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Comment & Response |

Restricting Benzodiazepines to Short-Term Prescription

John H. Krystal, MD1,2,3,4; Scott Stossel, BA5; Andrew D. Krystal, MD6,7
[+] Author Affiliations
1Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
2Department of Neurobiology, Yale University School of Medicine, New Haven, Connecticut
3Clinical Neuroscience Division, VA National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven
4Yale–New Haven Hospital, New Haven, Connecticut
5The Atlantic, Washington, DC
6Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
7Duke Clinical Research Institute, Durham, North Carolina
JAMA Psychiatry. 2015;72(7):734-735. doi:10.1001/jamapsychiatry.2015.0351.
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To the Editor In their Editorial, Moore et al1 presented as a foregone conclusion, unsupported by reference to the published literature, that benzodiazepines rapidly lose their efficacy as hypnotics and anxiolytics, while being associated with growing risks over time. From this perspective, long-term prescription of these drugs would seem to be unethical.

However, this view is not consistent with the published literature from randomized placebo-controlled trials.2 Notably, the longest placebo-controlled benzodiazepine insomnia trial, an 8-week temazepam study, demonstrated significant benefits in sleep in elderly patients with insomnia throughout the period of treatment, with no evidence of significant adverse effects on discontinuation.3 Further, long-term randomized studies of non–benzodiazepine-positive allosteric modulators of γ-aminobutyric acid type A receptors showed clear evidence of sustained efficacy and favorable safety for up to a year of nightly treatment without significant discontinuation effects.4,5 Similarly, a long-term follow-up study of patients who participated in randomized trials of benzodiazepines for anxiety disorders paint a favorable picture of sustained efficacy and safety.6


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July 1, 2015
Giovanni A. Fava, MD; Richard Balon, MD; Karl Rickels, MD
1Department of Psychology, University of Bologna, Bologna, Italy
2Department of Psychiatry, Wayne State University, Detroit, Michigan3Department of Anesthesiology, Wayne State University, Detroit, Michigan
4Department of Psychiatry, University of Pennsylvania, Philadelphia
JAMA Psychiatry. 2015;72(7):733-734. doi:10.1001/jamapsychiatry.2015.0182.
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