From the FDA Drug Label
INDICATIONS Diazepam is indicated for the management of anxiety disorders or for the short- term relief of the symptoms of anxiety. The FDA drug label does not answer the question.
From the Research
Neither diazepam nor quetiapine is typically preferred as first-line treatment for anxiety in patients with both acquired brain injury (ABI) and Parkinson's disease. For these complex patients, non-benzodiazepine options like SSRIs (particularly sertraline 25-100 mg daily or escitalopram 5-20 mg daily) are generally preferred, as they have a more favorable side effect profile and are less likely to exacerbate Parkinson's symptoms or contribute to cognitive decline 1. Diazepam carries significant risks in this population, including cognitive impairment, increased fall risk, dependency, and potential worsening of Parkinson's symptoms. Quetiapine, while sometimes used at low doses (25-100 mg), can worsen Parkinson's motor symptoms due to its dopamine-blocking properties. If medication is necessary, an SSRI would typically be started at a low dose with gradual titration while monitoring for side effects. Non-pharmacological approaches should be emphasized, including:
- Cognitive behavioral therapy
- Stress management techniques
- Environmental modifications Any medication choice should be made after careful consideration of the individual's specific symptoms, comorbidities, and in consultation with both neurology and psychiatry specialists given the complex interaction between ABI, Parkinson's disease, and anxiety symptoms 2, 3. Recent studies have shown that Acceptance and Commitment Therapy (ACT) and integrated neuropsychological and cognitive behavioral therapy (nCBT) may also be effective in reducing anxiety and depressive symptoms in patients with ABI 2, 3. However, more research is needed to confirm these findings and to determine the most effective treatment approaches for this population. In general, a multidisciplinary approach that incorporates both pharmacological and non-pharmacological interventions is likely to be the most effective in managing anxiety in patients with ABI and Parkinson's disease 4, 5.