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Letter to the editor
Editor, - Australian Prescriber has published a number of articles about the prescribing of benzodiazepines (Aust Prescr 1993;16:12-4 and 1993;16:75). Current fashion appears to be directed at restricting these drugs to short-term use only. There may be other psychiatrists who would agree that this emphasis is accompanied by a campaign which at times appears to reach the point of hysteria. There is a place for the long-term prescribing of benzodiazepines for some psychiatric patients.
One of the U.K.'s most eminent psychiatrists, in vigorously challenging the fashion, may well have stated what many clinicians believe and indeed practise, but are afraid to say. He has commented that 'There is a belief abroad that benzodiazepines usually lose their therapeutic power during prolonged administration. There is no convincing evidence for this belief. Indeed, the evidence to the contrary is stronger. Whenever rebound phenomena occur, they prove that benzodiazepines had been active in suppressing the clinical expression of a cerebromolecular pathology. Moreover, when patients have been fairly well adjusted on benzodiazepines for a long time but succumb, after a successful withdrawal procedure, almost immediately to a modified recurrence of their anxiety illness, the proof that there had been a continuing therapeutic activity of benzodiazepines could hardly be stronger. Of course, it then also follows that the patients are in need of further medication and perhaps even of further prescriptions for benzodiazepines. This would help the patients, even though it is anathema to a narrow-minded damnation chorus.'1 It might be worthwhile for the government to consider a new category of authority for long-term use of benzodiazepines: 'chronic psychiatric illness where other therapy has failed or is inappropriate'.
In general, benzodiazepines should be prescribed for short-term treatment only. There may be a very limited role for the long-term use of benzodiazepines in some patients who do not respond to cognitive, behavioural or other psychotherapeutic interventions.
Consultant Psychiatrist, Sydney, N.S.W.