Benzodiazepines and anxiety disorders: a review for the practicing physician

Objectives and scope: The objective of this article is to briefly review for practicing clinicians differences among the benzodiazepines (BZDs) that are commonly used to treat anxiety, the efficacy of BZDs in various anxiety disorders, and potential safety issues associated with BZDs, including adverse events, tolerance, dependence, and withdrawal. Methodology Information for this review was obtained using literature searches through PubMed (1966-2004), Google, and the Food and Drug Administration Catalog of Approved Drugs. Data sources were searched for information regarding anxiety disorders and the safety and efficacy of BZDs. Wherever possible and appropriate, information from randomized controlled trials was given priority. Findings: Benzodiazepines have demonstrated efficacy in treating patients with anxiety disorders, with varying degrees of efficacy. Use of BZDs is advantageous because they have a quick onset of action and are generally well tolerated. Extended-release formulations of BZDs may be particularly advantageous in some patients with anxiety as they allow for maximization of a drug's therapeutic window with consistent serum drug concentrations. Conclusions: BZDs remain a mainstay in the treatment of anxiety, as both monotherapy and adjunctive therapy. Factors to consider prior to prescribing a BZD include the patient's diagnosis, as well as drug characteristics, including the potential for interactions with other drugs, the risk of dependence and withdrawal, and the required frequency of dosing.