Is one month of temazepam (a benzodiazepine) a sufficient bridging duration for patients referred to psychiatry?

One Month of Temazepam is NOT Long Enough as a Bridging Strategy

One month of temazepam is insufficient as a bridging duration when referring patients to psychiatry, and this approach carries significant risks of creating benzodiazepine dependence that will complicate rather than simplify the patient's care. The evidence strongly indicates that benzodiazepines should be limited to 2-4 weeks maximum for most indications, and using them as a "bridge" often results in patients becoming dependent on the medication before psychiatric evaluation occurs 1, 2, 3.

Why This Strategy is Problematic

Dependence Develops Rapidly

• Regular benzodiazepine use leads to tolerance, addiction, depression, and cognitive impairment, with these changes occurring within weeks of continuous use 4.
• Benzodiazepines are recommended for short-term use only—ideally up to 4 weeks maximum—because dependence can supervene on long-term use 2, 3.
• Despite recommendations to limit benzodiazepines to 2-4 weeks, doctors worldwide continue prescribing them for months or years, resulting in large populations of dependent long-term users 5.

The "Bridge" Becomes the Problem

• By the time the patient reaches psychiatry at one month, you may have already created a benzodiazepine dependence problem that the psychiatrist must now manage 5.
• Few cases of addiction arise from legitimate use, but pharmacologic dependence is a predictable adaptation that occurs with continuous therapeutic dosing 6.
• Current practice often deviates significantly from clinical guidelines, with many patients receiving continuous prescriptions for much longer periods than recommended 7.

What to Do Instead

Immediate Psychiatric Referral Without Benzodiazepines

• Refer the patient to psychiatry immediately without initiating benzodiazepines if the wait time is reasonable (within 2-4 weeks). This avoids creating dependence 2, 3.
• If acute symptom management is needed during the wait, consider non-benzodiazepine alternatives first.

If Benzodiazepines Are Absolutely Necessary

• Limit temazepam to 2 weeks maximum, not one month 2, 3.
• Prescribe the lowest effective dose with explicit instructions for intermittent use (not nightly) when possible 2.
• Provide only enough medication to reach the psychiatric appointment, with no refills 3.
• Document clearly that this is a time-limited prescription and communicate this to both the patient and the receiving psychiatrist 5.

Alternative Bridging Strategies

• For insomnia specifically, provide sleep hygiene education rather than substituting medications 1.
• Consider brief psychosocial interventions incorporating individualized feedback and advice, which can be delivered in a single 5-30 minute session 8.
• For anxiety symptoms, trazodone may be used for short-term management as an alternative to benzodiazepines 1.

Critical Pitfalls to Avoid

The Handoff Problem

• Never assume the psychiatrist will automatically taper the benzodiazepine you started. You may be creating a clinical situation where the patient arrives at psychiatry already dependent, and the psychiatrist must now manage withdrawal while trying to address the underlying psychiatric condition 5.
• Benzodiazepine withdrawal requires a gradual taper over 6-12 months minimum, with reductions of 10-25% of the current dose every 1-2 weeks 1, 4.
• Abrupt discontinuation can cause seizures and death—this is not a trivial medication to stop 1, 4.

Setting Unrealistic Expectations

• Patients may expect continued benzodiazepine prescriptions after the "bridge" period ends, creating conflict with the psychiatrist who recognizes the dependence risk 9, 5.
• Long-term benzodiazepine use is associated with multiple consequences including dependence, and previous benzodiazepine use may increase the risk of other substance use disorders 9.

Special Population Risks

• In elderly patients, benzodiazepines including temazepam are associated with cognitive impairment, delirium, falls, fractures, motor vehicle crashes, reduced mobility, and loss of functional independence 1.
• The American Geriatrics Society explicitly recommends avoiding all benzodiazepines in older adults due to these substantial risks 1.

When Benzodiazepines Are Specifically Indicated

The only situations where benzodiazepines should be used as first-line treatment include 8:

• Alcohol or benzodiazepine withdrawal syndromes
• Acute severe agitation threatening substantial harm to self or others (after behavioral interventions have failed)
• Specific medical indications like seizure disorders

For routine anxiety or insomnia while awaiting psychiatric evaluation, benzodiazepines are not the appropriate choice, and a one-month "bridge" creates more problems than it solves 2, 3, 5.

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