Should benzodiazepines be replaced by antidepressants in the treatment of anxiety disorders? Fact or fiction?

摘要

In this issue of Psychotherapy and Psychosomatics, Of-fidani et al. 1 address the important clinical question of the role of benzodiazepines (BZs) in the treatment of anxiety disorders and whether there exists evidence in the literature that the BZs should be replaced by the newer antidepressants (ADs).Experts today recommend the use of newer ADs as first-line treatments for anxiety disorders 2, replacing the BZs; yet what is the evidence for this recommendation? Prescribing patterns in US outpatients for mood and anxiety disorders in the year 2007 do not seem to support this recommendation 3. For example, 136 million prescriptions were written for ADs and 85 million for BZs and the 10 most frequently prescribed medications for either an anxiety or depression diagnosis include 7 ADs and 3 BZs, alprazolam, lorazepam and diazepam (clonaz-epam was not included in this survey as its use was coded under 'convulsive disorders'). This 2007 prescribing pattern is very similar to the one reported by Stahl 4 for 2001.