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The Place of Benzodiazepines in Psychiatric Practice

Published online by Cambridge University Press:  02 January 2018

Peter Tyrer*
Affiliation:
Mapperley Hospital, Nottingham
Siobhan Murphy
Affiliation:
Mapperley Hospital, Nottingham
*
Mapperley Hospital, Nottingham NG3 6AA

Extract

For the past 20 years, benzodiazepines have been the most commonly prescribed psychotropic drugs. It is now difficult to imagine the excitement produced by this new class of compounds. Existing anti-anxiety drugs, mainly the barbiturates, were known to be dangerous in overdosage, tend to cause addiction, and have many side-effects. Previous compounds, including opium, alcohol, chloral, and bromides, were similarly burdened. The benzodiazepine era began almost 30 years ago, in style. “Four hours after being given chlordiazepoxide on New Year's day 1958, one of 12 chronically anxious but therapeutically recalcitrant patients previously studied by Tobin and N. D. C. Lewis telephoned that for the first time in many years he was totally free from symptoms” (Hordern, 1968). The early studies were all enthusiastic and confirmed the therapeutic potential of the drug (Tobin et al, 1960; Jenner et al, 1961). In the ‘tranquilliser decade’ of the 1970s, prescriptions of benzodiazepines increased at a rate that was perceived as alarming, ‘the relentless march of the psychotropic drug juggernaut’ (Trethowan, 1975). This concern was related more to the inappropriate use of these drugs for treating personal problems than to the demonstration of dangers with these compounds. The dangers, however, appeared to be remarkably few; the drugs were safe in overdose, had greater efficacy than the barbiturates (Lader et al, 1974), and had virtually no unwanted effects, apart from sedation when given in excessive dosage. It was therefore hardly surprising that they proved so popular with clinicians. As Priest (1980) commented when benzodiazepine prescription was at its peak: “it is a tremendous boon to the medical profession to have active weapons in the fight against misery that are not only effective but are relatively safe when abused by despairing and desperate patients”.

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Copyright © Royal College of Psychiatrists, 1987 

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