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Dépendance aux benzodiazépines et syndrome de sevrage. Revue de la littérature

Published online by Cambridge University Press:  28 April 2020

B. Hanin  and
J. Marks
B. Hanin
Affiliation:
Hôpital Sainte-Anne, Service du Dr Ropert, 1, rue Cabanis, 75014Paris, France
J. Marks
Affiliation:
Girton College, Cambridge, UK
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Résumé

Ce travail rapporte les résultats d'une revue de la littérature mondiale (247 publications), concernant les syndromes de sevrage et la dépendance aux benzodiazépines, réalisant ainsi une mise à jour de l'tude eifectuée par Marks (1986) pour la période 1961-1984. Quatre-vingts cas publiés individuellement et 269 cas publiés par séries ont été recensés pour la période 1984-1988 (janvier), soit en ajoutant ces chiffres à ceux de Marks (1986): 928 cas individuels et 969 cas publiés par séries, soit encore au total: 1 897 cas publiés. L'analyse détaillée de ces cas, leur signification en termes de risque sont rapportées et discutées.

Au plan pratique, il apparaît que toutes les benzodiazépines peuvent être à l'origine de syndrome de sevrage, y compris celles à demi-vie courte. Le risque de dépendance est d'autant plus important que la durée de la prescription et les posologies employées sont élevées. Il est donc nécessaire de préconiser un sevrage systématiquement progressif, quelles que soient la molécule et la durée de prescription, d'éviter l'administration aux sujets ayant des antécédents d'abus de toxiques ou de médicaments, de réserver l'usage à long terme aux pathologies anxieuses chroniques, en réévaluant régulièrement l'indication, de prescrire le moins longtemps possible et à la dose la plus faible possible dans tous les autres cas, en faisant varier la posologie selon l'évolution de l'intensité des symptômes.

Summary

Summary

This Paper reports the results of a review of worldwide literature (247 publications) on benzodiazepine dependence and withdrawal syndromes and is thus an update of the study carried out by Marks (1986) for the period 1961-1984. Eighty individually published cases and 269 cases published in series were collected over the period 1984-1988 (January), that is, including these figures with those of Marks (1986), 928 individual cases and 969 cases published in series, i.e., a total of 1897 published cases. A detailed analysis of these cases and their significance in terms of risk are reported and discussed.

From a practical point of view, it appears that all benzodiazepines can cause withdrawal syndromes, including the short half-life type. The risk of dependence is increased by the duration of the prescription and the use of high dosages. Gradual withdrawal is therefore recommended, whatever the substance used and the duration of prescription; benzodiazepines should not be administered to patients with a previous history of drug abuse, and their long-term use should be restricted to cases of chronic anxiety, with a regular re-evaluation of the patient's condition; in all other cases the drug should be prescribed for the shortest possible time and at the lowest dosage possible, with dosage determined by severity of symptoms.

Keywords

benzodiazépinessyndrome de sevragedépendancebenzodiazepineswithdrawal syndromesdependence
Type
Revue générale
Information
Psychiatry and Psychobiology , Volume 3 , Issue 5 , 1988 , pp. 347 - 364
Copyright
Copyright © European Psychiatric Association 1988

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