Long-term diazepam therapy and clinical outcome
K. Rickels, W. G. Case, R. W. Downing and A. Winokur
This double-blind study involved the continuous (six to 22 weeks) treatment
of 180 chronically anxious outpatients with diazepam, 15 to 40 mg/day. Our
findings indicate that a significant number of patients benefit from
prolonged diazepam treatment and that tolerance to the anxiolytic effect of
diazepam does not develop during a 22-week study period. The duration of
continual treatment with sedative-benzodiazepines was clearly the most
important determinant of withdrawal reactions. Patients treated
continuously for less than eight months with sedative-benzodiazepines had
an incidence of withdrawal of 5%, whereas 43% of patients treated for eight
months or more demonstrated clear withdrawal reactions. While these
withdrawal reactions produced considerable distress, they were neither life
threatening nor incapacitating and did not include convulsions or psychotic
reactions. In all cases, withdrawal reactions could be readily managed by
gradually tapering the dose of the benzodiazepine.
