Are benzodiazepines (Benzodiazepines) recommended for treating anxiety disorders for more than one year?

Benzodiazepines Are Not Recommended for Long-Term Treatment of Anxiety Disorders Beyond One Year

Current clinical guidelines do not recommend benzodiazepines for treating anxiety disorders for a duration exceeding one year. 1

Evidence Against Long-Term Benzodiazepine Use

• Benzodiazepines are primarily indicated for short-term treatment of anxiety, with prescriptions ideally limited to courses not exceeding 2-4 weeks 2
• Long-term benzodiazepine use is associated with significant risks including:
  • Development of tolerance requiring dose escalation 3
  • Physical dependence and withdrawal symptoms upon discontinuation 1
  • Potential cognitive impairment, especially in elderly patients 2
  • Risk of addiction in vulnerable individuals 3

Current Guideline Recommendations

• The Lancet Psychiatry (2019) explicitly states that long-term benzodiazepine treatment (≥12 months) is "either not recommended by clinical guidelines or of doubtful efficacy in many cases" 1
• For anxiety disorders specifically, benzodiazepines should generally be used:
  • In conjunction with other evidence-based treatments (psychological interventions, antidepressants) 2
  • For acute stress reactions, episodic anxiety, or as initial treatment for severe panic 2
  • In single doses or short courses (2-4 weeks maximum) 2

Preferred First-Line Treatments for Chronic Anxiety

• SSRIs and SNRIs are recommended as first-line pharmacological treatments for chronic anxiety disorders requiring long-term management 4
• Cognitive Behavioral Therapy (CBT) has strong evidence as an effective non-pharmacological treatment for anxiety disorders 5
• For patients with anxiety disorders who are already on long-term benzodiazepines, CBT plus gradual tapering is significantly more effective than tapering alone for discontinuation 5

Management of Patients on Long-Term Benzodiazepines

• For patients already on long-term benzodiazepine treatment:
  • Sudden cessation should be avoided due to risk of withdrawal symptoms including rebound anxiety, hallucinations, seizures, and in rare cases, death 1
  • A gradual tapering approach is recommended, typically reducing the dose by 25% every 1-2 weeks 1
  • CBT significantly increases success rates for benzodiazepine discontinuation, with studies showing 70-80% abstinence success compared to only 25-30% with physician guidance alone 6

Special Considerations

• In children and adolescents with intellectual disabilities, benzodiazepines are generally not recommended for chronic anxiety due to concerns about potential heightened sensitivity to behavioral side effects such as disinhibition 1
• When benzodiazepines are co-prescribed with opioids, there is a near quadrupling of risk for overdose death compared to opioid prescription alone 1

Conclusion

The evidence clearly indicates that benzodiazepines should be limited to short-term use for anxiety disorders. For chronic anxiety requiring treatment beyond one year, SSRIs, SNRIs, and evidence-based psychotherapies like CBT are preferred alternatives with better long-term safety profiles 4.