Short- and long-term use of benzodiazepines in patients with generalized anxiety disorder

Generalized anxiety disorder (GAD) is a chronic and disabling disorder that is primarily characterized by excessive anxiety and uncontrollable worry about everyday life. In addition to this worry, the patient must also present with three out of the following six symptoms for a definitive diagnosis: restlessness, difficulty concentrating, sleep disturbances, irritability, muscle tension, and becoming easily fatigued. The mainstay of GAD treatment involves pharmacologic treatment but can also consist of psychological treatment (i.e. cognitive behavioural therapy). First-line pharmacological treatment involves either the selective serotonin reuptake inhibitors (SSRIs) or the selective norepinephrine/noradrenaline reuptake inhibitors (SNRIs). While these are the most effective treatments, they can produce adverse events and they also have a slower onset of action, during which there may be an increase in anxiety. Benzodiazepines (BZDs) are a class of drug that is presumed to indirectly promote gamma-amino butyric acid (GABA) activity and rapidly control the core symptoms associated with GAD. They have been historically effective when used in the short-term treatment of GAD but have to be used with caution due to their adverse effect profile such as drowsiness, falls, confusion, impairment of memory, and incoordination (which can be particularly problematic in the elderly), their tendency for dependence, and potential for substance abuse. For these reasons and to determine their appropriate use, this report will review the evidence for the short- and long-term use of BZDs for the treatment of GAD. Research question: What are the guidelines associated with the short- and long-term use of benzodiazepines for patients with generalized anxiety disorder (GAD)?