Antonio E. Nardi, Richard Balon, Guy Chouinard, Fiammetta Cosci, Steven Dubovsky, Giovanni A. Fava, Rafael C. Freire, David J. Greenblatt, John H. Krystal, Karl Rickels, Thomas Roth, Carl Salzman, Richard I. Shader, Edward K. Silberman, Nicoletta Sonino, Vladan Starcevic and Steven J. Weintraub: The value of long-term clinical experience with benzodiazepines. International Task Force on Benzodiazepines

Hector Warnes’ additional comments

            Pharma is trying to persuade psychiatrists to switch from benzodiazepines to Pregabalin, a gabapentinoid which acts by inhibiting certain calcium channels. Pregabalin, unlike a benzodiazepines, has more common side effects, such as sleepiness, confusion, trouble with memory, poor motor coordination and weight gain, and is are not as effective as anxiolytics in most cases. I shall not mention the more severe adverse reactions reported by Lydiard, Rickels, Herman and Feltner (2010).

            Lorazepam for quite a while has had a bad reputation for inducing "addiction" or a need to increase the dosages. An increasing number of neurologists are scaring patients about memory loss and hippocampal lesions associated with the chronic use of a benzodiazepine.  

            Most Pharma companies include a warning that these drugs should not be used more than three to six months; it is rarely followed. With increasing age some patients are given at least five different compounds (co-morbidity) which increases the likelihood of side effects, including the likelihood of obstructive sleep apnea, nocturnal falling during attempts to go to the bathroom and memory dysfunction.

            I insist that we should not put all benzodiazepines in the "same basket."  I have seen retrograde amnesia with the use of triazolam which, in one patient, acted like an alcohol-inducing "black out" and caused an unawareness of how he got home while driving the previous night. I would suggest that a short review of the most used benzodiazepines (including by anesthesiologists, surgeons and neurologists) could be written by our prominent colleagues who participated in this collaborative review – the International BZD Task Force.

            What I have in mind is that each of the panel’s distinguished neuropsychopharmacologists (along with general practitioners and gynecologists who are likely to see up to 60 % of these functional disorders) should choose one of the commonly used benzodiazepines and elaborate on their general remarks of this paper.

Reference:

Lydiard, RB, Rickels, K. Herman, B.  and Feltner D. E. Comparative efficacy of pregabalin and benzodiazepines in treating psychic and somatic symptoms of generalized anxiety disorder. International Journal of Neuropsychopharmacology 2010; 13:  229 -41.

June 27, 2019