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To the Editor: A recent Clinical Crossroads¹ presented an 87-year-old woman taking a benzodiazepine for at least 15 years in addition to diphenhydramine hydrochloride as needed. Dr Salzman suggested that the patient continue with this regimen because he believed the patient experienced a continuous therapeutic effect. Salzman acknowledged the detrimental effect of benzodiazepines on short- and long-term memory in the elderly, but dismissed it based on data from his unpublished findings that many patients accept the loss of "sharp memory" for a "day that calms."

The issue of long-term use of benzodiazepines was raised in an American Geriatrics Society review syllabus,² in a question about a patient who had been taking a benzodiazepine for only 4 years. The correct answer was to taper and then discontinue the drug. The critique explaining the correct answer states that continued use of benzodiazepines in elderly patients can result in increased tolerance and increasing . . . [Full Text of this Article]

Carl Salzman, MD
Harvard Medical School
Boston, Mass

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