Benzodiazepines

What are benzodiazepines? 

Benzodiazepines have been proposed as an alternative therapy to standard antipsychotic treatments in an attempt to improve functional outcomes and treat symptoms that are not addressed by the antipsychotic medications. Benzodiazepine medications induce anxiolytic, sedative, muscle relaxant, and amnesic effects when used therapeutically. Benzodiazepines may be implemented as a short-term therapy in order to treat acute symptoms of psychosis, such as agitation or aggression. They have also been suggested as an ongoing treatment regime, as they may have fewer side effects than antipsychotics. However, the efficacy of benzodiazepines for reducing side effects of antipsychotics is unclear, as they may be associated with adverse effects of their own. Benzodiazepines are also associated with well-established patterns of tolerance and dependence and are prescribed with caution.

What is the evidence for benzodiazepines?

High quality evidence shows a lower risk of extrapyramidal (movement) side effects with benzodiazepines than with antipsychotics. Moderate quality evidence shows benzodiazepines were associated with a faster rate of sedation and more improvement in global state than antipsychotics. Moderate to low quality evidence suggests less excitation with antipsychotics than with benzodiazepines. No differences were found between benzodiazepines and antipsychotics in study attrition, behavioural improvement, mental state, need for additional medication or restraint, agitation, service use, hospital discharge, or relapse.

Compared to placebo, moderate to low quality evidence suggests greater clinical improvement but a significantly increased risk of side effects such as low energy levels and ataxia with benzodiazepines. No differences were found between benzodiazepines and placebo in study attrition, relapse, anxiety, or other adverse effects.

March 2019

Last updated at: 12:36 am, 21st March 2019
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