2. Duration of Therapy
Anxiety disorders are considered chronic disorders with low spontaneous remission rates and high rates of relapse. Pharmacotherapy for generalized anxiety disorder (GAD) in adults includes antidepressants, benzodiazepines, buspirone, hydroxyzine and pregabalin. Treatment duration for GAD ranges from 6 to 12 months to accomplish treatment goals of symptom remission and improvement in quality of life. Although antidepressants are considered the drugs of choice for managing GAD, benzodiazepines are used frequently for short-term management of anxiety, as an adjunct to initiating antidepressant therapy, or improvement in sleep disturbances associated with GAD and/or antidepressant therapy. Benzodiazepines are not recommended as first line agents or for long term use due to adverse reactions, risk of dependence, and increased mortality21.
In pediatric patients, selective serotonin reuptake inhibitors (SSRIs) are agents of choice to manage childhood anxiety disorders, with serotonin norepinephrine reuptake inhibitors (SNRIs) being recommended as another treatment option. The most recent guidelines published by the American Academy of Child & Adolescent Psychiatry state that there is insufficient evidence to draw conclusions about the benefits or harms of benzodiazepine therapy in pediatric patients with anxiety disorders22.
Panic disorder (PD) is a chronic, recurring condition requiring drug therapy suitable for prolonged use. Antidepressants are the agents of choice to manage PD, although benzodiazepines are frequently prescribed as well, usually in combination with antidepressant therapy. While benzodiazepines are effective in the short-term treatment of panic disorder due to rapid onset of action, long-term treatment may be less desirable due to the potential for withdrawal symptoms, rebound anxiety, and dependence21. Benzodiazepines should be tapered when discontinued, as patients may experience a withdrawal syndrome if therapy is discontinued abruptly. Benzodiazepine elimination half-life and seizure history for the patient also influence the taper duration. Patients receiving benzodiazepines in lower doses for shorter times periods (less than six months) may be effectively tapered over two to eight weeks, while patients receiving benzodiazepines with a short elimination half-life, in higher doses, and/or for a longer duration (six months or longer) may require a slow taper over two to four months23.
Benzodiazepines should be prescribed on a short-term basis to manage anxiety disorders. Benzodiazepine doses should be tapered rather than discontinued abruptly to avoid withdrawal symptoms. Patients receiving benzodiazepines for up to 6 months should be tapered over 2 to 8 weeks, while patients treated with benzodiazepines for up to 12 months should be tapered over 2 to 4 months23.
The use of benzodiazepines as an anti-epileptic is not limited in duration.