To the Editor.—
The study by Mellinger et al1 is a valuable contribution to our knowledge of anxiolytic use. It raises two issues, however, that should lead physicians to question their manner of prescribing benzodiazepine anxiolytics. The study notes that many long-term users of anxiolytics show high levels of both anxiety and depression. The study further notes that many long-term users suffer from such painful conditions as arthritis, bursitis, and tenosynovitis.
Physicians should view these findings with concern. The standard anxiolytics—alprazolam (Xanax) seems exceptional in this regard—may worsen depression or even suicidal ideation.2 Anxious, depressed patients are better treated with a sedating antidepressant, such as trazodone hydrochloride (Desyrel).3
Moreover, because benzodiazepines inhibit serotonin release, there is reason to believe they may increase pain perception. In contrast, antidepressants may be useful analgesics.4 In short, antidepressants may be useful in treating the anxious, depressed, pain-ridden patient.
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