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

            The International Task Force on Benzodiazepines is a group of researchers and psychiatrists who draw on an enormous depth of clinical experience and who have conducted clinical trials with many of the medications in this class in the treatment of a wide variety of psychiatric conditions (Balon et al. 2018). The benzodiazepines continue to be widely prescribed and they produce unquestionable benefits when prescribed appropriately. However, it seems to us that the public media mistakenly portrays benzodiazepines as medications that pose serious risks, particularly side effects and abuse liability, without offering commensurate benefits. Since the arrival of selective serotonin reuptake inhibitors (SSRIs) for the treatment of depression in the mid-1990s,they rapidly received FDA approval for the treatment of many anxiety disorders and treatment guidelines generally placed these medications ahead of benzodiazepines (Offidani, Guidi, Giamba, Tomba and Fava 2013). In addition, the scientific literature has been flooded with numerous articles on negative properties of benzodiazepines. Although many of these publications either were not based on adequate data or were frankly biased, they created the misconception that benzodiazepines are for the most part “bad” or “dangerous,” while overlooking their benefits.

            After their introduction into clinical medicine more than 50 years ago, benzodiazepines quickly became popular and widely used due to their versatility, tolerability, safety and ease ofuse. As they have anxiolytic, anticonvulsant, hypnotic, muscle relaxant and sedative properties, they have become the most prescribed psychotropic medications among all medical specialties. Psychiatrists have been using benzodiazepines to treat anxiety disorders and anxiety symptoms in other mental disorders.The anxiolytic properties of benzodiazepines frequently remain superior to those of antidepressants and antipsychotics,which are often usedforanxiety disorders and anxiety symptoms in other mental disorders. Their adverse effect profile is relatively benign, with sedation and possible cognitive and psychomotor impairment being noted most frequently.

Our group has had considerable experience in the treatment of various psychiatric disorders with benzodiazepines (Nardi et al. 2018). The following are examples of the expertise of some of our members. R. I. Shader and C. Salzman published their first paper on a benzodiazepine in 1967 Salzman, Shader and DiMascio 1967). D. Greenblatt wrote on prescribing benzodiazepines in 1970 (Greenblatt and Shader 1971).  Professor Guy Chouinard has studied nitrazepam, alprazolam and clonazepam, among many other benzodiazepines, and conducted his first double-blind placebo-controlled study with a benzodiazepine in 1965 and published in 1966 (Bordeleau, Chouinard and Tetrault 1966).  K. Rickels had his first paper on a benzodiazepine published in 1965 and was a co-author of probably the first publication reporting withdrawal symptoms (Covi, Park, Lipmann, Uhlenhuth and Rickels 1969; Rickels, Baum, Raab, Taylor and Moore 1966).  A.E. Nardi participated in many trials of clonazepam, midazolam, bromazepam, bretazenil and cloxazolam; his first benzodiazepine paper was published in 1987 (Piedade et al. 1987). E. Silberman had his first publication on benzodiazepines in 1998 (Silberman 1998). GA Fava has a large experience in daily assistance, clinical trials and published his first work on benzodiazepines in 1988 (Fava 1988).

We have come together to highlight the importance of preserving benzodiazepines as treatment, first and foremost because of our extensive clinical experience prescribing these medications to patients over the past 50 years. None of us has financial conflicts of interest related to the prescription of benzodiazepines.  The inflammatory reports related to dramatic negative effects of benzodiazepines seem to be written by people who do not have much clinical experience with these medications, as their comments are not consistent with accumulated clinical experience and empirical data.

This InternationalTask Force will be working on presenting information on benzodiazepines to various psychiatric and medical audiences. This information will be evidence-based, balanced, unbiased and clinically relevant.We believe that our colleagues deserve to receive such information as it would help them treat their patientsadequately - a common goal for all of us. We hope to preserve benzodiazepines as a valuable part of our therapeutic armamentarium.

References:

Balon R, Chouinard G, Cosci F, Dubovsky SL, Fava GA, Freire RC, Greenblatt DJ, Krystal JH, Nardi AE, Rickels K, Roth T, Salzman C, Shader R, Silberman EK, Sonino N, Starcevic V, Weintraub SJ. International Task Force on Benzodiazepines. PsychotherPsychosom. 2018; 22:1-2.

BordeleauJM, Chouinard G, Tétreault L. Étude des propriétéshypnotiquesd’une nouvelle benzodiazépine. Union Med Can. 1966; 95:50-3.

Covi L, Park LC, Lipman RS, Uhlenhuth EH, Rickels K. Factors affecting withdrawal response to certain minor tranquilizers. In Cole JO, Wittenborn I, eds.: Drug Abuse: Social and Psychopharmacological Aspects. Springfield:  Charles Thomas; 1969, pp 93-108.

Fava GA. Fading of therapeutic effects of alprazolam in agoraphobia. Casereports. Prog Neuropsychopharmacol Biol Psychiatry. 1988; 12:109-12.

Greenblatt DJ, Shader RI. Psychopharmacologic management of anxiety in thecardiac patient. Psychiatry Med. 1971; 2:55-66.

Nardi AE, Cosci F, Balon R, Weintraub SJ, Freire RC, Krystal JH, Roth T, Silberman EK,Sonino N, Fava GA, Starcevic V, Dubovsky SL, Salzman C, Rickels K, Greenblatt DJ, Shader RI, Chouinard G; International Task Force on Benzodiazepines. The Prescription of Benzodiazepines for Panic Disorder: Time for an Evidence-Based Educational Approach. J Clin Psychopharmacol. 2018; 38:283-5

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: 355-62.

Piedade RAM, Sougey EB, Almeida FJB,  Sokolowski A, Knijnik L, Camargo IB, Del Porto JA, Marcolin MA, Coutinho DM, Shirakawa I, Seibel S, Munhoz FEP, Lourenço LCA, Nardi AE, dos Santos AN. Study of the efficacy of cloxazolam versus placebo in anxiety disorders. J Bras Psiquiatria 1987; 36: 189-97.

Rickels K, Baumm C, Raab E, Taylor W, Moore E. A Psychopharmacological evaluation of chlordiazepoxide, LA-1 and placebo, carried out with anxious, neurotic medical clinic patients. Medical Times 1965; 98:238-45.

Salzman C, Shader RI and DiMascio A.  Collagen disease-like syndrome following administration of a benzodiazepine derivative.  Dis. Nerv. Sys. 1967; 28:614-5.

Silberman EK. Psychiatrists and internists beliefs about benzodiazepines. Primary Psychology 1998; 5: 1–8.

October 18, 2018