Short-term versus long-term benzodiazepine therapy.

Anxiety syndromes are poorly defined and classified and none of the systems at present in use is entirely satisfactory: some attempt to define anxiety states purely in terms of symptoms, while others do so by viewing anxiety as the product of interactions between external events and innate tendencies. Whatever scheme is used, however, it is essential that the type and level of anxiety is assessed before undertaking drug treatment. In general, tranquillizers such as benzodiazepines are more effective in lessening acute or chronic sustained levels of anxiety than peaks, as in panic attacks. With sustained levels of anxiety, long-acting benzodiazepines such as diazepam and clorazepate are usually preferred, while episodic anxiety normally responds best to shorter-acting drugs such as oxazepam or lorazepam. Short-term use of benzodiazepines is justified in patients with severe symptomatic distress and/or impairment of ability to cope. Long-term use is only justified in patients with chronic severe anxiety in which the symptomatic relief and improved functioning outweigh the risk of dependence.