Benzodiazepines

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a. Benzodiazepines can almost always relieve anxiety if given in adequate doses, and they have no delayed onset of action.

b. Despite their effectiveness, long-term use should be reserved for patients who have failed to respond to venlafaxine (Effexor), buspirone (BuSpar) and other antidepressants or who are intolerant to their side effects.

c. Benzodiazepines are very useful for treating anxiety during the period in which it takes buspirone or antidepressants to exert their effects. Benzodiazepines should then be tapered after several weeks.

d. Benzodiazepines have few side effects other than sedation. Tolerance to their sedative effects develops, but not to their antianxiety properties.

e. Since clonazepam (Klonopin) and diazepam (Valium) have long half-lives, they are less likely to result in interdose anxiety and are easier to taper.

f. Drug dependency becomes a clinical issue if the benzodiazepine is used regularly for more than 2-3 weeks. A withdrawal syndrome occurs in 70% of patients including intense anxiety, tremulousness dysphoria, sleep and perceptual disturbances and appetite suppression. Slow tapering of benzodiazepines is crucial (especially those with short half-lives).

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