Benzodiazepines

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Category: Medical Options

What is it?

Benzodiazepines are a class of drugs which have been used for many years in the treatment of symptoms including anxiety, insomnia, agitation, seizures, muscle spasms, as well as alcohol withdrawal. They can also be used before certain medical procedures in order to induce sedation and amnesia for the procedure. These medications have been used for PTSD patients. There are several benzodiazepines available which each have a slightly different chemical makeup and effects.

Benzodiazepams which have been trialed for PTSD symptoms include

  • alprazolam (trade names include Xanax, Reclam, Xanor and Niravam)
  • clonazepam (trade names include Rivotril, Ravotril and Rivatril)
  • diazepam (trade names includeValium, Valpam and Antenex)

Other benzodiazepams include brotizolam, bromazepam, chlordiazepoxide, clobazam , clorazepate, estazolam, flunitrazepam, flurazepam, lorazepam, loprazolam, lormetazepam, midazolam, nimetazepam, nitrazepam, nordazepam, oxazepam, prazepam, phenazepam, temazepam and triazolam.

How does it work?

Benzodiazepines produce a range of effects in the central nervous system by acting on the GABAA receptors in the brain.

Is it effective?

Despite anecdotal reports of widespread use, almost no controlled studies have investigated the effectiveness of benzodiazepines in the treatment of PTSD. In the two small studies which have been reported no significant benefit was found from the use of benzodiazepines in PTSD.

Are there any disadvantages?

Benzodiazepines commonly produce side effects including drowsiness, impaired coordination, confusion, nausea and dizziness. Other side effects are possible and health practitioners should be made aware of any changes. Long term use can cause significant problems with cognition and impaired learning in some people. Long term use of benzodiazepines is not recommended as physical dependence is common and the medications must be withdrawn very carefully under close supervision by a registered health professional.

Where do you get it?

Benzodiazepines can only be prescribed by registered health practitioners.

What are the evidence limitations?

The evidence base for benzodiazepine use in PTSD is poor. Studies to date have been on small numbers of patients and the methods of diagnosing PTSD were not reported in the review literature. Therefore interpreting this evidence should be undertaken with caution.

Recommendations

Based on current limited evidence, benzodiazepines cannot be recommended for the routine treatment of PTSD. It is important that any drug treatment is provided by a registered health professional, with appropriate assessment carried out prior to treatment as well as ongoing monitoring during the course of treatment.

Key References

Braun, P, Greenberg, D, Dasberg, H, et al. 1990, ‘Core symptoms of posttraumatic stress disorder unimproved by alprazolam treatment’, Journal of Clinical Psychiatry, vol. 51, pp. 236–238

Cooper, J, Carty, J, Creamer, M 2005, ‘Pharmacotherapy for posttraumatic stress disorder: empirical review and clinical recommendations’, Australian and New Zealand Journal of Psychiatry, vol. 39, pp. 674–682.

Gelpin, E, Bonne, O, Peri, T, et al. 1996, ‘Treatment of recent trauma survivors with benzodiazepines: a prospective study’, Journal of Clinical Psychiatry, vol. 57, pp. 390–394.

Maher, MJ, Rego, SA & Asnis, GM 2006, ‘Sleep disturbances in patients with post-traumatic stress disorder. Epidemiology, impact and approaches to management’, CNS Drugs, vol. 20(7), pp. 567-590.

Risse, SC, Whitters, A, Burke, J, et al. 1990, ‘Severe withdrawal symptoms after discontinuation of alprazolam in eight patients with combat-induced posttraumatic stress disorder’, Journal of Clinical Psychiatry, vol. 51, pp. 206–209.

Schoenfeld, F, Marmar, C & Neylan, T 2004, ‘Current concepts in pharmacotherapy for posttraumatic stress disorder’, Psychiatric Services, vol. 55, pp. 519–531.

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