++
Long-term use should be avoided and care should be taken with ‘new patients’ requesting a prescription. Have a firm prescribing policy, e.g. reserving for:
++
situational anxiety affecting lifestyle (e.g. plane travel—intermittent short-term use only)
self-perpetuating anxiety following a precipitating event, not responding to counselling etc. (give short course 2–4 wks)
emergency short-term use for agoraphobia and panic attacks
+++
BENZODIAZEPINE WITHDRAWAL SYNDROME
++
This syndrome is usu. relatively delayed in its onset and may continue for weeks or mths. Withdrawal features include:
++
anxiety (rebound)
depression
insomnia
nausea
loss of appetite
tremor
confusion
delirium
++
An effective management method is to withdraw the drug very slowly while providing counselling and support, including referral to a self-help group. Antidepressants can be substituted if there is evidence of depression, while beta blockers may help the withdrawal syndrome if other measures have failed. If severe, hospitalisation is required.