepate in the treatment of HIV-positive subjects with adjustment disorders: a pilot study. J Int Med Res. 1999;27(5):223-32. Abstract
Duguay R, Le Lorier J, Rochefort JG, et al. Efficacy and kinetics of chlorazepate administered to anxious patients in a single daily dose. Can J Psychiatry. 1985;30(6):414-7. Abstract
Dureman I, Malmgren H, Norrman B. Comparison studies of chlorazepate administered as a divided daily dose and as a single dose at night. Psychopharmacology (Berl). 1978;57(2):123-6. Abstract
Fabre LF, Putman HP. Depressive symptoms and intellectual functioning in anxiety patients treated with clorazepate. J Clin Psychiatry. 1988;49(5):189-92. Abstract
Healey M, Pickens R, Meisch R, McKenna T. Effects of clorazepate, diazepam, lorazepam, and placebo on human memory. J Clin Psychiatry. 1983;44(12):436-9. Abstract
Henderson JG. Value of a single night-time dose of potassium clorazepate in anxiety: a controlled trial comparison with diazepam. Scott Med J. 1982;27(4):292-6. Abstract
Kiejna A, Kantorska-Janiec M, Małyszczak K. The use of chlorazepate dipotassium (Tranxene) in the states of restlessness and agitation. Psychiatr Pol. 1997;31(6):753-60. Abstract
Lader MH, Curry S, Baker WJ. Physiological and psychological effects of clorazepate in man. Br J Clin Pharmacol. 1980;9(1):83-90. Article
Razavi D, Kormoss N, Collard A, et al. Comparative study of the efficacy and safety of trazodone versus clorazepate in the treatment of adjustment disorders in cancer patients: a pilot study. J Int Med Res. 1999;27(6):264-72. Abstract
Rickels K, Schweizer E, Csanalosi I, et al. Long-term treatment of anxiety and risk of withdrawal. Prospective comparison of clorazepate and buspirone. Arch Gen Psychiatry. 1988;45(5):444-50. Abstract
Rickels K, Fox IL, Greenblatt DJ, et al. Clorazepate and lorazepam: clinical improvement and rebound anxiety. Am J Psychiatry. 1988;145(3):312-7. Abstract
Scharf MB, Hirschowitz J, Woods M, Scharf S. Lack of amnestic effects of clorazepate on geriatric recall. J Clin Psychiatry. 1985;46(12):518-20. Abstract
Zung WW. Effect of clorazepate on depressed mood in anxious patients. J Clin Psychiatry. 1987;48(1):13-4. Abstract
Chlordiazepoxide
Librium
Prescribing Information: Chlordiazepoxide
Discovered 1957, marketed 1960
Baskin SI, Esdale A. Is chlordiazepoxide the rational choice among benzodiazepines? Pharmacotherapy. 1982;2(2):110-9. Abstract
Ruffalo RL, Thompson JF, Segal JL. Diazepam-cimetidine drug interaction: a clinically significant effect. South Med J. 1981;74(9):1075-8. Abstract
Clonazepam
Klonopin Klonopin wafers
Prescribing Information: Klonopin
Approved on 9 week & 6 week trials in panic disorder
Beauclair L, Fontaine R, Annable L, et al. Clonazepam in the treatment of panic disorder: a double-blind, placebo-controlled trial investigating the correlation between clonazepam concentrations in plasma and clinical response. J Clin Psychopharmacol. 1994;14(2):111-8. Abstract
Davidson JR, Moroz G. Pivotal studies of clonazepam in panic disorder. Psychopharmacol Bull. 1998;34(2):169-74. Abstract
Davidson JR, Tupler LA, Potts NL. Treatment of social phobia with benzodiazepines. J Clin Psychiatry. 1994;55 Suppl:28-32. Abstract
Davidson JR, Potts N, Richichi E, et al. Treatment of social phobia with clonazepam and placebo. J Clin Psychopharmacol. 1993;13(6):423-8. Abstract
Jacobs RJ, Davidson JR, Gupta S, Meyerhoff AS. The effects of clonazepam on quality of life and work productivity in panic disorder. Am J Manag Care. 1997;3(8):1187-96. Abstract
Moroz G, Rosenbaum JF. Efficacy, safety, and gradual discontinuation of clonazepam in panic disorder: a placebo-controlled, multicenter study using optimized dosages. J Clin Psychiatry. 1999;60(9):604-12. Abstract
Moroz G. High-potency benzodiazepines: recent clinical results. J Clin Psychiatry. 2004;65 Suppl 5:13-8. Abstract
Munjack DJ, Baltazar PL, Bohn PB, et al. Clonazepam in the treatment of social phobia: a pilot study. J Clin Psychiatry. 1990;51 Suppl:35-40; discussion 50-3. Abstract
Nardi AE, Machado S, Almada LF, et al. Clonazepam for the treatment of panic disorder. Curr Drug Targets. 2013;14(3):353-64. Abstract
Nardi AE, Perna G. Clonazepam in the treatment of psychiatric disorders: an update. Int Clin Psychopharmacol. 2006;21(3):131-42. Abstract
Ontiveros A, Fontaine R. Sodium valproate and clonazepam for treatment-resistant panic disorder. J Psychiatry Neurosci. 1992;17(2):78-80. Article
Ontiveros A, Fontaine R. Social phobia and clonazepam. Can J Psychiatry. 1990;35(5):439-41. Abstract
Pollack MH. Clonazepam: a review of open clinical trials. J Clin Psychiatry. 1987;48 Suppl:12-5. Abstract
Pollack MH. Long-term management of panic disorder. J Clin Psychiatry. 1990;51 Suppl:11-3; discussion 50-3. Abstract
Rosenbaum JF. The development of clonazepam as a psychotropic: the Massachusetts General Hospital experience. J Clin Psychiatry. 2004;65 Suppl 5:3-6. Abstract
Rosenbaum JF, Moroz G, Bowden CL. Clonazepam in the treatment of panic disorder with or without agoraphobia: a dose-response study of efficacy, safety, and discontinuance. Clonazepam Panic Disorder Dose-Response Study Group. J Clin Psychopharmacol. 1997;17(5):390-400. Abstract
Seedat S, Stein MB. Double-blind, placebo-controlled assessment of combined clonazepam with paroxetine compared with paroxetine monotherapy for generalized social anxiety disorder. J Clin Psychiatry. 2004;65(2):244-8. Abstract
Valença AM, Nardi AE, Nascimento I, et al. Double-blind clonazepam vs placebo in panic disorder treatment. Arq Neuropsiquiatr. 2000;58(4):1025-9. Article
Versiani M. A review of 19 double-blind placebo-controlled studies in social anxiety disorder (social phobia). World J Biol Psychiatry. 2000;1(1):27-33. Abstract
Worthington JJ, Pollack MH, Otto MW, et al. Long-term experience with clonazepam in patients with a primary diagnosis of panic disorder. Psychopharmacol Bull. 1998;34(2):199-205. Abstract
Diazepam
Valium
Prescribing Information: Valium
Launched in 1963
Burrows GD, Dumovic P, Smith JA, et al. A controlled comparative trial of clorazepate (Tranxene) and diazepam (Valium) for anxiety. Med J Aust. 1977;2(16):525-8. Abstract
Cohn JB, Rickels K. A pooled, double-blind comparison of the effects of buspirone, diazepam and placebo in women with chronic anxiety. Curr Med Res Opin. 1989;11(5):304-20. Abstract
Healey M, Pickens R, Meisch R, McKenna T. Effects of clorazepate, diazepam, lorazepam, and placebo on human memory. J Clin Psychiatry. 1983;44(12):436-9. Abstract
Henderson JG. Value of a single night-time dose of potassium clorazepate in anxiety: a controlled trial comparison with diazepam. Scott Med J. 1982;27(4):292-6. Abstract
Rickels K, Case WG, Downing RW, Winokur A. Long-term diazepam therapy and clinical outcome. JAMA. 1983;250(6):767-71. Abstract
Ruffalo RL, Thompson JF, Segal JL. Diazepam-cimetidine drug interaction: a clinically significant effect. South Med J. 1981;74(9):1075-8. Abstract
Salzman C, Shader RI, Greenblatt DJ, Harmatz JS. Long v short half-life benzodiazepines in the elderly. Kinetics and clinical effects of diazepam and oxazepam. Arch Gen Psychiatry. 1983;40(3):293-7. Abstract
Lorazepam
Ativan
Prescribing Information: Ativan
Abernethy DR, Greenblatt DJ, Ochs HR, et al. Lorazepam and oxazepam kinetics in women on low-dose oral contraceptives. Clin Pharmacol Ther. 1983;33(5):628-32. Abstract
Battaglia J. Pharmacological management of acute agitation. Drugs. 2005;65(9):1207-22. Abstract
Cohn JB, Wilcox CS. Low-sedation potential of buspirone compared with alprazolam and lorazepam in the treatment of anxious patients: a double-blind study. J Clin Psychiatry. 1986;47(8):409-12. Abstract
Cohn JB, Wilcox CS. Long-term comparison of alprazolam, lorazepam and placebo in patients with an anxiety disorder. Pharmacotherapy. 1984;4(2):93-8. Abstract
Kyriakopoulos AA, Greenblatt DJ, Shader RI. Clinical pharmacokinetics of lorazepam: a review. J Clin Psychiatry. 1978;39(10 Pt 2):16-23. Abstract
Laakmann G, Schüle C, Lorkowski G, et al. Buspirone and lorazepam in the treatment of generalized anxiety disorder in outpatients. Psychopharmacology (Berl). 1998;136(4):357-66. Abstract
Rickels K, Fox IL, Greenblatt DJ, et al. Clorazepate and lorazepam: clinical improvement and rebound anxiety. Am J Psychiatry. 1988;145(3):312-7. Abstract
Oxazepam
Serax
Prescribing Information: Oxazepam
Abernethy DR, Greenblatt DJ, Ochs HR, et al. Lorazepam and oxazepam kinetics in women on low-dose oral contraceptives. Clin Pharmacol Ther. 1983;33(5):628-32. Abstract
Ayd FJ. Oxazepam: update 1989. Int Clin Psychopharmacol. 1990;5(1):1-15. Abstract
Greenblatt DJ. Clinical pharmacokinetics of oxazepam and lorazepam. Clin Pharmacokinet. 1981;6(2):89-105. Abstract
Greenblatt DJ, Divoll M, Harmatz JS, Shader RI. Oxazepam kinetics: effects of age and sex. J Pharmacol Exp Ther. 1980;215(1):86-91. Abstract
Lader MH. The clinical pharmacology of oxazepam. Acta Psychiatr Scand Suppl. 1978;(274):89-93. Abstract
Ochs HR, Greenblatt DJ, Otten H. Disposition of oxazepam in relation to age, sex, and cigarette smoking. Klin Wochenschr. 1981;59(16):899-903. Abstract
Pilbrant A, Glenne PO, Sundwall A, et al. Comparative bioavailability of oral dosage forms of oxazepam–correlation with in vitro dissolution rate. Acta Pharmacol Toxicol (Copenh). 1977;40 Suppl 1(1):7-15. Abstract
Rimón R, Kultalahti ER, Kalli A, et al. Alprazolam and oxazepam in the treatment of anxious out-patients with depressive symptoms: a double-blind multicenter study. Pharmacopsychiatry. 1991;24(3):81-4. Abstract
Salzman C, Shader RI, Greenblatt DJ, Harmatz JS. Long v short half-life benzodiazepines in the elderly. Kinetics and clinical effects of diazepam and oxazepam. Arch Gen Psychiatry. 1983;40(3):293-7. Abstract
Stern RG, Duffelmeyer ME, Zemishlani Z, Davidson M. The use of benzodiazepines in the management of behavioral symptoms in demented patients. Psychiatr Clin North Am. 1991;14(2):375-84. Abstract
Väisänen E, Jalkanen E. A double-blind study of alprazolam and oxazepam in the treatment of anxiety. Acta Psychiatr Scand. 1987;75(5):536-41. Abstract
Voshaar RC, Verkes RJ, van Luijtelaar GL, et al. Effects of additional oxazepam in long-term users of oxazepam. J Clin Psychopharmacol. 2005;25(1):42-50. Abstract
14.9 Benzodiazepine Selection |
Ansseau M, Papart P, Gérard MA, et al. Controlled comparison of buspirone and oxazepam in generalized anxiety. Neuropsychobiology. 1990-1991;24(2):74-8. Abstract
Baskin SI, Esdale A. Is chlordiazepoxide the rational choice among benzodiazepines? Pharmacotherapy. 1982;2(2):110-9. Abstract
Bernardi F, Fossi L, Faravelli C, et al. Alprazolam versus lorazepam in the treatment of anxiety: controlled clinical study. Riv Patol Nerv Ment. 1984;105(1):1-13. Abstract
Botte L, Bienfait J, Dethier J, et al. Clinical comparison between alprazolam and lorazepam. A polycentric study in double blind. Acta Psychiatr Belg. 1981;81(6):595-608. Abstract
Busto UE, Kaplan HL, Wright CE, et al. A comparative pharmacokinetic and dynamic evaluation of alprazolam sustained-release, bromazepam, and lorazepam. J Clin Psychopharmacol. 2000;20(6):628-35. Abstract
Cohn JB, Wilcox CS. Long-term comparison of alprazolam, lorazepam and placebo in patients with an anxiety disorder. Pharmacotherapy. 1984;4(2):93-8. Abstract
Cohn JB. Multicenter double-blind efficacy and safety study comparing alprazolam, diazepam and placebo in clinically anxious patients. J Clin Psychiatry. 1981;42(9):347-51. Abstract
Greenblatt DJ, Harmatz JS, Dorsey C, Shader RI. Comparative single-dose kinetics and dynamics of lorazepam, alprazolam, prazepam, and placebo. Clin Pharmacol Ther. 1988;44(3):326-34. Abstract
Imlah NW. The episodic nature of anxiety and its treatment with oxazepam. Acta Psychiatr Scand Suppl. 1978;(274):94-8. Abstract
Ruffalo RL, Thompson JF, Segal JL. Diazepam-cimetidine drug interaction: a clinically significant effect. South Med J. 1981;74(9):1075-8. Abstract
Ruiz AT. A double-blind study of alprazolam and lorazepam in the treatment of anxiety. J Clin Psychiatry. 1983;44(2):60-2. Abstract
Sheehan DV. Benzodiazepines in panic disorder and agoraphobia. J Affect Disord. 1987;13(2):169-81. Abstract
Strand M, Hetta J, Rosen A, et al. A double-blind, controlled trial in primary care patients with generalized anxiety: a comparison between buspirone and oxazepam. J Clin Psychiatry. 1990;51 Suppl:40-5. Abstract
Teboul E, Chouinard G. A guide to benzodiazepine selection. Part II: Clinical aspects. Can J Psychiatry. 1991;36(1):62-73. Abstract
Tesar GE. High-potency benzodiazepines for short-term management of panic disorder: the US experience. J Clin Psychiatry. 1990;51 Suppl:4-10; discussion 50-3. Abstract
Vinkers CH, Tijdink JK, Luykx JJ, Vis R. Choosing the correct benzodiazepine: mechanism of action and pharmacokinetics. Ned Tijdschr Geneeskd. 2012;155(35):A4900. Abstract
Switching Benzodiazepines
Ashton: Benzodiazepine Equivalency Table
Benzodiazpeine Equivalency Charts
14.10 Benzodiazepines for Anxiety by Anxiety Type |
Generalized Anxiety Disorder (GAD)
Ansseau M, Papart P, Gérard MA, et al. Controlled comparison of buspirone and oxazepam in generalized anxiety. Neuropsychobiology. 1990-1991;24(2):74-8. Abstract
Bandelow B, Reitt M, Röver C, et al. Efficacy of treatments for anxiety disorders: a meta-analysis. Int Clin Psychopharmacol. 2015;30(4):183-92. Abstract
Beauclair L, Fontaine R, Annable L, et al. Clonazepam in the treatment of panic disorder: a double-blind, placebo-controlled trial investigating the correlation between clonazepam concentrations in plasma and clinical response. J Clin Psychopharmacol. 1994;14(2):111-8. Abstract
Berney P, Halperin D, Tango R, et al. A major change of prescribing pattern in absence of adequate evidence: benzodiazepines versus newer antidepressants in anxiety disorders. Psychopharmacol Bull. 2008;41(3):39-47. Abstract
Casacalenda N, Boulenger JP. Pharmacologic treatments effective in both generalized anxiety disorder and major depressive disorder: clinical and theoretical implications. Can J Psychiatry. 1998;43(7):722-30. Abstract
Cohn JB, Rickels K. A pooled, double-blind comparison of the effects of buspirone, diazepam and placebo in women with chronic anxiety. Curr Med Res Opin. 1989;11(5):304-20. Abstract
Cohn JB, Wilcox CS. Low-sedation potential of buspirone compared with alprazolam and lorazepam in the treatment of anxious patients: a double-blind study. J Clin Psychiatry. 1986;47(8):409-12. Abstract
Fabre LF, Putman HP. Depressive symptoms and intellectual functioning in anxiety patients treated with clorazepate. J Clin Psychiatry. 1988;49(5):189-92. Abstract
Klein E. The role of extended-release benzodiazepines in the treatment of anxiety: a risk-benefit evaluation with a focus on extended-release alprazolam. J Clin Psychiatry. 2002;63 Suppl 14:27-33. Article
Laakmann G, Schüle C, Lorkowski G, et al. Buspirone and lorazepam in the treatment of generalized anxiety disorder in outpatients. Psychopharmacology (Berl). 1998;136(4):357-66. Abstract
Lesser IM, Lydiard RB, Antal E, et al. Alprazolam plasma concentrations and treatment response in panic disorder and agoraphobia. Am J Psychiatry. 1992;149(11):1556-62. Abstract
Locke AB, Kirst N, Shultz CG. Diagnosis and management of generalized anxiety disorder and panic disorder in adults. Am Fam Physician. 2015;91(9):617-24. Article
National Institute for Health and Clinical Excellence: Guidance. Generalized anxiety disorder and panic disorder (with or without agoraphobia) in adults: management in primary, secondary and community care. January 2011. Document
Offidani E, Guidi J, Tomba E, Fava GA. Efficacy and tolerability of benzodiazepines versus antidepressants in anxiety disorders: a systematic review and meta-analysis. Psychother Psychosom. 2013;82(6):355-62. Abstract
Perna G, Alciati A, Riva A, et al. Long-term pharmacological treatments of anxiety disorders: an updated systematic review. Curr Psychiatry Rep. 2016;18(3):23. Abstract
Strand M, Hetta J, Rosen A, et al. A double-blind, controlled trial in primary care patients with generalized anxiety: a comparison between buspirone and oxazepam. J Clin Psychiatry. 1990;51 Suppl:40-5. Abstract
Verster JC, Volkerts ER. Clinical pharmacology, clinical efficacy, and behavioral toxicity of alprazolam: a review of the literature. CNS Drug Rev. 2004;10(1):45-76. Abstract
Zung WW. Effect of clorazepate on depressed mood in anxious patients. J Clin Psychiatry. 1987;48(1):13-4. Abstract
Panic Disorder (PD)
Ballenger JC, Burrows GD, DuPont RL, et al. Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. I. Efficacy in short-term treatment. Arch Gen Psychiatry. 1988;45(5):413-22. Abstract
Bandelow B, Reitt M, Röver C, et al. Efficacy of treatments for anxiety disorders: a meta-analysis. Int Clin Psychopharmacol. 2015;30(4):183-92. Abstract
Beauclair L, Fontaine R, Annable L, et al. Clonazepam in the treatment of panic disorder: a double-blind, placebo-controlled trial investigating the correlation between clonazepam concentrations in plasma and clinical response. J Clin Psychopharmacol. 1994;14(2):111-8. Abstract
Berney P, Halperin D, Tango R, et al. A major change of prescribing pattern in absence of adequate evidence: benzodiazepines versus newer antidepressants in anxiety disorders. Psychopharmacol Bull. 2008;41(3):39-47. Abstract
Başoğlu M, Marks IM, Swinson RP, et al. Pre-treatment predictors of treatment outcome in panic disorder and agoraphobia treated with alprazolam and exposure. J Affect Disord. 1994;30(2):123-32. Abstract
Başoğlu M, Marks IM, Kiliç C, et al. Alprazolam and exposure for panic disorder with agoraphobia. Attribution of improvement to medication predicts subsequent relapse. Br J Psychiatry. 1994;164(5):652-9. Abstract
Başoğlu M, Marks IM, Kiliç C, et al. Relationship of panic, anticipatory anxiety, agoraphobia and global improvement in panic disorder with agoraphobia treated with alprazolam and exposure. Br J Psychiatry. 1994;164(5):647-52. Abstract
Jacobs RJ, Davidson JR, Gupta S, Meyerhoff AS. The effects of clonazepam on quality of life and work productivity in panic disorder. Am J Manag Care. 1997;3(8):1187-96. Abstract
Klein E. The role of extended-release benzodiazepines in the treatment of anxiety: a risk-benefit evaluation with a focus on extended-release alprazolam. J Clin Psychiatry. 2002;63 Suppl 14:27-33. Article
Lesser IM, Lydiard RB, Antal E, et al. Alprazolam plasma concentrations and treatment response in panic disorder and agoraphobia. Am J Psychiatry. 1992;149(11):1556-62. Abstract
Locke AB, Kirst N, Shultz CG. Diagnosis and management of generalized anxiety disorder and panic disorder in adults. Am Fam Physician. 2015;91(9):617-24. Article
Marks IM, Swinson RP, Başoğlu M, et al. Alprazolam and exposure alone and combined in panic disorder with agoraphobia. A controlled study in London and Toronto. Br J Psychiatry. 1993;162:776-87. Abstract
Moroz G. High-potency benzodiazepines: recent clinical results. J Clin Psychiatry. 2004;65 Suppl 5:13-8. Abstract
Munjack DJ, Crocker B, Cabe D, et al. Alprazolam, propranolol, and placebo in the treatment of panic disorder and agoraphobia with panic attacks. J Clin Psychopharmacol. 1989;9(1):22-7. Abstract
Nagy LM, Krystal JH, Woods SW, Charney DS. Clinical and medication outcome after short-term alprazolam and behavioral group treatment in panic disorder. 2.5 year naturalistic follow-up study. Arch Gen Psychiatry. 1989;46(11):993-9. Abstract
Nardi AE, Machado S, Almada LF, et al. Clonazepam for the treatment of panic disorder. Curr Drug Targets. 2013;14(3):353-64. Abstract
Nardi AE, Perna G. Clonazepam in the treatment of psychiatric disorders: an update. Int Clin Psychopharmacol. 2006;21(3):131-42. Abstract
National Institute for Health and Clinical Excellence: Guidance. Generalized anxiety disorder and panic disorder (with or without agoraphobia) in adults: management in primary, secondary and community care. January 2011. Document
Offidani E, Guidi J, Tomba E, Fava GA. Efficacy and tolerability of benzodiazepines versus antidepressants in anxiety disorders: a systematic review and meta-analysis. Psychother Psychosom. 2013;82(6):355-62. Abstract
Ontiveros A, Fontaine R. Sodium valproate and clonazepam for treatment-resistant panic disorder. J Psychiatry Neurosci. 1992;17(2):78-80. Article
Perna G, Alciati A, Riva A, et al. Long-term pharmacological treatments of anxiety disorders: an updated systematic review. Curr Psychiatry Rep. 2016;18(3):23. Abstract
Pollack MH. Long-term management of panic disorder. J Clin Psychiatry. 1990;51 Suppl:11-3; discussion 50-3. Abstract
Pyke RE, Kraus M. Alprazolam in the treatment of panic attack patients with and without major depression. J Clin Psychiatry. 1988 ;49(2):66-8. Abstract
Rickels K. Alprazolam extended-release in panic disorder. Expert Opin Pharmacother. 2004;5(7):1599-611. Abstract
Rosenbaum JF, Moroz G, Bowden CL. Clonazepam in the treatment of panic disorder with or without agoraphobia: a dose-response study of efficacy, safety, and discontinuance. Clonazepam Panic Disorder Dose-Response Study Group. J Clin Psychopharmacol. 1997;17(5):390-400. Abstract
Seedat S, Stein MB. Double-blind, placebo-controlled assessment of combined clonazepam with paroxetine compared with paroxetine monotherapy for generalized social anxiety disorder. J Clin Psychiatry. 2004;65(2):244-8. Abstract
Swinson RP, Pecknold JC, Kuch K. Psychopharmacological treatment of panic disorder and related states: a placebo controlled study of alprazolam. Prog Neuropsychopharmacol Biol Psychiatry. 1987;11(2-3):105-13. Abstract
Sheehan DV. Benzodiazepines in panic disorder and agoraphobia. J Affect Disord. 1987;13(2):169-81. Abstract
Spiegel DA, Bruce TJ. Benzodiazepines and exposure-based cognitive behavior therapies for panic disorder: conclusions from combined treatment trials. Am J Psychiatry. 1997;154(6):773-81. Abstract
Teboul E, Chouinard G. A guide to benzodiazepine selection. Part II: Clinical aspects. Can J Psychiatry. 1991;36(1):62-73. Abstract
Tesar GE. High-potency benzodiazepines for short-term management of panic disorder: the US experience. J Clin Psychiatry. 1990;51 Suppl:4-10; discussion 50-3. Abstract
Valença AM, Nardi AE, Nascimento I, et al. Double-blind clonazepam vs placebo in panic disorder treatment. Arq Neuropsiquiatr. 2000;58(4):1025-9. Article
Verster JC, Volkerts ER. Clinical pharmacology, clinical efficacy, and behavioral toxicity of alprazolam: a review of the literature. CNS Drug Rev. 2004;10(1):45-76. Abstract
Worthington JJ, Pollack MH, Otto MW, et al. Long-term experience with clonazepam in patients with a primary diagnosis of panic disorder. Psychopharmacol Bull. 1998;34(2):199-205. Abstract
Post-Traumatic Stress Disorder (PTSD)
Asnis GM, Kohn SR, Henderson M, Brown NL. SSRIs versus non-SSRIs in post-traumatic stress disorder: an update with recommendations. Drugs. 2004;64(4):383-404. Abstract
Bisson JI. Post-traumatic stress disorder. BMJ Clin Evid. 2010;2010. pii: 1005. Article
Davidson JR. Use of benzodiazepines in social anxiety disorder, generalized anxiety disorder, and posttraumatic stress disorder. J Clin Psychiatry. 2004;65 Suppl 5:29-33. Link
Greenbaum MA, Neylan TC, Rosen CS. Symptom presentation and prescription of sleep medications for veterans with posttraumatic stress disorder. J Nerv Ment Dis. 2017;205(2):112-118. Abstract
Jeffreys M, Capehart B, Friedman MJ. Pharmacotherapy for posttraumatic stress disorder: review with clinical applications. J Rehabil Res Dev. 2012;49(5):703-15. Article
Maher MJ, Rego SA, Asnis GM. Sleep disturbances in patients with post-traumatic stress disorder: epidemiology, impact and approaches to management. CNS Drugs. 2006;20(7):567-90. Abstract
Martényi F. Three paradigms in the treatment of posttraumatic stress disorder. Neuropsychopharmacol Hung. 2005;7(1):11-21. Abstract
Rosen CS, Greenbaum MA, Schnurr PP, et al. Do benzodiazepines reduce the effectiveness of exposure therapy for posttraumatic stress disorder? J Clin Psychiatry. 2013;74(12):1241-8. Abstract
Villagonzalo KA, Dodd S, Ng F, et al. The relationship between substance use and posttraumatic stress disorder in a methadone maintenance treatment program. Compr Psychiatry. 2011;52(5):562-6. Link
Social Anxiety Disorder (SAD)
Bandelow B, Reitt M, Röver C, et al. Efficacy of treatments for anxiety disorders: a meta-analysis. Int Clin Psychopharmacol. 2015;30(4):183-92. Abstract
Davidson JR. Pharmacotherapy of social anxiety disorder: what does the evidence tell us? J Clin Psychiatry. 2006;67 Suppl 12:20-6. Abstract
Davidson JR, Tupler LA, Potts NL. Treatment of social phobia with benzodiazepines. J Clin Psychiatry. 1994;55 Suppl:28-32. Abstract
Davidson JR, Potts N, Richichi E, et al. Treatment of social phobia with clonazepam and placebo. J Clin Psychopharmacol. 1993;13(6):423-8. Abstract
Munjack DJ, Baltazar PL, Bohn PB, et al. Clonazepam in the treatment of social phobia: a pilot study. J Clin Psychiatry. 1990;51 Suppl:35-40; discussion 50-3. Abstract
Nardi AE, Perna G. Clonazepam in the treatment of psychiatric disorders: an update. Int Clin Psychopharmacol. 2006;21(3):131-42. Abstract
National Guideline Alliance 2013 Social Anxiety Disorder: Recognition, Assessment and Treatment
Ontiveros A, Fontaine R. Social phobia and clonazepam. Can J Psychiatry. 1990;35(5):439-41. Abstract
Perna G, Alciati A, Riva A, et al. Long-term pharmacological treatments of anxiety disorders: an updated systematic review. Curr Psychiatry Rep. 2016;18(3):23. Abstract
Rosenbaum JF. The development of clonazepam as a psychotropic: the Massachusetts General Hospital experience. J Clin Psychiatry. 2004;65 Suppl 5:3-6. Abstract
Rosenbaum JF, Moroz G, Bowden CL. Clonazepam in the treatment of panic disorder with or without agoraphobia: a dose-response study of efficacy, safety, and discontinuance. Clonazepam Panic Disorder Dose-Response Study Group. J Clin Psychopharmacol. 1997;17(5):390-400. Abstract
Seedat S, Stein MB. Double-blind, placebo-controlled assessment of combined clonazepam with paroxetine compared with paroxetine monotherapy for generalized social anxiety disorder. J Clin Psychiatry. 2004;65(2):244-8. Abstract
Sheehan DV. Benzodiazepines in panic disorder and agoraphobia. J Affect Disord. 1987;13(2):169-81. Abstract
14.11 Using |
Duration of Action
Extended Release
Klein E. The role of extended-release benzodiazepines in the treatment of anxiety: a risk-benefit evaluation with a focus on extended-release alprazolam. J Clin Psychiatry. 2002;63 Suppl 14:27-33. Article
Brand v Generic
Desmarais JE, Beauclair L, Margolese HC. Switching from brand-name to generic psychotropic medications: a literature review. CNS Neurosci Ther. 2011;17(6):750-60. Abstract
Dose
Dose Ceiling
Dose Equivalents
Dose Interval
Initiation
Maintenance
Route of Administration
Tolerance
Duration of Use
Isacson D. Long-term benzodiazepine use: factors of importance and the development of individual use patterns over time–a 13-year follow-up in a Swedish community. Soc Sci Med. 1997;44(12):1871-80. Abstract
Isacson D, Carsjö K, Bergman U, Blackburn JL. Long-term use of benzodiazepines in a Swedish community: an eight-year follow-up. J Clin Epidemiol. 1992;45(4):429-36. Abstract
Luderer HJ, Schulz M, Mayer M. Long-term administration of benzodiazepines – disease follow-up, sequelae, treatment. A retrospective clinical record evaluation of 194 patients. Psychiatr Prax. 1995;22(6):231-4. Abstract
Pélissolo A, Maniere F, Boutges B, et al. Anxiety and depressive disorders in 4,425 long term benzodiazepine users in general practice. Encephale. 2007;33(1):32-8. Abstract
van Hulten R, Isacson D, Bakker A, Leufkens HG. Comparing patterns of long-term benzodiazepine use between a Dutch and a Swedish community. Pharmacoepidemiol Drug Saf. 2003;12(1):49-53. Abstract
van Hulten R, Teeuw KB, Bakker A, Leufkens HG. Initial 3-month usage characteristics predict long-term use of benzodiazepines: an 8-year follow-up. Eur J Clin Pharmacol. 2003;58(10):689-94. Abstract
Voshaar RC, Verkes RJ, van Luijtelaar GL, et al. Effects of additional oxazepam in long-term users of oxazepam. J Clin Psychopharmacol. 2005;25(1):42-50. Abstract
14.12 Comparative Outcomes: Other Medications |
van Balkom AJ, Bakker A, Spinhoven P, et al. A meta-analysis of the treatment of panic disorder with or without agoraphobia: a comparison of psychopharmacological, cognitive-behavioral, and combination treatments. J Nerv Ment Dis. 1997;185(8):510-6. Abstract
Antipsychotics
Calcium Channel Modulators
Gabapentin
Pregabalin
Mono-Amine Reuptake Inhibitors
Asnis GM, Kohn SR, Henderson M, Brown NL. SSRIs versus non-SSRIs in post-traumatic stress disorder: an update with recommendations. Drugs. 2004;64(4):383-404. Abstract
Berney P, Halperin D, Tango R, et al. A major change of prescribing pattern in absence of adequate evidence: benzodiazepines versus newer antidepressants in anxiety disorders. Psychopharmacol Bull. 2008;41(3):39-47. Abstract
Demyttenaere K, Bonnewyn A, Bruffaerts R, et al. Clinical factors influencing the prescription of antidepressants and benzodiazepines: results from the European study of the epidemiology of mental disorders (ESEMeD). J Affect Disord. 2008;110(1-2):84-93. Abstract
Offidani E, Guidi J, Tomba E, Fava GA. Efficacy and tolerability of benzodiazepines versus antidepressants in anxiety disorders: a systematic review and meta-analysis. Psychother Psychosom. 2013;82(6):355-62. Abstract
Seratonin Receptor Agents
Azapirones
Buspirone
Cohn JB, Rickels K. A pooled, double-blind comparison of the effects of buspirone, diazepam and placebo in women with chronic anxiety. Curr Med Res Opin. 1989;11(5):304-20. Abstract
Cohn JB, Wilcox CS. Low-sedation potential of buspirone compared with alprazolam and lorazepam in the treatment of anxious patients: a double-blind study. J Clin Psychiatry. 1986;47(8):409-12. Abstract
Cohn JB, Bowden CL, Fisher JG, Rodos JJ. Double-blind comparison of buspirone and clorazepate in anxious outpatients. Am J Med. 1986;80(3B):10-6. Abstract
Delle Chiaie R, Pancheri P, Casacchia M, et al. Assessment of the efficacy of buspirone in patients affected by generalized anxiety disorder, shifting to buspirone from prior treatment with lorazepam: a placebo-controlled, double-blind study. J Clin Psychopharmacol. 1995;15(1):12-9. Abstract
Laakmann G, Schüle C, Lorkowski G, et al. Buspirone and lorazepam in the treatment of generalized anxiety disorder in outpatients. Psychopharmacology (Berl). 1998;136(4):357-66. Abstract
Petracca A, Nisita C, McNair D, et al. Treatment of generalized anxiety disorder: preliminary clinical experience with buspirone. J Clin Psychiatry. 1990;51 Suppl:31-9. Abstract
Rickels K, Schweizer E, Csanalosi I, et al. Long-term treatment of anxiety and risk of withdrawal. Prospective comparison of clorazepate and buspirone. Arch Gen Psychiatry. 1988;45(5):444-50. Abstract
14.13 Comparative Outcomes: Non-Pharmacologic |
van Balkom AJ, Bakker A, Spinhoven P, et al. A meta-analysis of the treatment of panic disorder with or without agoraphobia: a comparison of psychopharmacological, cognitive-behavioral, and combination treatments. J Nerv Ment Dis. 1997;185(8):510-6. Abstract
Alternative / Complementary
Brief Intervention
Diet / Nutrition / Weight Management
Faith-Based
Mind-Body Therapies
Biofeedback
Hypnosis
Imagery
Meditative Movement
Meditation
Mindfulness Meditation
Relaxation
Mutual Help Programs
Psych Modalities
Acceptance and Commitment Therapy (ACT)
Cognitive Behavioral Therapy (CBT)
Bandelow B, Reitt M, Röver C, et al. Efficacy of treatments for anxiety disorders: a meta-analysis. Int Clin Psychopharmacol. 2015;30(4):183-92. Abstract
Exposure Therapy
Kiliç C, Noshirvani H, Başoğlu M, Marks I. Agoraphobia and panic disorder: 3.5 years after alprazolam and/or exposure treatment. Psychother Psychosom. 1997;66(4):175-8. Abstract
Marks IM, Swinson RP, Başoğlu M, et al. Alprazolam and exposure alone and combined in panic disorder with agoraphobia. A controlled study in London and Toronto. Br J Psychiatry. 1993;162:776-87. Abstract
Physical Modalities
Acupuncture
Exercise
Manipulation
Massage
14.14 Combination Outcomes: With Other Medications |
Antipsychotics
Calcium Channel Modulators
Gabapentin
Pregabalin
Mono-Amine Reuptake Inhibitors
Seratonin Receptor Agents
14.15 Combination Outcomes: Non-Pharmacologic + Benzodiazepines |
CBT
Hofmann SG, Sawyer AT, Korte KJ, Smits JA. Is it beneficial to add pharmacotherapy to Cognitive-Behavioral Therapy when treating anxiety disorders? A meta-analytic review. Int J Cogn Ther. 2009;2(2):160-75. Article
Otto MW, Bruce SE, Deckersbach T. Benzodiazepine use, cognitive impairment, and cognitive-behavioral therapy for anxiety disorders: issues in the treatment of a patient in need. J Clin Psychiatry. 2005;66 Suppl 2:34-8. Abstract
Spiegel DA, Bruce TJ. Benzodiazepines and exposure-based cognitive behavior therapies for panic disorder: conclusions from combined treatment trials. Am J Psychiatry. 1997;154(6):773-81. Abstract
Westra HA, Stewart SH, Conrad BE. Naturalistic manner of benzodiazepine use and cognitive behavioral therapy outcome in panic disorder with agoraphobia. J Anxiety Disord. 2002;16(3):233-46. Abstract
Westra HA, Stewart SH. Cognitive behavioral therapy and pharmacotherapy: complementary or contradictory approaches to the treatment of anxiety? Clin Psychol Rev. 1998;18(3):307-40. Abstract
Exposure Therapy
Marks IM, Swinson RP, Başoğlu M, et al. Alprazolam and exposure alone and combined in panic disorder with agoraphobia. A controlled study in London and Toronto. Br J Psychiatry. 1993;162:776-87. Abstract
Rosen CS, Greenbaum MA, Schnurr PP, et al. Do benzodiazepines reduce the effectiveness of exposure therapy for posttraumatic stress disorder? J Clin Psychiatry. 2013;74(12):1241-8. Abstract
14.16 Benzodiazepines for Anxiety By Subpopulation |
Armed Services / Veterans
Leggett A, Kavanagh J, Zivin K, et al. The association between benzodiazepine use and depression outcomes in older veterans. J Geriatr Psychiatry Neurol. 2015;28(4):281-7. Article
Addiction
Alcohol
Ipser JC, Wilson D, Akindipe TO, et al. Pharmacotherapy for anxiety and comorbid alcohol use disorders. Cochrane Database Syst Rev. 2015;1:CD007505. Article
Behavioral Addiction
Cannabis
Nicotine
Opioid
Stimulant
Cocaine
Cancer
Cardiovascular Disease
Care Facilities
Battaglia J. Pharmacological management of acute agitation. Drugs. 2005;65(9):1207-22. Abstract
Emergency Department
Yildiz A, Sachs GS, Turgay A. Pharmacological management of agitation in emergency settings. Emerg Med J. 2003;20(4):339-46. Article
Yildiz A. Benzodiazepines, typical and atypical antipsychotics in the management of acute agitation: a review. Turk Psikiyatri Derg. 2003;14(2):134-44. Abstract
Hospital
Edwards C, Bushnell JL, Ashton CH, Rawlins MD. Hospital prescribing and usage of hypnotics and anxiolytics. Br J Clin Pharmacol. 1991;31(2):190-2. Link
Srivastava A. Limited evidence for the effectiveness of p.r.n. Medications among psychiatric inpatients. J Psychiatr Pract. 2009;15(3):193-201. Abstract
Cognitive Dysfunction
Stern RG, Duffelmeyer ME, Zemishlani Z, Davidson M. The use of benzodiazepines in the management of behavioral symptoms in demented patients. Psychiatr Clin North Am. 1991;14(2):375-84. Abstract
Criminal Justice
Elderly
Salzman C, Shader RI, Greenblatt DJ, Harmatz JS. Long v short half-life benzodiazepines in the elderly. Kinetics and clinical effects of diazepam and oxazepam. Arch Gen Psychiatry. 1983;40(3):293-7. Abstract
Ethnicity
Pearson SA, Soumerai S, Mah C, et al. Racial disparities in access after regulatory surveillance of benzodiazepines. Arch Intern Med. 2006;166(5):572-9. Abstract
African-American
Asian
Caucasian
Hispanic
Native American
Pacific Island
Health Care Providers
Hepatic Disease
HIV / AIDS
De Wit S, Cremers L, Hirsch D, et al. Efficacy and safety of trazodone versus clorazepate in the treatment of HIV-positive subjects with adjustment disorders: a pilot study. J Int Med Res. 1999;27(5):223-32. Abstract
LGBT
Men
Pain
Palliative Care – End of Life
Pediatric
Kuang H, Johnson JA, Mulqueen JM, Bloch MH. The efficacy of benzodiazepines as acute anxiolytics in children: a meta-analysis. Depress Anxiety. 2017 May 15. [Epub ahead of print] Abstract
Pejovic-Milovancevic M, Miletic V, Popovic-Deusic S, et al. Psychotropic medication use in children and adolescents in an inpatient setting. Psychiatriki. 2011;22(4):314-9. Abstract
Ilomäki R, Ilomäki E, Hakko H, Räsänen P. Psychotropic medication history of inpatient adolescents – is there a rationale for benzodiazepine prescription? Addict Behav. 2011;36(1-2):161-5. Abstract
Pejovic-Milovancevic M, Miletic V, Popovic-Deusic S, et al. Psychotropic medication use in children and adolescents in an inpatient setting. Psychiatriki. 2011;22(4):314-9. Abstract
Steinhausen HC. Recent international trends in psychotropic medication prescriptions for children and adolescents. Eur Child Adolesc Psychiatry. 2015;24(6):635-40. Abstract
Pulmonary Disease
Psychiatric Comorbidity
Smolders M, Laurant M, van Rijswijk E, et al. The impact of co-morbidity on GPs’ pharmacological treatment decisions for patients with an anxiety disorder. Fam Pract. 2007;24(6):538-46.
Depression
Psychosis
Gaillard R, Ouanas A, Spadone C, et al. Benzodiazepines and schizophrenia, a review of the literature. Encephale. 2006;32(6 Pt 1):1003-10. Abstract
Renal Disease
Sleep Disorders
Sleep Apnea
Surgical
Swallowing Disorders
Women
Abernethy DR, Greenblatt DJ, Ochs HR, et al. Lorazepam and oxazepam kinetics in women on low-dose oral contraceptives. Clin Pharmacol Ther. 1983;33(5):628-32. Abstract
Ashton H. Psychotropic-drug prescribing for women. Br J Psychiatry Suppl. 1991;(10):30-5. Abstract
Cohn JB, Rickels K. A pooled, double-blind comparison of the effects of buspirone, diazepam and placebo in women with chronic anxiety. Curr Med Res Opin. 1989;11(5):304-20. Abstract
Perinatal
Nursing
