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Comment & Response |

The Popularity of Benzodiazepines, Their Advantages, and Inadequate Pharmacological Alternatives

Vladan Starcevic, MD, PhD, FRANZCP1
[+] Author Affiliations
1University of Sydney, Sydney Medical School–Nepean, Discipline of Psychiatry, Sydney, Australia
JAMA Psychiatry. 2015;72(6):623-624. doi:10.1001/jamapsychiatry.2014.3248.
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To the Editor In an article, Olfson et al1 reported higher rates of long-term benzodiazepine use among older adults in the United States. They assumed that benzodiazepines are prescribed to older individuals mainly for insomnia and anxiety and stated alarmingly that “most physicians do not view continuous use of benzodiazepines by older adults as a public health problem.”

Is long-term benzodiazepine use by older adults really a public health problem? Before rushing to respond affirmatively, it would be useful to reconsider a number of negative notions about benzodiazepines that have not received unequivocal empirical support. For example, hip fracture rates in the elderly population were not found to be necessarily associated with benzodiazepine use2 and the effectiveness of benzodiazepines during long-term treatment of anxiety disorders usually does not diminish over time.3 Benzodiazepines remain popular because of their consistent and reliable effectiveness against many symptoms of anxiety, relatively good tolerability, quick onset of action, and possibility of use on an as-needed basis. Furthermore, alternative medications, such as antidepressants, have not been as useful for anxiety disorders as they had initially seemed to be.


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June 1, 2015
Mark Olfson, MD, MPH; Marissa King, PhD; Michael Schoenbaum, PhD
1Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York
2School of Management, Yale University, New Haven, Connecticut
3Office of the Director, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
JAMA Psychiatry. 2015;72(6):624. doi:10.1001/jamapsychiatry.2015.24.
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